Suggest Remedies For Recurring Abdominal Discomfort

Posted on Thu, 9 Jun 2016

Question: I am by all accounts a very healthy 60 year old male. For the past 9 months I have been experiencing recurring abdominal discomfort (right side under rib cage) that radiates from time to time to the back. At times it is pulsating burning at other times it feels like a pulled abdominal muscle. I've if I bend over to tie my shoes or pick something up it feels like a cramp. I have been to my doctor and have had 2 abdominal ultrasounds (last one in late November 2015) and a variety of blood tests. My blood work is normal (creatinine a little above normal) and ultra sound showed nothing abnormal (ie Gall bladder, pancreas, kidneys, liver fine). I have previously had a stomach ulcer caused from aspirin. An endoscopy in March of 2015 showed that the previous ulcer was cured and no other abnormalities existed. It is an annoying discomfort that is more prevalent when sitting. I am at a loss and would love to know your thoughts?

Could you please let me know when a response might be forthcoming? As of this writing it gas been 6 hours since I placed my question and have heard nothing back

Answered by Dr. Saad Sultan (9 hours later)

Brief Answer:
needs further investigations

Detailed Answer:
Welcome at HCM
I am Dr Saad Sultan and will be answering your query. I have read and understood your health concerns.
Based upon the description provided it is difficult to comment. There is need to do the clinical examination before a reasoned conclusion can be drawn.
What about your BP reading and blood sugar? Is there any history of trauma to abdomen?
As two ultrasound scan came normal and blood tests showed nothing so you should not be worried about it much. Kindly specifically elaborate your blood tests which were performed.
If I am your attending physician I will get your CT scan of chest and abdomen with contrast to delineate any pathology if present. ECG should also be done to look for heart abnormalities particularly inferior wall.
Most probably this pain appear to be musculoskeletal. Or it may be small epigastric hernia which gives intermittent symptoms.
Stay calm and meet your physician and discuss this.
Use acetaminophen to relieve pain.
Feel free to write me on HCM any time.
Regards
Dr Saad Sultan

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Saad Sultan (1 hour later)

Thank you for your response. There has been no trauma to the abdomen. Blood pressure is 120/70. Last EKG was normal as was blood sugar. Utica acid was a bit high at 491mol/L and PSAwas .54g/L. This started last March (2015) after having contracted a mild case of pneumonia which was treated with antibiotics. Symptoms are worse when I sit for extended periods (given my work which has me at a desk for most of the day). I also experience the burning / stinging sensation after drinking alcohol or eating spicy foods. Also I have over the past few months noticed that my bowel movements are softer than normal and i urinate more frequently. When I am standing or lying down, I rarely notice the symptoms. I am scheduled to do a update on the blood work in early April. Should I have another endoscopy performed or perhaps even a colonoscopy(last one done end of 2012)? I have pondered the thought of perhaps a hernia or muscle related issues but it has been going on for almost year now and would the burning radiating to the back sensation be associated with this? I played several rounds of Golf last week (had not played since last September) and the symptoms got worse as did the muscle aches on the right side of my back. Thots???

Answered by Dr. Saad Sultan (11 hours later)

Brief Answer:
Need workup.

Detailed Answer:
welcome at HCM
I really appreciate your follow up.
After going through your response , in my opinion it is not wise to jump directly over the ENDOSCOPY or COLONOSCOPY. there are certain indications for these tests.
You should see the GASTROENTROLOGIST , in my opinion you should be investigated for the CHRONIC PANCREATITIS , H. PYLORI INFECTION, and EPIGASTRIC HERNIA.
You may use OMPEPRAZOLE 40 mg once daily before breakfast to relieve the pain.
See GASTROENTROLOGIST.
Feel free to write me directly on HCM.
Hope it helps
Regards
Dr XXXXXXX XXXXXXX

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Saad Sultan (52 minutes later)

Thank you. As mentioned I go for a follow up blood work in early April unless you suggest to go earlier. As mentioned it does feel like a pulled muscle under the right rib cage. I feel it when I bend over and rise it feel like a pulled muscle. Other times when I eat spicy food or if I have several successive evenings with wine I will feel a burning sensation on the right side. Red peppers in particular appear to flare things up. It is never a debilitating pain but more of a discomfort and annoyance that plays on my mind. Questions for you
1: Would pancreatitis not have shown up in either my blood work or abdominal ultrasounds?
2:Would a epiggastrick hernia cause the burning sensation when eating certain spicy foods or drinking alcohol or caffeine?
3: Would the Pylori infection have been ongoing to this point? (Note when I had mild pneumonia last March it relapsed a few weeks later and I was on a fairly extended period of antibiotics to cure it) Also would this not have appeared in my blood work?
4:As mentioned I have noticed more frequent urination over the last several months and in the last couple of weeks my bowel movements have become more soft but that could be a less than stellar diet
Appreciate your responses to these questions. XXXXXXX

Answered by Dr. Saad Sultan (10 minutes later)

Brief Answer:
see explanation

Detailed Answer:
Welcome XXXXXXX at HCM
I appreciate your follow up.
1: For chronic pancreatitis S. amylase ans S lipase should be done coupled with the CT SCAN of abdomen to look specifically for the pancreas.
2. Yes , Epigastric hernia do present with the pain which exacerbates with eating but no association with certain foods. Small hernia can not be picked with routine investigations .
3: H. pylori can be cured with specific antibiotics for a certain duration. normally routine antibiotics can not cure it.
4:frequent urination without burning and dryness of mouth should not be a matter of concern.
Based upon your symptoms, i dont think there is need for emergency appointment. OMEPRAZOLE along with muscle relaxants( THIOCHOLCHICOSIDE) would be helpful in your case.
Hope it helps.
kindly close the discussion and do write to me on HCM directly any time
regards
Dr XXXXXXX XXXXXXX

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Above answer was peer-reviewed by : Dr. Vaishalee Punj