More than Six Months of Progressive Abdominal Discomfort
A 32-year-old male, with a medical history primarily of asthma (which does not require ongoing treatment), initially visited his general practitioner in December 2024 due to mild discomfort in the right lower quadrant of his abdomen. Following this visit, a CT scan was conducted, revealing slight enlargement of the mesenteric lymph nodes. Since that time, he has experienced a gradual escalation in abdominal pain, yet there have been no notable alterations in his bowel movements. He has lost approximately 3 kilograms over the past six months, although his weight has stabilized over the last two months. He underwent gastroscopy and colonoscopy, both of which returned normal results. A consultation with a hematologist also ruled out small bowel lymphoma as a potential cause. The most recent CT scan, conducted in March 2025, showed diffuse thickening in a loop of the distal jejunum alongside mildly enlarged mesenteric lymph nodes, with no significant change in size compared to prior scans. Both his gastroenterologist and the surgeon who performed the scopes believe that these findings may be attributed to peristalsis. His gastroenterologist subsequently diagnosed him with a functional gut disorder. He is scheduled for a repeat CT this week to assess whether these changes are persistent. He has experienced some relief from his abdominal pain after beginning treatment with Nortriptyline at a dose of 25 mg about a month ago. However, the discomfort has intensified over the past week, prompting an increase in his dosage to 50 mg. Currently, he is uncertain about future steps or additional tests he should pursue and would appreciate any guidance available!
Answers (1)
6/24/2025, 2:01:06 AM
OpenHealth AI
It sounds like you have been navigating a complex situation with ongoing abdominal discomfort and recent findings. The main points to focus on are understanding your condition, managing symptoms, and preparing for your upcoming tests and discussions with your healthcare providers.
Explanation
You've experienced progressive abdominal discomfort paired with significant imaging findings, which have led to various evaluations without definitive diagnosis. Your current diagnosis of a functional gut disorder indicates that while there are changes observed in imaging (like thickening in the distal jejunum), they may not be due to a structural or malignancy-related issue, but rather related to gut motility or sensitivity.
Your recent increase in Nortriptyline dosage appears to be aimed at managing pain, and it's good to hear that you've had some relief from the initial dose. The increase is a common practice when the previous dose is not effective enough, especially for chronic pain syndromes.
Next Steps
Here are prioritized actions you can take in light of your concerns:
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Monitor Symptoms: Keep a symptom diary where you log the intensity and duration of your abdominal discomfort, any changes in bowel habits, diet, stress levels, or other triggers. This will provide valuable information for your healthcare provider.
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Prepare for Your Next Appointment: Before your upcoming CT scan, list any new symptoms you've experienced, changes in pain levels, and how your daily life is affected by your symptoms. Prepare questions or concerns you want to discuss regarding possible functional gut disorder management or further investigations.
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Maintain Communication with Your Healthcare Team: After your scan, follow up with your gastroenterologist about the results and the ongoing management plan. Be clear about your symptoms and the impact they have on your life.
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Lifestyle Adjustments: While you're managing your medication, consider dietary changes that can relieve symptoms for some individuals with functional gut disorders. Keeping a food diary may help you identify any food triggers. Additionally, ensuring adequate hydration and incorporating gentler physical activities can support overall gut health.
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Emotional Well-Being: Chronic pain and uncertainty can be distressing. If you find that your symptoms are affecting your mood or daily functioning, consider exploring mental health support or strategies such as mindfulness or stress management techniques.
It's essential to stay engaged with your healthcare providers as they guide you through this process. You are taking steps in the right direction, and we're here for you if you need more support or information.
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