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Went home Undiagnosed with severe stomach pains
I am twenty I have had reoccurring stomach pain for the last 5 years and go to the hospital and fall in debt and get sent home undiagnosed here are my symptoms in order
1. It is always very early morning when it starts, like between 3-6am I start to vomit the last thing I ate then after that serving of what ever I ate I throw up this aweful green mucus for a few hours then I start to throw up black liquid vomit (stomach bile)
2. I then become very weak, dizzy, still nauseous, heartburn, and start to become constipated but I can not go due to the constant vomiting, It gives me severe stomach pain that I really can not even describe how unbearable it is.
3. I try and try to ignore it with Tylenol pain meds nothing stops the pain I can not eat anything for I will vomit and start the process all over again. These symptoms last anywhere from one day to five.
I have been to the ER for these symptoms and first thought it was appendicitis. Cervical cancer, ovarian cancer, ovarian cysts, pregnancy, and every test came up negative and sent home undiagnosed.
1. It is always very early morning when it starts, like between 3-6am I start to vomit the last thing I ate then after that serving of what ever I ate I throw up this aweful green mucus for a few hours then I start to throw up black liquid vomit (stomach bile)
2. I then become very weak, dizzy, still nauseous, heartburn, and start to become constipated but I can not go due to the constant vomiting, It gives me severe stomach pain that I really can not even describe how unbearable it is.
3. I try and try to ignore it with Tylenol pain meds nothing stops the pain I can not eat anything for I will vomit and start the process all over again. These symptoms last anywhere from one day to five.
I have been to the ER for these symptoms and first thought it was appendicitis. Cervical cancer, ovarian cancer, ovarian cysts, pregnancy, and every test came up negative and sent home undiagnosed.
Gallbladder disease is a possibility, but I'm also wondering about gastroparesis:
Symptoms of gastroparesis may include chronic or intermittent nausea, vomiting, early satiety, abdominal distention after eating, and abdominal pain, which also often follows meals. Acute flares can result in severe vomiting. Morning nausea is an important indicator of gastroparesis. Vomiting may not be a dominant complaint, as the patient may have adjusted his/her diet to include only small amounts of food at a time.
Diagnosis
A patient’s medical history may help clarify the cause of gastroparesis. A history of prior ulcer disease or gastric surgery is obviously significant. The patient’s history might also emphasize other medical illnesses and reasons for which the patient may be on medications that contribute to nausea or delayed gastric emptying. These patients are often on numerous medications, and having a physician carefully review the side effects of these drugs can be rewarding.
The details of the nature of the symptoms, particularly the character of the vomitus, associated complaints, the relations to abdominal pain, and the relation to meals, are important. Gastroparesis typically involves vomiting one to three hours after eating, and "old food" from previous meals can even be seen the next morning. The presence of freshly ingested food is suggestive of a mechanical problem, such as a gastric outlet obstruction. Abdominal pain is common in "idiopathic" gastroparesis, and unusual in diabetics.
Patients with viral gastroparesis typically have an abrupt onset of their disease preceded by an acute gastroenteritis-like illness. These patients have a good prognosis, with shorter recovery periods and better quality of life. Patients may be diagnosed with viral gastroparesis when they: are healthy subjects who experienced the acute onset of symptoms typical of a "viral-like" illness; experience persistent symptoms (nausea, vomiting, early satiety, weight loss) for longer than three months; and have no obstruction, metabolic disease, systemic illness, surgery, or use of antimotility medication. Viral serology, can be used too, if it is available.
Gastric Emptying Assessment
Gastric scintigraphy is the best method for diagnosing delayed gastric emptying. A 4-hour test which has the patient eat low-fat egg meals (egg substitute) is standard. Normal ranges for gastric emptying in healthy subjects at 1 hour, 2 hours and 4 hours is 90, 60 and 10 percent, respectively. Gastric retention of greater than 10 percent at 4 hours is indicative of delayed gastric emptying. Unfortunately, many centers use only a 2-hour study to save costs. In a soon-to-be-published multicenter study, we compared 2-hour and 4-hour results in patients suspected of having gastroparesis and showed that limiting the gastric emptying time to 2 hours would have missed 44 percent of patients studied who went on to have delayed gastric emptying at 4 hours (See graph). Thus, while an abnormal result at 2 hours is fairly reliable, and the test may be stopped at that point for patients with abnormal results, the study should be continued for patients with normal results for the full 4 hours.
