OpenHealth Q&A

Seeking Insights on Unexplained Upper Abdominal Pain

My daughter, who is 16 years old, has been suffering from severe pain just beneath her ribs in the upper abdomen. This issue began at school a few days back without any prior incidents that could have led to it; she was simply in math class when the discomfort began. Out of nowhere, she was struck by such a sudden and intense pain that she doubled over in agony, crying uncontrollably. Her mother picked her up from school and took her to the emergency room where a doctor, during an initial examination, suspected he heard a murmur, which was later referred to as a bruit murmur. While I'm unsure about the accuracy of that term, I do know it was identified as a murmur. The medical team proceeded with blood tests, a CT scan, and an ultrasound of her abdomen. The blood tests indicated elevated bilirubin levels, while the ultrasound suggested that her gallbladder was producing more bile than normal, although no gallstones were found. The imaging revealed that several duct passages from the gallbladder appeared narrowed, possibly due to slight dehydration. There was also a mention of a ligament that might have been putting slight pressure on an artery, although the specifics were never clearly detailed, and no follow-up was made about this after the appointment. Due to these findings being beyond the doctor's experience, they referred her to a larger hospital for further evaluation. They provided her with an IV for presumed dehydration but did not offer any prescriptions, aside from general pain relief medication until the follow-up. The following day, my daughter experienced a few mild pain episodes, manageable enough not to cause significant concern. She was also well-hydrated. Unfortunately, around 3 PM, she had another acute episode while her mother was at an appointment with her brother. Realizing the pain was escalating, her mother took her to a different hospital for a second opinion where tests included blood work and reviewing past imaging, but no new procedures were initiated. The results showed a minor decrease in bilirubin levels, leading the doctor to conclude that her pain was residual. She was prescribed Bentyl, a medication meant to alleviate biliary colic, and they discharged her after a brief visit. Despite these setbacks, we felt reassured as over 24 hours passed without major incidents. Her mother provided her a small grilled chicken wrap to eat, based on their shared knowledge of dietary management for gallbladder concerns. However, that night around 9 PM, my daughter experienced a third significant pain episode. The intensity was so overwhelming that she cried out, requiring me to carry her to the car—an alarming sign given her typical resilience at 16. We bypassed the local hospital due to negative past experiences and drove nearly an hour to what we believed to be the best hospital available. Interestingly, her pain eased somewhat during the journey, but the growing severity of her symptoms kept us anxious. Upon arrival around 10:30 PM, the hospital staff conducted their standard check-in process, asking numerous questions—far more than either of the previous hospitals had done combined. They examined her, requested her medical records from the earlier visits, and expressed concerns over her worsening condition. While waiting for the attending physician to arrive, she experienced yet another pain episode, albeit lesser than the previous, lasting about ten minutes. When the doctor finally appeared, she ordered an ultrasound, which revealed that while there were signs indicative of stone presence (enlarged gallbladder ducts), no stones were detected on the imaging. Additional blood work was taken. In the meantime, my daughter had another episode around 12:30 AM, prompting the doctor to rule out numerous conditions relating to her gallbladder and pancreas and reassure us that pain management would continue while they gathered further information. After some wait, they decided on an MRI, which left us puzzled since the prior evaluations didn't suggest a need for further imaging beyond the ultrasound. Throughout the ordeal, doctors checked in and provided pain relief as needed. Yet, when the MRI results returned, they revealed no discernible reason for her pain—which has persisted, with all primary organ functions appearing normal. The only anomaly was the dilated gallbladder ducts, but no prior images existed for reliable comparison. We were instructed to maintain regular follow-ups with her healthcare provider and given a different pain medication. Currently, my daughter is staying with her mother, and while she has managed to sleep some since returning, she awoke still in discomfort—albeit at a more tolerable level. Her mother and I are filled with uncertainty and are concerned due to our experiences with doctors potentially overlooking significant issues in similar situations. We hope that her discomfort is merely a temporary concern that was missed during examinations. However, we are seeking any insights or suggestions for further investigation into the causes of her pain symptoms, particularly now that common conditions have been ruled out. Does anyone have insight into what could be responsible for her episodes of pain?

Answers (1)

3/28/2025, 8:30:48 PM

OpenHealth AI

It sounds like your daughter has been through a very challenging and painful experience. Given the complexity of her situation, it’s understandable that you are feeling concerned and seeking further insights into her upper abdominal pain.

Summary of Key Points:

1. Previous Tests and Findings: Elevated bilirubin, dilated gallbladder ducts, and no gallstones found.
2. Current State: Episodes of severe pain persisting even after multiple hospital visits and imaging studies returning normal results.
3. Future Considerations: Ongoing monitoring and follow-up are essential, along with potential further investigations to understand the cause.

Explanation:

The symptoms your daughter is experiencing—sudden, severe pain in the upper abdomen—can arise from several issues. Since gallstones have been ruled out, the next possibilities might include:

• Biliary Colic or Dysfunction: Sometimes, the gallbladder can still cause pain even in the absence of stones if it's not functioning properly.
• Pancreatitis: Irritation of the pancreas can cause severe abdominal pain, although this was likely considered given the tests performed.
• Muscle or Ligament Strain: Sometimes, pain can come from surrounding muscles or ligaments if there was a strain or unusual physical activity.
• Esophageal Issues: Conditions such as esophageal spasms can mimic abdominal pain.
• Referred Pain: Pain could be stemming from other areas in the body, manifesting as abdominal pain.

Next Steps:

1. Diet Management: Continue with a bland diet. Avoid fatty foods and caffeine, which can irritate the digestive system and gallbladder.
2. Symptom Journal: Keep a detailed diary of her pain episodes, including onset, duration, intensity, and any medications or foods consumed before each episode. This information can be very useful during doctors' visits.
3. Hydration: Ensure she stays well-hydrated, as dehydration can exacerbate certain digestive issues.
4. Follow-Up Specialist Appointment: Given the referrals to a larger hospital, ensure you follow up with a gastroenterologist who specializes in biliary and gastrointestinal disorders. This could provide a deeper insight into possible complex conditions affecting her gallbladder or liver.
5. Consider Other Imaging or Tests: Discuss with the specialist the possibility of more focused imaging studies, such as MRCP (Magnetic Resonance Cholangiopancreatography), which offers more detailed views of the biliary system.

Reassurance:

It's understandable to feel anxious about your daughter's health. While the symptoms are concerning, many conditions can manifest with abdominal pain that may not be serious or could resolve with time and appropriate management. By staying proactive with her healthcare and considering specialized care, you're taking important steps towards finding a resolution.

Continue to monitor her condition closely, and ensure she gets plenty of support during this difficult time. If her pain worsens or other alarming symptoms arise, do not hesitate to seek immediate medical attention.