Need Advice! Very uncomfortable making sure it is nothing serious!

[Whtshot]

I am a 25-year-old female that weighs about 180 lbs. and is 5’4. I am not pregnant and have recently had a menstrual cycle. I have a history of GERD. I have had four  surgeries and two procedures: C-Section (2017), Fractured Arm (1998), Tonsils, Adenoids, and Sinus Surgery (2010), Gallbladder Removal laparoscopic (2015), Endoscopy (2015), and EGD (2019). I am also on the following medications daily: Concerta (36 Mg 2 a day), Microgestin 1/20 (1- 20mg-mcg a day), and Pantoprazole Sodium (40mg 1 a day). My symptoms began about four months ago on Thanksgiving night. I started feeling bloated after eating thanksgiving dinner, which was normal for thanksgiving, but this kind of bloating was different. My stomach kept growing to the point to where I felt like I was 40 weeks pregnant and about to go into labor. The bloating was concentrated to the top, middle part of my abdomen in between my ribs. It almost looked like a big bump. Where my belly was bloated, it was tinder to the touch, and very hard. Along with the bloating I would have bouts of nausea and cold sweats. I went to bed that night and about 3 a.m. I was awaking by a sharp paid under my ribcage on my left and right side that radiated around to my back. It was like someone was stabbing me. The pain was so severe that it caused me to begin to vomit. It felt different than a stomach virus or food poisoning. As the night went on the pain was on and off and finally began to ease. I was not able to eat anything the next day and only drank. When I would drink anything or attempt to eat anything the pain began again. Even fasting from eating or drinking I would still get sharp pains under both ribs radiating to my back. The pain never completely subsided so I decided to take a trip to the E.R. They did lab work and a C.T. and ruled out everything they thought it could be. They diagnosed me with a U.T.I. and gastritis from unknown cause and sent me home on Bentyl (10mg every 6 hours), Famotidine (20mg twice daily), and Keflex (500 MG twice daily). They also gave me a GI cocktail and told me to follow up with a gastrologist. Four days later, still unable to eat, I was able to get an appointment with the gastrologist. Still unable to figure out what is wrong, they had a few theories. One theory was that I had a gallstone and passed it. Another theory was that it could have been some kind of bacteria that cleared out on its own. They wanted me to do an ultrasound since my liver enzymes were elevated, but by then I was able to eat again so I decided I would not follow up. Now, fast forward four months later, the bloating and hard stomach is back again, along with nausea and light headedness. This time I do not have as much pain, but the bloating is very uncomfortable. It hurts when I stretch, and my stomach stretches out.  The bloating also gets worse when I eat. I am curious as to what I need to do about this. Could it be something serious or is it just something I just need to live with. I do not get paid if I take a day off even if it is to go to the doctor, so I would like an opinion before I decide if it is worth going or not.  Labs are in the comments because I exceeded the character limit.

[Whtshot]