Treatment Strategies
Management of gastroparesis centers on hydration, dietary manipulation, nutritional supplementation, and pharmacologic therapy after gastroduodenal disease, systemic disease and offending drugs have been excluded. Nutritional support in gastroparesis begins with encouraging smaller-volume, low-fat, low-fiber meals, and if necessary, liquid caloric supplements. Patients are encouraged to drink at least 1 liter of fluids per day in the form of water, fruit juices, or other low-fat drinks. During periods of acute decompensation, intravenous hydration may be necessary. Jejunal feeding tubes may be used at night to supplement daytime feedings and ensure that medications are fully absorbed. These tubes should be placed either by laparoscopy or mini-laparotomy. There is no role for percutaneous endoscopic gastrostomy (PEG) decompression in gastroparesis unless it is accompanied by dilation of the small bowel. Placement of a percutaneous endoscopic jejunostomy (PEJ) is discouraged because in a patient who is frequently vomiting, the PEJ component is consistently regurgitated back into the stomach. Parenteral nutrition should be used only briefly during hospitalization and not encouraged or sustained on an outpatient diagnosed only with gastroparesis, because of the serious complications associated with its use.
Prokinetics
Medical therapy has changed in this field because of the withdrawal of cisapride from the US market. With the loss of this agent, metoclopramide has again become the prokinetic of choice. It can coordinate antral duodenal and pyloric muscle function and be a powerful, centrally-acting antiemetic. Approximately 70 percent of patients have no side effects and can tolerate this agent, but its antidopaminergic properties (it may cause Parkinson-like symptoms) remain the major obstacle to its more widespread use. Parenteral, oral and rectal preparations are available; a less appreciated, but very important route of administration, is subcutaneous, to allow for continued absorption despite vomiting, which would lead to unpredictable blood levels if taken orally. Even the most severely symptomatic patients can be stabilized by using a subcutaneous injection of 2 ml, two to four times a day. This can be supplemented orally, until the desired control is achieved. The subcutaneous approach is particularly helpful as an alternative to emergency room visits for hydration and IV metoclopramide, and gives patients the option of fasting or drinking only liquids while gaining symptomatic control with subcutaneous injections. In the IV form, metoclopramide needs to be given every three hours, based on the fact that there is a rapid peak. It is generally well tolerated for two or three days in gastroparetic patients, where there really is no other recourse to break their vomiting cycle. Diphenhydramine hydrochloride (Benadryl) can be used to control side effects.
Erythromycin is the only other prokinetic currently available in the United States. This drug binds to motilin receptors on gastrointestinal tract smooth-muscle membranes, thereby mimicking motilin’s actions. It is more effectively given intravenously than orally, and has decreased efficacy with long-term use. Another potential problem is antimicrobial resistance. Erythromycin is effective in gastroparesis in very low doses of 125-250 mg twice a day, administered in liquid suspension form and can be used in combination with metoclopramide. Reduced dosing lessens the possibility of drug tolerance while maintaining options to increase the dose during symptom exacerbation. Motilin agonists without antimicrobial properties are currently under investigation.
Domperidone is another option that blocks receptors in the central and peripheral nervous systems. The approval of domperidone is not being pursued in the US, but remains the drug of choice in patients who cannot tolerate metoclopramide, and is uniquely suited for patients with Parkinson’s disease who have GI symptoms as a side effect of dopamine-agonist therapy.
Symptoms of gastroparesis may include chronic or intermittent nausea, vomiting, early satiety, abdominal distention after eating, and abdominal pain, which also often follows meals. Acute flares can result in severe vomiting. Morning nausea is an important indicator of gastroparesis. Vomiting may not be a dominant complaint, as the patient may have adjusted his/her diet to include only small amounts of food at a time.
Diagnosis
A patient’s medical history may help clarify the cause of gastroparesis. A history of prior ulcer disease or gastric surgery is obviously significant. The patient’s history might also emphasize other medical illnesses and reasons for which the patient may be on medications that contribute to nausea or delayed gastric emptying. These patients are often on numerous medications, and having a physician carefully review the side effects of these drugs can be rewarding.
