Nausea

[Telaine719]

I have been under medical care for three years for the following symptoms:
Pain in the upper right side of my abdomen when I eat a slightly fatty meal and frequent diarrhea.
Two stool studies showed that I was not digesting fat, the doctor said that if the test came back at #7 it would be abnormally high, mine came back at #11.
An EUS showed scarring in the pancreas.
I was told that these tests pointed to possible Sphincter of  Oddi Dysfunction and the SOD caused the scarring in the pancreas.

Pain in my stomach and indigestion when I eat too large of a meal.
I was told that a  gastric emptying test showed that I my stomach was emptying slightly too fast due to the top portion of the stomach not expanding to allow food.

I have not been able to get an answer about what is causing this daily nausea when I wake each morning for the last 3 year.  The longer block of time I sleep the more severe the nausea. Typically I am up from one to three times every the night, each time I wake with nausea then in the morning it is worst, yet.
Once I am up and I sip on fluids and chew sugarless gum the nausea usually improves.

If I lie down during the day for more than 30 minutes I wake again, sick to my stomach.
If I sleep on my stomach or back it is worse than if I sleep on my side.
This isn't an occasional thing.. it happens every day and every night.. no exception.... since my gall bladder was removed three years ago.

I am on Previcid twice a day for reflux and the head of my bed is elevated 6”.   I can pretty much control the SOD with diet and Creon and I am on an experimental use of a relaxant (buspirone) to 'loosen' the stomach when I eat but I cannot get any relief from the daily nausea and it is quite difficult to deal with.  

What illness could cause daily nausea after sleeping?
What tests would be available to determine this daily nausea ?  

[Kevin Pho, MD]

I agree with the testing that has been done, and indeed, many of the major causes of chronic nausea would have been ruled out with the imaging scans and upper endoscopy.  

There are more specialized tests you can consider, including the ERCP with Sphincter of Oddi manometry that you had mentioned, as well as a 24-hr pH study looking for GERD and an esophageal motility test.

If the GI workup continues to be negative, there are a variety of neurological diseases that can lead to chronic nausea.  If your doctor wants to pursue this route, head imaging with a CT scan or MRI can be considered.

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.

KevinMD.com
Twitter.com/kevinmd

[Telaine719]

I have had scans of every part of my body including my brain. Blood work to rule out adrenal gland problems.  Endoscopies and Colonoscopy.  I have not had the ERCP yet but that is planned.  One doctor mentioned that he thinks that the "problem is on the 'molecular/ hormonal level'  'gut nerve or hormones'"