What Causes Fatigue, Muscle Aches And Upper Abdominal Pain?

Brief Answer:
Cause of your symptoms and how to confirm

Detailed Answer:
Hi XXXX, thanks for asking from HCM.


I can understand your concern. You are having generalised body symptoms with long duration. Such type of symptoms could be due to variety of multi systemic diseases or multiple diseases at one time. I will describe them and tell you how your doctor can rule out them -

1) Diabetes Mellitus with gastroparesis and neuropathy - If there is history of diabetes in you or your family, kindly ask your doctor to rule out uncontrolled diabetes. As it can cause involvement of intestines, nerves and every body part. It can cause all the mentioned symptoms.

The required blood work is
- Blood sugar before and after food
- HbA1c to know status of sugar in past 1 month
- Nerve conduction velocity of involved limbs
- Ultrasound of abdomen

2) Hormonal deficiency like thyroid and cortisol - Hypothyroidism with cortisol level (Steroid low) in body can cause weight loss, loss of appetite, hair loss, myopathy and muscle aches, depression or psychosis not responding to medication.

Even excess of steroid or cortisol which is more common, can cause above symptoms with central obesity, weak bones, neuropathy.

The blood investigations required for screening are

- Thyroid function test

- Serum cortisol level

- Ultrasound of neck and abdomen

If any abnormality, steroid hormone workup requires many more tests.

3) Chronic multivitamin and mineral deficiency disease - Deficiency of vitamin D3, B12, A, calcium, iron all can occur at same time due to poor eating habits, intestinal worms, chronic drug intake preventing absorption of these vitamins, chronic illness.

Deficiency of all these can manifest just like you described and it can also cause repeated fractures, tongue ulcers.

The investigations required are

- Blood level of B12, D3, calcium, iron
- Complete blood count and peripheral smear
- Bone densiometery

4) Chronic illness like tuberculosis, fungal infection of lungs/abdomen/candidiasis especially in diabetics - These illnesses are very slow and long duration. They manifest without pain and lead to overall downfall in health.

They can be ruled out by
- ESR level
- Chest X ray
- Immunblot assays or antibody tests
- For tuberculosis, tuberculin test/gamma interferon level/adenosideaminase level.

5) Less commonly cancer/neoplasia of stomach/Intestine/lymphoma can present like that. It is least common cause. It can be ruled out by

- Ultrasound of abdomen
- CT abdomen with contrast
- Peripheral smear and lymph node biopsy

6) If everything turns out be normal, kindly consult psychiatrist to rule out severe depression - It can present like anything

Hope my answer will help you. If still in doubt, do let me know.
Thanks. Take care.

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