The details of the nature of the symptoms, particularly the character of the vomitus, associated complaints, the relations to abdominal pain, and the relation to meals, are important. Gastroparesis typically involves vomiting one to three hours after eating, and "old food" from previous meals can even be seen the next morning. The presence of freshly ingested food is suggestive of a mechanical problem, such as a gastric outlet obstruction. Abdominal pain is common in "idiopathic" gastroparesis, and unusual in diabetics.
Patients with viral gastroparesis typically have an abrupt onset of their disease preceded by an acute gastroenteritis-like illness. These patients have a good prognosis, with shorter recovery periods and better quality of life. Patients may be diagnosed with viral gastroparesis when they: are healthy subjects who experienced the acute onset of symptoms typical of a "viral-like" illness; experience persistent symptoms (nausea, vomiting, early satiety, weight loss) for longer than three months; and have no obstruction, metabolic disease, systemic illness, surgery, or use of antimotility medication. Viral serology, can be used too, if it is available.
Gastric Emptying Assessment
Gastric scintigraphy is the best method for diagnosing delayed gastric emptying. A 4-hour test which has the patient eat low-fat egg meals (egg substitute) is standard. Normal ranges for gastric emptying in healthy subjects at 1 hour, 2 hours and 4 hours is 90, 60 and 10 percent, respectively. Gastric retention of greater than 10 percent at 4 hours is indicative of delayed gastric emptying. Unfortunately, many centers use only a 2-hour study to save costs. In a soon-to-be-published multicenter study, we compared 2-hour and 4-hour results in patients suspected of having gastroparesis and showed that limiting the gastric emptying time to 2 hours would have missed 44 percent of patients studied who went on to have delayed gastric emptying at 4 hours (See graph). Thus, while an abnormal result at 2 hours is fairly reliable, and the test may be stopped at that point for patients with abnormal results, the study should be continued for patients with normal results for the full 4 hours.
Treatment Strategies
Management of gastroparesis centers on hydration, dietary manipulation, nutritional supplementation, and pharmacologic therapy after gastroduodenal disease, systemic disease and offending drugs have been excluded. Nutritional support in gastroparesis begins with encouraging smaller-volume, low-fat, low-fiber meals, and if necessary, liquid caloric supplements. Patients are encouraged to drink at least 1 liter of fluids per day in the form of water, fruit juices, or other low-fat drinks. During periods of acute decompensation, intravenous hydration may be necessary. Jejunal feeding tubes may be used at night to supplement daytime feedings and ensure that medications are fully absorbed. These tubes should be placed either by laparoscopy or mini-laparotomy. There is no role for percutaneous endoscopic gastrostomy (PEG) decompression in gastroparesis unless it is accompanied by dilation of the small bowel. Placement of a percutaneous endoscopic jejunostomy (PEJ) is discouraged because in a patient who is frequently vomiting, the PEJ component is consistently regurgitated back into the stomach. Parenteral nutrition should be used only briefly during hospitalization and not encouraged or sustained on an outpatient diagnosed only with gastroparesis, because of the serious complications associated with its use.
Prokinetics
Medical therapy has changed in this field because of the withdrawal of cisapride from the US market. With the loss of this agent, metoclopramide has again become the prokinetic of choice. It can coordinate antral duodenal and pyloric muscle function and be a powerful, centrally-acting antiemetic. Approximately 70 percent of patients have no side effects and can tolerate this agent, but its antidopaminergic properties (it may cause Parkinson-like symptoms) remain the major obstacle to its more widespread use. Parenteral, oral and rectal preparations are available; a less appreciated, but very important route of administration, is subcutaneous, to allow for continued absorption despite vomiting, which would lead to unpredictable blood levels if taken orally. Even the most severely symptomatic patients can be stabilized by using a subcutaneous injection of 2 ml, two to four times a day. This can be supplemented orally, until the desired control is achieved. The subcutaneous approach is particularly helpful as an alternative to emergency room visits for hydration and IV metoclopramide, and gives patients the option of fasting or drinking only liquids while gaining symptomatic control with subcutaneous injections. In the IV form, metoclopramide needs to be given every three hours, based on the fact that there is a rapid peak. It is generally well tolerated for two or three days in gastroparetic patients, where there really is no other recourse to break their vomiting cycle. Diphenhydramine hydrochloride (Benadryl) can be used to control side effects.
