My wife Kathy has Upper Right Abdominal Pain and has had many tests without an answer as to why. Please Help!?
Here are some specifics:
1) Dull pain which she has had for over two years in her upper right abdomen.
2) Eating does not seem to make the pain in her right side worse. The pain does not seem to follow any eating pattern.
3) Joint pain in the hips shoulders, neck and back which is worse in the mornings. At times she classifies is as severe.
4) An Arthritis test came back as negative.
5) Red itchy rash on her arms, legs and chest when exposed to extended periods of sunlight.
6) Fatigued all the time.
7) Passed a Hida-Scan to test the gall bladder with an 87% evacuation rate. From an article online, anything > 35% would be acceptable.
Missed or late periods for almost every month for the last year.
9) Had a colonoscopy and upper GI performed last Friday with no problems detected.
10) Weight gain of almost 30 pounds in the last year. She has stopped working out due to the abdominal pain which I am certain contributed to the problem.
11) Lowgrade fever in the 99-100 range.
12) Elevated Sed Rate of 49. A subsequent test was at 35 with 20 being the max for the normal range.
13) Swollen lymph nodes in her abdomen which was detected in a CT scan (listed as mild mesenteric adentis on the report)
14) RBC and HCT count was low on 6/3/09.
She went back to her family physician today who is sending her to a Rheaumatologist for the joint pain but did not have a recommendation for the abdominal pain. Any suggestions would be greatly appreciated!.
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Thank you VERY much for the question. I’m sorry to hear about your wife’s illness.
First, some philosophical points.
In medicine, things are not always what they to appear to be. This phenomenon has been born out a plethora of times dating all the way back to Dr. Osler himself.
Further, in medicine, there are two competing approaches to diagnosis. The first is Occam’s Razor: all things being equal, the simplest explanation is likely to be the correct one. That is to say, a single unifying diagnosis is the most plausible and likely the correct and only one. The second approach is entrenched in what is called Saint’s Triad: more than one disease process may be responsible for the presenting illness.
So, which philosophy do internists, pediatricians, etc., take in the process of differential diagnosis? Well, that is highly dependent on the intelligence, experience, and acumen of the individual clinician.
Without knowing all the facts, I suspect that your wife’s abdominal pain is the NOTmain problem. Her pain may simply be a manifestsation of the problem (Occam’s Razor) or problems (Saint’s Triad). Often, clincians are fooled by the fallacy that a symptom or sign MUST be originating from the geographical organ system. Not true . . . ohhhh, so not true . . .
Based on the information that you’ve provided (thank you), I suspect that the abdominal pain is not visceral per se, but is being caused by either a systemic inflammatory process, (i.e., autoimmune disease, paraneoplastic syndrome) or a metabolic syndrome (i.e., acute intermittent porphyria) or an infectious process.
There are several salient features in your wife’s case, but the one that intrigues (and worries) me the most is PHOTOSENSITIVITY, which has a limited differential diagnosis. But what immediately comes to mind is systemic lupus erythematosis and acute intermittent porphyria.
If I may ask for additional details,
1. How old is your wife?
November 30th, 2009 at 12:47 am2. Does she have any oral or canker sores?
3. Does her urine change color when the abdominal pain strikes?
4. Is her serum calcium normal?
5. Has she been evaluated for primary hyperparathyroidism?
yes,i would suggest you don’t seek this kind of advice from yahoo answers…..
November 30th, 2009 at 12:47 amFever indicates infection, but that may, or may not be the cause of the pain. Elevated sed rate indicates inflammation.
Your gall bladder evacuates at a normal rate, but there may be disease there anyway.
If I were a doctor, and I have no medical training, I would also see an endocrinologist.
The liver, pancreas, and gall bladder all hang out there, and it is possible there is infection.
Inflammation also may indicate auto-immune possibilities. Some of the symptoms are lupus-like, and it wouldn’t hurt to get checked out. Joint pain and sun-sensitive rashes raise my suspicions. There’s a blood test (ANA) that can rule it out.
The endocrinologist can help with the hormone changes and may be able to narrow down what’s wrong.
November 30th, 2009 at 12:47 amI’m guessing that you’re getting pretty desperate to be posting this on here. An endocrinologist is a better route than a rheumatologist, as many of the symptoms appear to be hormonally related. In all honesty, the best way to get a diagnosis is to be admitted to a teaching hospital. Young doctors who have something to prove, combined with decades of combined experience and access to dozens of specialists equals the best health care one can receive in the USA. Failing that, see an endocrinologist.
November 30th, 2009 at 12:47 amWell, the answer is completely obvious to me, and I’m sure it would be to the esteemed Dr. Gregory House (New Jersey), as well. It’s certainly not lupus. No, I’d say the problem’s in her pancreas. Consult a neurologist, immunologist, and an Australian; make sure you do so in that particular order.
November 30th, 2009 at 12:47 amIt sounds like this ship needs a captain who can assimilate all this information, add a few appropriate diagnostic tests and use his/her clinical acumen to solve this problem. Agree with Joe above, you need a good diagnostician. These guys are usually found at University (medical school ) teaching hospitals. Call your nearest medical school hospital and talk to someone in the Internal Medicine department.
November 30th, 2009 at 12:47 am