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Suggest Treatment For Abdominal Pain And Nausea
Question: I'm on day 10 of gripey lower abdominal pain, intermittent nausea (no vomiting), soft somewhat churned up stool (not diarrhea) that is now more normal but still smaller size than normal, intermittent stabbing pain in lower pelvis just above symphysis pubis that radiates to vaginal area near cuff and is worsened by palpation (had TAH/BSO 3/2012), with fever varying from normal-101.4 (currently 100.4). PMH positive for invasive ductal CA of L breast, S/P chemo (Abraxane, Carboplatin and Avastin) from 8-11/2009, and bilateral mastectomies in 12/2009. Any ideas?
Brief Answer:
many possbilities with your symptoms.
Detailed Answer:
Hi,
If you don't have any dysuria, symptoms of urgency and increased frequency of urination( which can occur with cystitis), first thing i would suggest is an abdominal X ray to see if there is any obstruction, physical examination for any hernia,next thing I would suggest you undergo a colonoscopy especially if you haven't had it before. If you are anemic or your HB is less than 10, thats also an indication of colonoscopy. If your colonoscopy is fine, you don't need to worry. You may want to do a baseline urinalysis as well. If everything is normal, it may be a simple GI tract infection and you may go on ciprofloxacin for that. Since your pain is not localised to left lower quadrant and you dont have a history of constipation, diverticulitis is not a possibility with your symptoms.
In short do a baseline urinalysis, abdominal Xray, colonoscopy for colorectal cancer, if everything is negative then you may take ciprofloxacin for GI infection.
Please consult a gastroenterologist for further evaluation.
Dr. Khan
many possbilities with your symptoms.
Detailed Answer:
Hi,
If you don't have any dysuria, symptoms of urgency and increased frequency of urination( which can occur with cystitis), first thing i would suggest is an abdominal X ray to see if there is any obstruction, physical examination for any hernia,next thing I would suggest you undergo a colonoscopy especially if you haven't had it before. If you are anemic or your HB is less than 10, thats also an indication of colonoscopy. If your colonoscopy is fine, you don't need to worry. You may want to do a baseline urinalysis as well. If everything is normal, it may be a simple GI tract infection and you may go on ciprofloxacin for that. Since your pain is not localised to left lower quadrant and you dont have a history of constipation, diverticulitis is not a possibility with your symptoms.
In short do a baseline urinalysis, abdominal Xray, colonoscopy for colorectal cancer, if everything is negative then you may take ciprofloxacin for GI infection.
Please consult a gastroenterologist for further evaluation.
Dr. Khan
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
No dysuria. I've had many UTIs since menopause however none since I started using cranberry capsules about 1 1/2 yrs ago. Had my second colonoscopy 2/2012 which was negative and cleared for 8-10 years (had a few polyps with first colonoscopy 5 years prior to that). Last CBC 3 mos ago was wnl: H&H 13 and nearly 40. Actually the pain IS in the LLQ (although it was more diffuse in the first week) and very tender to touch but no constipation (unless there's a small impaction that I'm passing softer stool around). At this point my fever is 101.4 but I've been sleeping all day so know I need fluids. Sounds like diverticulitis vs GI infection is what we've narrowed it down to. I'm pleased that that is what I was thinking and appreciate your input. This is a great service. Guess I'll go to ED if pain gets worse or see my PCP Monday. Thanks again, Dr. Khan! :o). XXXXXXX
Brief Answer:
yes diverticulitis is now into the equation
Detailed Answer:
Hi,
With your pain in LLQ initially, now in fact yes diverticulitis is what is on the top of differntial. For that they usually do a CBC and if thats elevated or on upper range of normal, you can do CT scan if the pain is severe or if the pain is mild, then on the basis of suspicion of mild diverticulitis, you can straight away go to treatment which is
A clear liquid diet
7-10 days of oral broad-spectrum antimicrobial therapy classically ciprofloxacin and metronidazole.
Patients can advance the diet slowly as tolerated after clinical improvement occurs, which should be within 48-72 hours
please note colonoscopy in the acute setting is contraindicated if diverticulitis is suspected. However its equally important to do colonoscopy to exclude colon cancer once your symptoms resolve say after a month, especially given the history of your polyps. Please consult your gastroenterologist on that you need to undergo colonoscopy after resolution of the event. Thank you and wish you best of your health
Dr. Khan
yes diverticulitis is now into the equation
Detailed Answer:
Hi,
With your pain in LLQ initially, now in fact yes diverticulitis is what is on the top of differntial. For that they usually do a CBC and if thats elevated or on upper range of normal, you can do CT scan if the pain is severe or if the pain is mild, then on the basis of suspicion of mild diverticulitis, you can straight away go to treatment which is
A clear liquid diet
7-10 days of oral broad-spectrum antimicrobial therapy classically ciprofloxacin and metronidazole.