Erythromycin is the only other prokinetic currently available in the United States. This drug binds to motilin receptors on gastrointestinal tract smooth-muscle membranes, thereby mimicking motilin’s actions. It is more effectively given intravenously than orally, and has decreased efficacy with long-term use. Another potential problem is antimicrobial resistance. Erythromycin is effective in gastroparesis in very low doses of 125-250 mg twice a day, administered in liquid suspension form and can be used in combination with metoclopramide. Reduced dosing lessens the possibility of drug tolerance while maintaining options to increase the dose during symptom exacerbation. Motilin agonists without antimicrobial properties are currently under investigation.
Domperidone is another option that blocks receptors in the central and peripheral nervous systems. The approval of domperidone is not being pursued in the US, but remains the drug of choice in patients who cannot tolerate metoclopramide, and is uniquely suited for patients with Parkinson’s disease who have GI symptoms as a side effect of dopamine-agonist therapy.
hi there, i can identify with your symptoms. i have had this before. but it hasnt happend in a while. also my mother ,two of my sisters and nephew had this. it was there gallblader that was causing the problems. they had to have an op to get it removed..
just a suggestion hope it helps
take care
just a suggestion hope it helps
take care
MEDICAL PROFESSIONAL
Hi
Welcome to the MedHelp forum!
You will be surprised to know that stomach ulcers and severe acidity can result in hunger pangs and these can be very painful. Even GERD presents with similar symptoms. At times the hunger pangs due to acidity wakes up a person in the wee hours of night or early in the morning. Uncontrolled, this can cause vomiting.
Treatment is a combination of drugs to reduce the acid and lifestyle changes. You will need to take a combination of medications (under medical supervision) like a proton pump inhibitor such as omeprazole, lansoprazole or pantoprazole empty stomach in the morning and an antacid gel after meals for complete relief. Possibility of H pylori infection too should be looked into by a carbon urea breath test and a combination antibiotic tried.
Life style changes that will help include: Avoid heavy meals and eat frequent small meals. Avoid too much of caffeine, tea, smoking, fried food and drinks both alcoholic and non alcoholic fuzzy ones. Avoid heavy exercises within 4 hours of a heavy meal. Raise the head end of the bed by pillows to 30 degrees. Avoid lying down for least 2 hours after food. Take a late night snack.
Maybe these tips will help you. You should consult a gastroenterologist (a specialist who looks after the diseases of our digestive system) or a physician for this if these tips reduce your symptoms. You may need upper GI endoscopy for confirmation and to know the degree of damage.
Hope this helps. It is difficult to comment beyond this at this stage. Please let me know if there is any thing else and do keep me posted. Take care!
Welcome to the MedHelp forum!
You will be surprised to know that stomach ulcers and severe acidity can result in hunger pangs and these can be very painful. Even GERD presents with similar symptoms. At times the hunger pangs due to acidity wakes up a person in the wee hours of night or early in the morning. Uncontrolled, this can cause vomiting.
Treatment is a combination of drugs to reduce the acid and lifestyle changes. You will need to take a combination of medications (under medical supervision) like a proton pump inhibitor such as omeprazole, lansoprazole or pantoprazole empty stomach in the morning and an antacid gel after meals for complete relief. Possibility of H pylori infection too should be looked into by a carbon urea breath test and a combination antibiotic tried.
Life style changes that will help include: Avoid heavy meals and eat frequent small meals. Avoid too much of caffeine, tea, smoking, fried food and drinks both alcoholic and non alcoholic fuzzy ones. Avoid heavy exercises within 4 hours of a heavy meal. Raise the head end of the bed by pillows to 30 degrees. Avoid lying down for least 2 hours after food. Take a late night snack.
Maybe these tips will help you. You should consult a gastroenterologist (a specialist who looks after the diseases of our digestive system) or a physician for this if these tips reduce your symptoms. You may need upper GI endoscopy for confirmation and to know the degree of damage.
Hope this helps. It is difficult to comment beyond this at this stage. Please let me know if there is any thing else and do keep me posted. Take care!
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