Ongoing Abdominal Discomfort Despite Normal Test Results
Subject: 22-year-old female. Current Medications: - Spironolactone 50mg for hormonal acne - Sertraline 100mg - Memantine 5mg, taken twice daily - Hailey FE 1.5/30, one 28-day pack - Rizatriptan 10mg as required. Chronic Health Issues: - Asthma - Migraines with aura Intensifying discomfort began in January with sharp, stabbing sensations located in the upper left quadrant of my abdomen post-meal. After a visit to my primary care physician, an ultrasound was recommended due to a suspicion of gallstones. Subsequent blood tests, including a complete blood count with differential, lipase levels, and a comprehensive metabolic panel, yielded normal results. Ultrasound results indicated: "The pancreas appears normal upon imaging. The liver demonstrates increased echogenicity compared to the right kidney, suggesting diffuse fatty infiltration. There is no dilation of intrahepatic or extrahepatic bile ducts noted. The common bile duct measures at 3 mm. The gallbladder is moderately enlarged without stones, wall thickening, or fluid surrounding the gallbladder. No sonographic Murphy's sign was observed. The right kidney measures 11.1 x 4.0 x 5.0 cm with a cortical thickness of 8 mm, showing normal echogenicity without dilation of the right renal collecting system." Additionally, my physician documented her thoughts: 1. Mild fatty liver infiltration. 2. No presence of gallstones or bile duct dilation. No signs of acute cholecystitis seen via ultrasound. 3. There is some thinning noted in the right kidney's cortex. A HIDA scan conducted yesterday also revealed unremarkable results: "RESULTS: There was rapid uptake and excretion of the radiopharmaceutical from the liver. Visualization of the common duct occurred at 10 minutes. Gallbladder filling began after 15 minutes with evidence of transit into the small intestine noted by 45 minutes. No signs of enterogastric reflux were detected. The gallbladder ejection fraction was determined to be 55% (normal >33%). IMPRESSION: No indications of cholecystitis or biliary dyskinesia." Despite the clear test outcomes, I continue to experience symptoms like constipation, diarrhea, diminished appetite, and sharp pain in the upper left quadrant following meals, sudden movements, or at seemingly random intervals. I have also experienced acute pain in the mid-abdomen near the navel, discomfort in the lower back by the kidneys, and sharp sensations between the shoulder blades as well as in the upper right quadrant. Interestingly, there are days when the pain is absent. When present, the pain usually lasts from a few seconds to several minutes, generally rating around 4-5 out of 10 on the pain scale. This situation has become increasingly challenging as I am a full-time Master of Public Health student, juggling 30+ work hours weekly, while also managing my migraines. My primary care doctor is likely to refer me to a surgeon; however, I am hesitant to undergo surgery unless it is absolutely essential. I have adopted dietary changes advised by my doctor, steering clear of fatty and greasy foods, which provided some relief for a few weeks. Unfortunately, the pain has intensified over the past week despite maintaining these dietary adjustments. Could the source of my issues be related to my gallbladder, or should further exploration for alternative causes be conducted? I would be grateful for any guidance or suggestions on the next steps to take. The most frustrating aspect is the absence of findings from the tests, leaving me uncertain about the justification for surgical intervention.
Answers (1)
3/19/2025, 3:21:11 PM
OpenHealth AI
It sounds like you're experiencing significant abdominal discomfort despite thorough testing showing normal results. Given your symptoms and medical history, it's understandable to feel frustrated and uncertain about the next steps. Here’s a structured approach to consider moving forward.
Key Points:
- Your tests, including blood tests, ultrasound, and HIDA scan, returned normal results, ruling out gallstones, cholecystitis, and major complications.
- You continue to experience persistent abdominal pain, changes in bowel habits, and discomfort that affects your daily life.
- It's important to explore other potential causes and consider management strategies while avoiding unnecessary procedures.
Explanation:
Your symptoms—sharp, stabbing pain in the upper left abdomen, changes in bowel habits (constipation and diarrhea), and referred pain—can arise from various non-organic causes, including functional gastrointestinal disorders. Common conditions that could fit your situation include:
- Functional Dyspepsia: This can cause upper abdominal pain, bloating, and discomfort after meals.
- Irritable Bowel Syndrome (IBS): Characterized by alternating patterns of constipation and diarrhea, abdominal pain can also be part of this condition.
- Dietary Triggers: Even with healthy changes, certain foods may still irritate your gut.
Next Steps:
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Keep a Food and Symptom Diary: Documenting what you eat and any associated symptoms can help identify potential triggers and patterns. Note any foods that seem to worsen your pain.
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Consult a Gastroenterologist: While the tests are normal, a specialist may help explore functional causes or further investigate through additional testing, such as an esophagogastroduodenoscopy (EGD) or a referral for gastric motility studies.
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Consider Dietary Adjustments: Since you've mentioned dietary management, consider seeking a registered dietitian who specializes in gastrointestinal issues. They can help tailor a diet plan, possibly including a low-FODMAP diet, which may relieve symptoms if IBS is suspected.
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Monitor Stress and Lifestyle Factors: As a full-time student juggling work, stress could exacerbate your symptoms. Try implementing stress-reducing techniques like mindfulness, yoga, or gentle exercise.
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Medications for Symptom Relief: Discuss with your doctor the potential use of medications for IBS or functional dyspepsia, such as antispasmodics or acid-reducing agents.
Reassurance:
It's completely normal to feel uncertain after extensive testing with no clear diagnosis. The path to understanding gastrointestinal issues can sometimes be complex and multifaceted. By taking proactive steps to monitor your symptoms and seek targeted support, you can work towards finding relief. Please remember, you're not alone in this; many people experience similar challenges, and with the right approach, improvement is possible. Let me know if you need further clarification or support!
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