UPPER ABDOMEN

[jjdcce]

I have had pain in my upper left abdomen for almost 2 months.  I had a 3 1/2" cyst on my kidney and they drained it thinking it was the problem.  I am still experiencing the same pain.  It is isolated and about the size of a silver dollar and felt right beneath my rib and I can also feel it in my back.  The urologist said if it wasn't the cyst it must be gastro and did not ask to see me again.  The cat scan shows no diverticulitis, and no abnormalties other than the cyst.  I have no infection.  I am tired, I am belching and have had nausea but not near like I had it before the cyst drainage.  The gastro doctor has me on Cipro and wants to do a colonoscopy in 2 weeks.  He has mentioned diverticulits, IBS and constipation.  I am not constipated, and the pain is isolated.  It's normally a dull pain, not severe, but there are times it will get sharp.  I have not noticed anything that would cause it (food, sitting, etc).
  YOUR ANSWER w/ MY QUESTIONS IN CAPS
I agree with the CT scan, and this test would have evaluated for colitis, diverticulitis, or problems with the spleen.

I would further investigate the stomach and upper digestive tract, which can result in left upper abdominal pain.  This can be done with an upper endoscopy, which can exclude GERD, inflammation or an ulcer.  REFLUX. WOULD THAT STAY IN ONE SPOT FOR 2 MONTHS?  INFLAMMATION?  WOULD THE ANTIBIOTIC TAKE CARE OF IT?  WOULD IT BE IN ONE SPOT FOR 2 MONTHS?  ULCER?  WHAT DO YOU DO WITH THAT?

If negative, a colonoscopy can be performed to look for lower GI causes.  WHAT COULD WE FIND IN A COLONSCOPY?

AGAIN, IT IS LOCATED IN ONE SPOT AT THE BOTTOM OF MY LEFT RIB.  I FEEL IN MY BACK AS WELL.

[Kevin Pho, MD]

To answer your questions:

1) I agree with the upper endoscopy.  It is possible that reflux can stay in one spot, and this can vary from person to person.  If GERD or ulcer is a concern, then a proton pump inhibitor would be a recommended option to proceed.  

If GERD is the diagnosis, and the upper endoscopy is inconclusive, a 24-hr pH study can be done to quantify the severity.

2) A colonoscopy can exclude inflammation (i.e. from colitis or inflammatory bowel disease), polyps or masses.

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 Pho, M.D.
www.kevinmd.com
www.twitter.com/kevinmd

[tedm]

Dr. Pho,

I recently had a ct scan on my abodomen because I have been experiencing a lot of pressure in my upper stomach. It has been going on for several months and feels like I have something in my upper stomach that doesn't belong there. The ct scan came back with everything being normal with the exception of a slightly bulky pancreas. My doctor ordered blood and stool tests and they all came back normal. My doctor told me, that since I am not loosing weight, do not have jaundice and have no other symptoms, not to worry about the slighty bulky pancreas and that it is not causing my problem. He told me he thought it was either my gallbladder or GERD. I have had GERD for several years now, but have not experieced these symptoms. Could the slighty bulky pancreas be a sign of a problem or should I not worry about it like my doctor told me to.

Thanks