Have Had Lower Abdominal Discomfort. CT Came With Enlarged Spleen. What To Do?

Posted on Thu, 14 Mar 2013

Question: I have had lower right abdominal discomfort for several weeks...since the beginning of the year. It is not sharp but crampy, dull discomfort that is intermittent...not overwhelming pain but not comfortable either. Four inches to right of the belly button and down between the lower abdomen and just north of the my waist area. Palpating does not cause pain and no rebound tenderness. Does not wake me up at night and on morning waking it is not there but as my day progresses it gets worse. Normal weight, bowel movements. For the first few weeks of January I had a lot of nausea and fatigue but that all cleared up...maybe a stomach bug. I also changed my diet in mid-December to be a carb free diet so that I can work on improving my lipids. Currently I feel great other than the abdominal discomfort. I am going to see my doctor in a week. I do not want to sound paranoid(which I am to be honest), but if she sends me for imaging can I opt to start with an ultrasound? Would an abdominal/pelvic MRI also be an option? About 10 years ago I had an abdominal/pelvic CT scan with and without contrast due to similar symptoms in my upper abdomen and the day of the CT I was feeling 100% better and my physician sent me for the scan anyway. All that was noted was a borderline enlarged spleen which was not thought to be of any consequence. Recently, I also have had sinus CT and fluoroscopic-guided nerve block injection for an orofacial nerve problem caused by dental work 5 years ago and I may have more(nerve blocks) of those done in the coming months. I have a very wonderful physician who is a great communicator, but I really don't want another CT scan at this time. If I did not have one 10 years ago or if I were an older adult I would not be as worried. The radiation exposure makes me feel very uncomfortable to the point where I dont even want to see her in fear that she might send me for a CT. And of course she may not even send me for one. What to do in this situation? Regards, XXXXXXX

Answered by Dr. Enrique Molina (23 minutes later)

Hi XXXXXXX I would be happy to provide answers based on your explanation. It seems that your lower abdominal pain has been going on for a few weeks already. You do not describe any "alarm" symptoms, such as blood in stool, weight loss, abdominal distention, fevers. This could all be intestinal "spasms", which can result in crampy abdominal pain. This can occur after a viral infection (your possible stomach bug?), and it is call "post-viral irritable bowel syndrome". Anti-spasmodics prescribed by your doctor may help (such as Bentyl or Levsin), and this may take months to go away. If medications such as those don't work, I would consider performing the abdominal ultrasound that you mention. This is a good imaging tool to look for kidney stones, gallstones, spleen size, liver, etc. Only if that is negative and symptoms still persist I would order an MRI (very minimal radiation compared to a CT scan). The only downside of an MRI is that the test takes longer, and if you have claustrophobia you may not be able to complete the test. A colonoscopy is unlikely to give any useful information since you do not complain of any other gastrointestinal symptoms.
When you visit your doctor, it would also be a good idea to check basic laboratory studies (including a CBC, electrolytes, thyroid tests).
I understand you changed your diet in order to improve your lipids, but if you haven't done so, I would highly recommend you visiting a nutritionist for further advice.
Hope that helped, let me know if I can answer anything else.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Enrique Molina (8 minutes later)

Thank you very much. I might have had a quick flu back at the beginning of the year with one evening of fever. Have only lost a few pounds in the last several weeks due to my change in diet. Did have a lot of gas at one time and still do although it is better. My appetite is excellent. Yes, I have no alarming symptoms. Are MRIs of the abdomen becoming more common these days to investigate abdomial pain, especially in the non-hospital and sub-acute setting? Is appedicitis also a possibility for me?

Answered by Dr. Enrique Molina (33 minutes later)

Yes MRI are more and more commonly performed nowadays, however it is much more expensive than CT scans and ultrasounds, reasons why it is not the initial test in cases like yours, but if radiation is a concern, then MRI is a great choice. There should be outpatient radiology centers that provide MRI services in your area (unless you live in a rural area).
Appendicitis is not what would come to mind given the fact that your symptoms have been going on for weeks. The location of your pain might be in the same area of your appendix, but that doesn't mean that is the cause of your pain. Appendicitis causes severe pain within 48-72 hours that inevitably leads you to go to the emergency room. You could not be walking around for weeks with appendicitis.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Enrique Molina (5 minutes later)

Thank you Dr. Molina. I appreciate your informative and quick response.
XXXXXXX

Answered by Dr. Enrique Molina (9 minutes later)

I'm glad I helped, hope you feel better.

Note: Revert back with your health reports to get further guidance on your gastric problems. Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar