Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
What Causes Abdominal Pain With Nausea,weakness And Weight Loss?
Question: My 17 year old grandson was recently discharged from Children's Hospital in XXXXXXX XXXXXXX after 11 days. He has acute/chronic pain in his lower right side that sometimes radiates to his back. It is still undiagnosed after xrays, mri, colonoscopy, ctscans, ultrasounds etc. He had a large kidney stone a year ago that was removed in an operation. The doctors feel he may have nerve endings in the kidney that keep firing. He has lost at least 45 pounds in 3 months. He has been nauseated and is now just starting to eat after weeks with just a little water. He had his appendix removed recently with no change in pain. He is on pain pills but no longer any narcotics and the pills are not very effective.. He is home since XXXXXXX 6th and weak and can barely climb stairs.
Brief Answer:
ACUTE INTERMITTENT PORPHYRIA!!!
Detailed Answer:
Hello
I am Dr.Omer and I am here to help you with your query.
I am really sorry to hear about your Grandson.
Your grandson have gone intensive imaging and testing for his severe abdominal pain + nausea + weakness+weight loss.
The place where your grandson is feeling the pain is known as Right Iliac Fossa (RIF) of abdominal wall.
The cause of pain in RIF are appendicitis , kidney stones and others but when MRI and CT are done it means the abdomen is normal in that area so the pain originating must be from nerves or nerve endings , You are RIGHT!
Based on the information given to me about your grandson shows he has Porphyrias. Porhyrias is a diverse disease , it has 4 main subtypes and your grandson may have AIP Acute Intermittent Porphyria.
IN AIP the disease usually starts in teen life i.e 10-15 years.In this disease there is a missing catalyst which forms Heam part of Heamoglobin ( heamoglobin carries oxygen to tissues)
The most common presenting symptom of AIP is severe , partially responsive to narcotics, pain in lower abdominal area usually Right Iliac Fossa.The attack or pain in abdomin stays for days to week and then goes away and comes back.
The miss-formed Heam starts to accumulate in blood and causes pain nerve ending irritation and hence severe excrutiating pain.
There are other symptoms of porphyrias i.e vomiting , nausea , weight loss , depression , brain problems , kidney stones etc.
The best test for porphyrias is 24 hr urinary collection for PBG and ALA level. Other test is simply give sugar drip ( dextrose 25% ) solution when in severe pain , if pain decreases by 50 % this shows porphyrias disease.
Treatment is also simple and your grandson will live a happy life where he can eat as much he wants too.Get a internist appointment and discuss this with him he will also proceed like i told you.Hope this explains your query in detail.
Feel free to ask any further queries.
Take care
ACUTE INTERMITTENT PORPHYRIA!!!
Detailed Answer:
Hello
I am Dr.Omer and I am here to help you with your query.
I am really sorry to hear about your Grandson.
Your grandson have gone intensive imaging and testing for his severe abdominal pain + nausea + weakness+weight loss.
The place where your grandson is feeling the pain is known as Right Iliac Fossa (RIF) of abdominal wall.
The cause of pain in RIF are appendicitis , kidney stones and others but when MRI and CT are done it means the abdomen is normal in that area so the pain originating must be from nerves or nerve endings , You are RIGHT!
Based on the information given to me about your grandson shows he has Porphyrias. Porhyrias is a diverse disease , it has 4 main subtypes and your grandson may have AIP Acute Intermittent Porphyria.
IN AIP the disease usually starts in teen life i.e 10-15 years.In this disease there is a missing catalyst which forms Heam part of Heamoglobin ( heamoglobin carries oxygen to tissues)
The most common presenting symptom of AIP is severe , partially responsive to narcotics, pain in lower abdominal area usually Right Iliac Fossa.The attack or pain in abdomin stays for days to week and then goes away and comes back.
The miss-formed Heam starts to accumulate in blood and causes pain nerve ending irritation and hence severe excrutiating pain.
There are other symptoms of porphyrias i.e vomiting , nausea , weight loss , depression , brain problems , kidney stones etc.
The best test for porphyrias is 24 hr urinary collection for PBG and ALA level. Other test is simply give sugar drip ( dextrose 25% ) solution when in severe pain , if pain decreases by 50 % this shows porphyrias disease.
Treatment is also simple and your grandson will live a happy life where he can eat as much he wants too.Get a internist appointment and discuss this with him he will also proceed like i told you.Hope this explains your query in detail.
Feel free to ask any further queries.
Take care
Above answer was peer-reviewed by :
Dr. Prasad
Children's Hospital checked for porphyria last week, as a last resort, and it was negative. This pain, in various degrees and less at first,has been going on for 3 months now. He hurts when we go over any bumps in the car. What else can it be? What therapy and medications should he be on?
Brief Answer:
TESTING OF AIP IS DIFFICULT!!!
Detailed Answer:
Hello again
Thankyou for understanding.
Thats good that they did the test of porphyrias of your grandson , but i would like to know whether they did spot urine PBG test or a complete 24 hr urinary PBG and ALA level. Because in most of the porphyrias patient the spot urine test is negative even though they have AIP.
