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Could this be vascular?

I have had an MRCP, a colonoscopy, and an EU in the past 18 months..All look normal exept for a relatively mild  hiatal hernia first  diagnosed 3 years ago by simple endoscopies(2). My blood work is  fine. I have been experiencing upper  abdominal " charley horses" following certain moves, or under certain conditions.Tying shoe laces, or bending/crouching down to do something.Bad coughing. Anything like" crunches"Standing up and stretching hard, relieves it, but the area stays quite sore for at least a day afterwards. I call it a " charley horse" because the muscle-diaphragm?-- draws up in a ball just as a calf muscle does--about the size of  a golf ball-- Absolutely cannot vomit bending over as most people would. Have to stay standing in a bath tub or, at best tilting slightly over sink. No, nausea is NOT a problem,---but  have had severe food poisoning abroad-also the flu- etc. over a period of time. Most recently I have frequent pain in an area  under my right rib-s and now,-the cramp has begun to happen if I strain at all on the toilet.  It has been  a slow progression but whatever triggers this spasm seems to be getting worse and more frequent.-- I have mild IBS -like symptoms, am 66 years old. generally in good health 5' 7&3/4"-  165 lbs.-. The extra lbs(25 ?) are unfortunately around my waist. Since I have had the tests I mentioned,--and the time period is pretty long even if it is getting worse--.as  a layperson--my thought is that it might be vascular--something pushing against a vein.,and briefly causing ischemia. I am reluctant to have further tests unless they are truly non-invasive.
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There has been a pretty comprehensive GI workup, which would have ruled out many of the major disorders.

I agree with the imaging studies as well as endoscopy.

You can consider a metabolic panel and thyroid tests, since imbalances here can lead to muscle cramps.

Pain on straining may be indicative of an abdominal hernia.  An examination by a surgeon as well as CT scan may be helpful.

Another option would be to further evaluate the gallbladder with a HIDA scan with CCK stimulation, which would evaluate the gallbladder ejection fraction.  If low, this may be responsible for the symptoms and small studies suggest that removing the gallbladder can be helpful.

These options can be discussed with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patients education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
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