ER Lab Results:
Results:
Blood Pressure: 127/88 mmHg
Heart Rate: 81 bpm
Respiratory Rate: 18br/min
O2 Sat: 99%
Weight: 180lb
Lab Results:
General Chemistry
Sodium: 139 mMol/L (Reference Range: 137 mMol/L- 145 mMol/L)
Potassium: 3.7 mMol/L (Reference Range: 3.6 mMol/L- 5.1 mMol/L)
Chloride: 106 mMol/L (Reference Range: 98 mMol/L – 107 mMol/L)
Bicarbonate: 23 mMol/L (Reference Range: 22mMol/L- 32 mMol/L)
AGAP: 10.0 mEq/L (Reference Range: 4.0 mEq/L- 16.0 mEq/L)
Glucose Level: 80 mg/dL (Reference Range: 74 mg/dL- 106 mg/dL)
Lactic Acid: 0.7 mMol/L (Reference Range: 0.7 mMol/L- 2.1 mMol/L)
BUN: 8 mg/dL (Reference Range: 7mg/dL- 17 mg/dL)
Creatinine: 0.64 mg/dL (Reference Range: 0.52 mg/dL- 1.04 mg/dL)
GFR Calc: >60 mL/min/1.73 m2
Magnesium: 1.9 mg/dL (Reference Range: 1.6 mg/dL- 2.3 mg/dL)
Calcium: 9.0 mg/dL (Reference Range: 8.4 mg/dL- 10.2 mg/dL)
Protein: 7.6 gm/dL (Reference Range: 6.3 gm/dL- 8.2 gm/dL)
Albumin: 4.0 gm/dL (Reference Range: 3.5 gm/dL- 5.0 gm/dL)
Bili Total: 0.5 mg/dL (Reference Range: 0.2 mg/dL- 1.2 mg/dL)
Bili Direct: 0.1 mg/dL (Reference Range: 0.1 mg/dL- 0.5 mg/dL)
Bili Indirect: 0.4 mg/dL (Reference Range: 0.0 mg/dL- 0.8 mg/dL)
Enzymes
Alk Phos: 116 units/L (Reference Range: 38 units/L- 126 units/L)
ALT: 23 units/L (Reference Range: 5 units/L- 34 units/L)
AST: 25 units/L (Reference Range: 14 units/L- 36 units/L)
Lipase Level: 44 units/L (Reference Range: 23 units/L- 300 units/L)
Cardiac Markers
hs Troponin-I: <3 ng/L (Reference Range: 3 ng/L- 15 ng/L)
Special Chemistry
TSH (Thy Stim Hormone)- 2.467 mInt-unit(s)/mL (Reference Range: 0.450 mInt-unit(s)/mL- 5.330 mInt-unit(s)/mL)
CBC
WBC: 3.53 10^3/cmm (Reference Range: 4.00 10^3/cmm- 11.00 10^3/cmm)
RBC: 4.89 10^6/cmm (Reference Range: 3.80 10^6/cmm- 5.20 10^6/cmm)
Hgb: 14.9 gm/dL (Reference Range: 11.3 gm/dL- 15.2 gm/dL)
Hct: 43% (Reference Range: 33%- 45%)
MCV: 87 fL (Reference Range: 80fL- 96fL)
MCH: 30 pg (Reference Range: 27pg- 33pg)
MCHC: 30 gm/dL (Reference Range: 32 gm/dL- 36 gm/dL)
Platelet: 225 10^3/cmm (Reference Range: 150 10^3/cmm- 400 10^3/cmm)
RDW: 12.5% (Reference Range: 11.0%- 16.0%)
MPV: 8 fL
Differential
Neutrophils: 54% (Reference Range: 35%- 73%)
Abs. Neutrophils: 1.91 10^3/cmm
Lymphocytes: 34% (Reference Range: 15%- 52%)
Monocytes: 11% (Reference Range: 4%- 13%)
Eosinophils: 1% (Reference Range: 0%- 5%)
Basophils: 0% (Reference Range: 0%- 2%)
Urinalysis
U Color: Yellow
U Clarity: Clear
U Spec Gravity: 1.020 (Reference Range: 1.003- 1.035)
U PH: 6.0 (Reference Range: 4.5- 8.0)
U Protein: Negative
U Glu: Negative
U Ketones: 3+
U Blood: Negative
U Nitrite: Negative
U Leu Est: 2+
U Sq Epi: Moderate/ HPF
U RBC: 0-2 /HPF (Reference Range: 0-2)
U WBC: 6-10 /HPF (Reference Range:0-5)
U Bact: Few /HPF
UCG: Negative

[Whtshot]

ER CT Results
Radiology Reports
Structured Report: CT Abdomen Pelvis
Lower Chest:
Lung Bases/ Pleura: Normal
Distal Esophagus: Small Sliding Hiatal Hernia
Heart/ Vessels: No significant abnormality
Abdomen and Pelvis:
Liver: Normal
Biliary Tract: Normal
Gallbladder: Surgically absent
Pancreas: Normal
Spleen: Normal
Adrenals: Normal
Kidneys: Normal
Lymph Nodes: Multiple prominent mesenteric nodes, likely reactive. No pathologic adenopathy.
Stomach/Small Bowel: No abnormality
Colon/ Appendix: No acute abnormality
Peritoneum/ Mesentery: Normal
Retroperitoneum: Normal
Vessels: No significant abnormality
Urinary Bladder: Normal
Reproductive Organs: No abnormality
Body Wall: Small fat-containing umbilical hernia.
Musculoskeletal: No significant abnormality
Conclusion: No acute findings in the abdomen or pelvis.

[Whtshot]