When the doctors have done the MRI and CT , AIP is the most probable diagnosis of your grandson , others are:
Angioedema limited to abdominal wall only and in CT enterography there is Intestine wall thickening , pain is chronic and severe in nature , for that you need to do C3 , C4 level.
Abdominal migraine in which patient has no headache just episodic severe pain with nausea and vomiting and the pain is chronic usually starts in this age group.
Autoimmune disease like Henoch schleon purpura which presents with severe abdominal pain in their teens with vomiting and weight loss.
His therapy or medication depends on his diagnosis , for all the diseases i told you there is a different treatment from one another.
In the end i would say if he has motor weakness as he cannot or is difficult climbing stairs , with other symptoms then all these lead to Acute intermittent porphyrias , diagnosis is very difficult for AIP.
You need to get a second opinion of another internist , he will do the right testing for AIP as in porphyrias only during attack the urine PBG and ALA increases otherwise they are normal.Treatment for AIP is HEMATIN and Dextrose solution for 14 days.
Hope this explains your query , if satisfied with answers kindly write a review , obliged.
Bye.
TESTING OF AIP IS DIFFICULT!!!
Detailed Answer:
Hello again
Thankyou for understanding.
Thats good that they did the test of porphyrias of your grandson , but i would like to know whether they did spot urine PBG test or a complete 24 hr urinary PBG and ALA level. Because in most of the porphyrias patient the spot urine test is negative even though they have AIP.
When the doctors have done the MRI and CT , AIP is the most probable diagnosis of your grandson , others are:
Angioedema limited to abdominal wall only and in CT enterography there is Intestine wall thickening , pain is chronic and severe in nature , for that you need to do C3 , C4 level.
Abdominal migraine in which patient has no headache just episodic severe pain with nausea and vomiting and the pain is chronic usually starts in this age group.
Autoimmune disease like Henoch schleon purpura which presents with severe abdominal pain in their teens with vomiting and weight loss.
His therapy or medication depends on his diagnosis , for all the diseases i told you there is a different treatment from one another.
In the end i would say if he has motor weakness as he cannot or is difficult climbing stairs , with other symptoms then all these lead to Acute intermittent porphyrias , diagnosis is very difficult for AIP.
You need to get a second opinion of another internist , he will do the right testing for AIP as in porphyrias only during attack the urine PBG and ALA increases otherwise they are normal.Treatment for AIP is HEMATIN and Dextrose solution for 14 days.
Hope this explains your query , if satisfied with answers kindly write a review , obliged.
Bye.
Above answer was peer-reviewed by :
Dr. Yogesh D
Thank you Dr. Omer. Do you have any suggestions for a good Internist is the Denver/Boulder XXXXXXX area? Should he see an Internist rather than a Urologist?
Would any acupuncture, laser light, massage or healing touch help relieve any pain or help his muscles? Can you recommend any diet? He is just starting to eat a little (small amount of oatmeal at breakfast and a chicken rice and mushroom soup mixture at dinner) and keep it down.
Would any acupuncture, laser light, massage or healing touch help relieve any pain or help his muscles? Can you recommend any diet? He is just starting to eat a little (small amount of oatmeal at breakfast and a chicken rice and mushroom soup mixture at dinner) and keep it down.
Brief Answer:
Answer below:
Detailed Answer:
Hello again,
Thank-you for understanding.
I have searched it and i think you can try XXXXXXX community hospital or university of colarado hospital , they have the best internist there.
When MRI abdomen is normal meaning normal kidney size and functioning with no stones then to have a review from urologist will be useless.If your doctor has advised it then there must be a reason for reffering to urologist and you should go.
Urologists DO NOT diagnose or treat porphyrias.You need to have an internist review.
HIGH SUGAR intake can decrease the pain like chocolates , honey , XXXXXXX , moderate amount will be good to take.He can also eat anything he likes which he can digest without vomiting.
Palliative care from acupuncture , massage will be insignificantly useful , unless he has a trust on these things that they work.
Hope this is helpful.
Take care.
Answer below:
Detailed Answer:
Hello again,
Thank-you for understanding.
I have searched it and i think you can try XXXXXXX community hospital or university of colarado hospital , they have the best internist there.
When MRI abdomen is normal meaning normal kidney size and functioning with no stones then to have a review from urologist will be useless.If your doctor has advised it then there must be a reason for reffering to urologist and you should go.
Urologists DO NOT diagnose or treat porphyrias.You need to have an internist review.
HIGH SUGAR intake can decrease the pain like chocolates , honey , XXXXXXX , moderate amount will be good to take.He can also eat anything he likes which he can digest without vomiting.
Palliative care from acupuncture , massage will be insignificantly useful , unless he has a trust on these things that they work.
Hope this is helpful.
Take care.
Note: Consult a Urologist online for consultation about prostate and bladder problems, sexual dysfunction, kidney stones, prostate enlargement, urinary incontinence, impotence and erectile dysfunction - Click here.
Above answer was peer-reviewed by :
Dr. Yogesh D
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