Patients can advance the diet slowly as tolerated after clinical improvement occurs, which should be within 48-72 hours
please note colonoscopy in the acute setting is contraindicated if diverticulitis is suspected. However its equally important to do colonoscopy to exclude colon cancer once your symptoms resolve say after a month, especially given the history of your polyps. Please consult your gastroenterologist on that you need to undergo colonoscopy after resolution of the event. Thank you and wish you best of your health
Dr. Khan
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Tried to hold off on ibuprofen (didn't have Tylenol) last night but my head hurt so badly and fever wasn't dropping below 101 even after pushing fluids so I gave in about 10pm and took 600mg so I could sleep. I sweated all night and temp normal this morning. LLQ pain markedly reduced and I sneezed this morning without pain (hurt really badly before). Fever 3 hrs ago was 99.8. Mild headache now but just back from grocery shopping etc and am really tired. Soreness only on palpation of LLQ. No change in stool as of this morning. Have been eating small amounts at a time but regular diet and symptoms improved. Also my last colonoscopy was 2/2013 not 2012, if that makes any difference. Does the pain come and go with diverticulitis? I'm a Peds ICU nurse and diverticulitis is definitely out of my expertise! Is it only in LLQ? Can my immune system (which is historically very strong) take care of this or do I definitely need abx? Thanks, XXXXXXX
Brief Answer:
antibiotics for two weeks
Detailed Answer:
Hi,
Although diverticulitis may be seen more in immunodeficient patients, however there is nothing to suggest in your case that suggest immunodeficiency so don't at all worry about it and you don't need antibiotics for life-long. Yes the pain of diverticulitis is in LLQ and with kind of fever you are having, it is diverticulitis until proven otherwise. I will tell you what you can do based on the intensity of pain. If you have mild pain and the fever is dropping, then you can start on soft diet and outpatient ciprofloxacin and metronidazole for 10-14days.
If you have severe pain or signs of systemic inflammation fever being one of them or you have signs of peritonitis or you are not able to tolerate even liquid diet then you need hospitalisation, where you should be kept NPO and on Iv antibiotics. If your fever doesnt resolve in 2-3 days after starting antibiotics, the suspicion of abscess is there so the next step is to do CT for which Ct guided abscess may be done.
You may skip on the colonoscopy part if you want since you had it a while ago or can replace it with rectosigmoidoscopy.
To prevent future episodes of acute diverticulitis start on bulk like psylium 2-3 weeks after complete resolution. Please note constipation is the primary factor behind the pathophysiology of diverticulitis.
Elective surgery can be done for repeated episodes of acute diverticulitis for more than 2 episodes that were successfully treated medically. As for your queries thats what we are here for. Hopefully everything will be fine XXXXXXX
Dr. Khan
antibiotics for two weeks
Detailed Answer:
Hi,
Although diverticulitis may be seen more in immunodeficient patients, however there is nothing to suggest in your case that suggest immunodeficiency so don't at all worry about it and you don't need antibiotics for life-long. Yes the pain of diverticulitis is in LLQ and with kind of fever you are having, it is diverticulitis until proven otherwise. I will tell you what you can do based on the intensity of pain. If you have mild pain and the fever is dropping, then you can start on soft diet and outpatient ciprofloxacin and metronidazole for 10-14days.
If you have severe pain or signs of systemic inflammation fever being one of them or you have signs of peritonitis or you are not able to tolerate even liquid diet then you need hospitalisation, where you should be kept NPO and on Iv antibiotics. If your fever doesnt resolve in 2-3 days after starting antibiotics, the suspicion of abscess is there so the next step is to do CT for which Ct guided abscess may be done.
You may skip on the colonoscopy part if you want since you had it a while ago or can replace it with rectosigmoidoscopy.
To prevent future episodes of acute diverticulitis start on bulk like psylium 2-3 weeks after complete resolution. Please note constipation is the primary factor behind the pathophysiology of diverticulitis.
Elective surgery can be done for repeated episodes of acute diverticulitis for more than 2 episodes that were successfully treated medically. As for your queries thats what we are here for. Hopefully everything will be fine XXXXXXX
Dr. Khan
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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