Gastrologist Results
CMP
eGFR If NonAfricn Am: 117 mL/min./1.73 (Reference Range: >59)
Albumin: 4.0 gm/dL (Reference Range: 3.5 gm/dL- 5.5 gm/dL)
Sodium: 140 mMol/L (Reference Range: 134 mMol/L- 144 mMol/L)
ALT: 23 IU/L (Reference Range: 0 IU/L -32 IU/L)
AST: 20 IU/L (Reference Range: 0 IU/L -40 IU/L)
Globulin, Total: 2.8 g/dL (Reference Range: 1.5 g/dL – 4.5 g/dL)
Alk Phos: 134 units/L (Reference Range: 39 units/L- 117 units/L)
Protein: 7.1 gm/dL (Reference Range: 6.0 gm/dL- 8.5 gm/dL)
Bili Total: 0.4 mg/dL (Reference Range: 0.0 mg/dL- 1.2 mg/dL)
Carbon Dioxide, Total: 19 mmol/L (Reference Range: 20 mmol/L- 29 mmol/L)
Glucose: 79 mg/dL (Reference Range: 65 mg/dL- 99 mg/dL)
Chloride: 104 mMol/L (Reference Range: 96 mMol/L – 106 mMol/L)
Potassium: 4.3 mMol/L (Reference Range: 3.5 mMol/L- 5.2 mMol/L)
A/G Ratio: 1.5 (Reference Range: 1.2- 2.2)
Calcium: 9.5 mg/dL (Reference Range: 8.7 mg/dL- 10.2 mg/dL)
Creatinine: 0.72 mg/dL (Reference Range: 0.57 mg/dL- 1.00 mg/dL)
BUN: 10 mg/dL (Reference Range: 6mg/dL- 20 mg/dL)
BUN/Creatinine Ratio: 14 (Reference Range: 9-23)
Lipase Level: 40 units/L (Reference Range: 23 units/L- 300 units/L)
CBC
Baso (Absolute): 0 x10E3/UL (Reference Range: 0.0 x10E3/UL- 0.2 x10E3/UL)
Lymphs: 36% (Reference Range: Not Estab.)
Monocytes (Absolute): 0.3 x10E3/UL (Reference Range: 0.1 x10E3/UL- 0.9 x10E3/UL)
Immature Granulocytes: 1% (Reference Range: Not Established)
Eos (Absolute): 0.1 x10E3/UL (Reference Range: 0.0 x10E3/UL- 0. x10E3/UL)
Neutrophils: 54% (Reference Range: Not Estab.)
Lymphs (Absolute): 1.6 x10E3/UL (Reference Range: 0.7 x10E3/UL- 3.1 x10E3/UL)
Basos: 1% (Reference Range: Not Estab.)
Eos: 1% (Reference Range: Not Estab.)
Monocytes: 7% (Reference Range: Not Estab.)
Neutrophils (Absolute): 2.4 x10E3/UL (Reference Range: 1.4 x10E3/UL- 7.0 x10E3/UL)
Immature Grans (Abs): 0 x10E3/UL (Reference Range: 0.0 x10E3/UL- 0.1 x10E3/UL)
Platelets: 254 x10E3/UL (Reference Range: 150 x10E3/UL- 450 x10E3/UL)
WBC: 4.4 x10E3/UL (Reference Range: 3.4 x10E3/UL- 10.8 x10E3/UL)
Hematocrit: 44.8% (Reference Range: 34.0%- 46.6%)
MCHC: 33.7 g/dL (Reference Range: 31.5 g/dL- 35.7 g/dL)
RDW: 12.4% (Reference Range: 12.3%- 15.4%)
MCV: 89 fL (Reference Range: 79 fL- 97 fL)
MCH: 29.9 pg (Reference Range: 26.6 pg- 33.0 pg)
Hemoglobin: 15.1 g/dL (Reference Range: 11.1 g/dL- 15.9 g/dL)
RBC: 5.05 x10E6/uL (Reference Range: 3.77 x10E6/uL- 5.28 x10E6/uL)
C-Reactive Protein, Quant: 11 mg/L (Reference Range: 0 mg/L- 10 mg/L)

[Ken_PA]

Hi, Whtshot. Here's one way to look at things:

There doesn't seem to be anything eye catching in your tests, with most results being normal or near normal. Except this from the CT: "Lymph Nodes: Multiple prominent mesenteric nodes, likely reactive. No pathologic adenopathy." Having 'Mesenteric Lymphadenitis' can be from having a bad gut bacteria. The nodes do not look cancerous or diseased, just normally enlarged. (Let's just say that 'mesenteric' roughly means being around the intestines.)

"My symptoms began about four months ago on Thanksgiving night."
As you likely know, stuffing is infamous for bacteria.

"It felt different than a stomach virus or food poisoning."
Well, maybe because of the tremendous volume of gas and the pressure that it created. The
infection would also result in inflammation in the gut lining, which would make you even more susceptible to feeling severe pain. Then the Keflex antibiotic given for the UTI would have additionally wiped out bad (and good) gut bacteria.

It's possible there is a perfect storm involving your immune system, with the background of "Tonsils, Adenoids, and Sinus Surgery" and "Endoscopy (2015)". Did your gallbladder happen to be free from stones (acalculous cholecystitis)? Does food ever get stuck going down?

https://www.drugs.com/interactions-check.php?drug_list=1606-976,1044-6742,1790-0  shows no drug interactions. But Concerta can have GI side effects on its own.

"Alk Phos: 134 units/L (Reference Range: 39 units/L- 117 units/L)"
That's commonly related to the liver, but also can be related to the gut.

"Could it be something serious or is it just something I just need to live with."
I'm guessing that the CT probably would have seen any cancer. It wouldn't seem very likely that cancer would behave in such a way, either - creating fierce symptoms and then subsiding, then reactivating problems months later. The EGD probably went deep enough to where the main symptoms were after Thanksgiving, too.

You can try to think very hard about whether there was a common trigger in something you ingested, then and now. A food sensitivity is also a possibility, that creates an elevated baseline inflammation.

So, it's all nebulous; but that's apparently why the docs didn't pursue anything further. Good luck to you.