Upper Left Quadrent Abdominal pain, Lump

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Male, age 40.  5'10", 190lbs.  No past surgery or serious illness. Symptoms began 3 months ago. Bowel movement mixed color (brown mixed with unusually light brown/tan). Sense of pressure under middle of ribs, mild nausea no vomiting. Fatigue/Flu-like feeling, no fever. Pain persists for 2-3 weeks.  BM's continue to be light in color, mucousy, strange shape, texture.
Fatigue/Flu-like feeling retreats. Pain moves to mostly right side radiating to back.
After a week or 2, pain moves to mostly left side, radiating to back. 3 weeks ago that left/right pain subsides, and a swelling/bump appears below lower left rib.  Also, pain between ribs after eating, fading after a period of hours to vague feeling of "weight" in the area.  Throughout the entire experience, point pain is present in joints and other locations. Knees, Armpits, Pectoral area. Under right jaw (small lump) Right armpit-radiating to right bicep/deltoid-sore/numb.  These pains come & go,disappearing from one area to move to the next. Lump under jaw disappeared after a week.

Stool returns to normal brown, still mixed as far as consitancy.  No mucous recently.  Lately I have also noticed almost daily stiffness on both flanks...below ribs/down to pelvis.  Finally, I notice that I get a substantial reflux after eating... burps easily bring stomach contents into mouth.  Lots of gas rumbling in gut. Feeling of a "lump" in throat as well. I take Atenolol for high BP & Nexium as needed for reflux. Nexium does resolve the lump and reflux, but not other pains in upper abdomen. 1 recent bout of extreme dizziness lasting 1min.

CBC 4/12/06-Normal (Routine bp/cholesterol checkup, prior to symptoms.)
CBC 7/10/06-Normal
Upper GI/Barium,Gallbladder Ultrasound-Normal
Stool test for parasites,& Blood test for Hepatitis A/B/C-Negative

CT Scan with & w/o contrast-Negative except for scattered diverticula.
Home test for stool blood-negative. Urine test, Giardia & C Diff, Normal.
Blood Culture tests-no growth. HSV IGM-Negative
Epstein-Barr virus VCA IGM AB - 1.19 (Antibody detected)
CMV IGM Antibody-0.24 (Negative)
Amylase-40,Lipase-19 (Normal)

It seems I've been through a bout with EBV, and that seems to explain some of the point pain and fatigue. I still don't understand what's causing all the abdominal stress I've been going through.  Stools are a better color now but overall not what I consider normal.  The lump below my left rib came up a few weeks after my CT scan. I've since gone for a Spleen ultrasound (they also scanned the lump) Waiting for results.What puzzles me is the variable nature of my symptoms as well as the point pain. What are the gastrointestinal illnesses that can present like this? Could this be Gastritis? Crohns? The pain gets worse after eating and moderate physical activity,lawn mowing, etc. Does the negative CT rule out pancreatic cancer? What other tests should I push for?  What organs may be involved given the location of the "bump"?

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Update 2: Endoscopy showed indications of Barrett's.  Biopsys were taken and now I await the results of those.

I doubt Barretts is the core cause of my symptoms... too many other things going on.  Barretts doesn't explain the lump below my left rib, the abnormal stools or the other aches and pains.  I suspect a colonoscopy is next.

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Update: I had a followup with my GI today.  Spleen ultrasound showed an organ at the upper end of normal size range.  No unusual masses.  Given my post-meal pain of late, the doctor recommended an endoscopy, and I agreed.  The test is scheduled for 2 weeks from today...I'll post an update here if the thread is still open at that time.  Thanks for the input, Doctor Kevin...

[Kevin Pho, MD]

To answer your questions:
1) Many possible causes.  Can include various causes of dyspepsia (GERD, ulcers, inflammation), inflammatory bowel disease, malabsorption, celiac disease, irritable bowel syndrome etc.

2) Atypically, you want to exclude heart causes with its relation to exertion.  A stress test can be considered.

3) Pancreatic cancer can be seen on CT scan.  If suspected, endoscopic ultrasound or MRI are more sensitive tests.

4) I would consider an upper endoscopy to more thoroughly look at the upper GI tract as well as a colonoscopy to evaluat ethe lower GI tract.  A blood test for celiac disease can be considered.  

5) Regarding the bump - the spleen or soft tissue masses can be felt on physical exam.

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 patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
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