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What Causes Lower Right Quadrant Pain With Nausea And Fever?
Question: Hi, my eighteen-year-old son started experiencing lower right quadrant pain 6 weeks ago. It is accompanied by nausea and fever. His fever has been anywhere from 99 - 103.7. He wakes up with a fever and goes to bed with a fever. The nausea is constant and he takes Zofran to help with it. His blood pressure has also gone as high as 164/130. He has been prescribed Percocet and other pain meds, but nothing helps. The pain and nausea interrupts his sleep and he is tired and now has bags under his eyes. We have been to the ER twice (once on our own and the second time our pcp sent us.) Cat Scans were done revealing a healthy appendix, liver, pancreas and gall bladder. Last week he had a colonoscopy with a clean result. He was tested last week for mononucleosis, lyme disease and one other disease. All negative results. This is definitely affecting his quality of life, particularly the fever, as he seems most fatigued when his fever is high. Any ideas. I'm out of ideas as to what doctor to call. We have seen emergency medicine, family medicine and gastrointestinal medicine. I would appreciate any advice you can give. Thank you!
Brief Answer:
Please give detailed and additional information
Detailed Answer:
Hi.
Thanks for your query about your 18 year old son having pain in right lower abdomen, fever, nausea disturbing the sleep - 6 weeks - high blood pressure - tired - bags under eyes - consulted many Doctors/ Specialist as noted - CT normal - normal colonoscopy - negative for mononucleosis, Lyme's and other diseases - wants advise ...
As per the available history I can suggest you the following:
Urine: Routine, microscopy, culture and sensitivity.
Blood: CBC, liver, kidney, thyroid functions; blood culture and sensitivity > blood to be collected when he has high fever.
C-reactive protein CRP.
Tests for Tuberculosis.
MRI of the thoraco-lumbar spine, spinal cord as there may be a referred pain from the lesion in the spinal cord or nearby structures.; this is so as CT scan abdomen is normal in spite of pain in right lower abdomen and has fever, fatigue and so.
X-ray chest.
Ultrasonography of the abdomen although CT scan has already been done.
I was wondering about a few things:
What is the treatment offered till now?
What are the other associated symptoms like Chills, any bowel or urinary symptoms, headache and muscle ache, cough and cold, any other symptoms which may be related or unrelated.
Awaiting for your feedback, reports of the remaining investigations as mentioned if not done already.
Please give detailed and additional information
Detailed Answer:
Hi.
Thanks for your query about your 18 year old son having pain in right lower abdomen, fever, nausea disturbing the sleep - 6 weeks - high blood pressure - tired - bags under eyes - consulted many Doctors/ Specialist as noted - CT normal - normal colonoscopy - negative for mononucleosis, Lyme's and other diseases - wants advise ...
As per the available history I can suggest you the following:
Urine: Routine, microscopy, culture and sensitivity.
Blood: CBC, liver, kidney, thyroid functions; blood culture and sensitivity > blood to be collected when he has high fever.
C-reactive protein CRP.
Tests for Tuberculosis.
MRI of the thoraco-lumbar spine, spinal cord as there may be a referred pain from the lesion in the spinal cord or nearby structures.; this is so as CT scan abdomen is normal in spite of pain in right lower abdomen and has fever, fatigue and so.
X-ray chest.
Ultrasonography of the abdomen although CT scan has already been done.
I was wondering about a few things:
What is the treatment offered till now?
What are the other associated symptoms like Chills, any bowel or urinary symptoms, headache and muscle ache, cough and cold, any other symptoms which may be related or unrelated.
Awaiting for your feedback, reports of the remaining investigations as mentioned if not done already.
Above answer was peer-reviewed by :
Dr. Prasad
Thank you so much for your quick response.
In reply to your questions, he complains of a headache, but he always has headaches. He had a tumor removed from the left side of his head when he was 12.
So, yes. He has headaches. No congestion or cough or anything like that. He has been lifting weights regularly until six weeks ago when the pain started. He is 6'2" tall and weighs 272lbs. His bowel habits are normal and urine output is normal. Normal urine function test as well. He has been treated with pain medicine (percocet) and zofran. He was given a steroid and an antibiotic; however, neither yielded any change in the few days that he took it, so he was advised to discontinue use.
In reply to your questions, he complains of a headache, but he always has headaches. He had a tumor removed from the left side of his head when he was 12.
So, yes. He has headaches. No congestion or cough or anything like that. He has been lifting weights regularly until six weeks ago when the pain started. He is 6'2" tall and weighs 272lbs. His bowel habits are normal and urine output is normal. Normal urine function test as well. He has been treated with pain medicine (percocet) and zofran. He was given a steroid and an antibiotic; however, neither yielded any change in the few days that he took it, so he was advised to discontinue use.
Brief Answer:
As detailed below.
Detailed Answer:
Thanks for your additional information which leads me to advise few more tests:
Review MRI of the brain .
Tests of spinal fluid removed by lumbar puncture.
Since the problem is lingering for 6 weeks a complete course of an antibiotic, Metronidazole should have been given even on empirical basis. Of course the strategies change a bit from place to place according to the local protocols and variations in geographic distribution of the diseases.
Still a proper carpet-treatment or treatment on clinical evaluation should be given, Percocet and Zofran are symptomatic medicines, not the curative one.
Since there are symptoms, there has to be a reason.
Please discuss all these points with your treating Doctors to go ahead with proper investigations and management.
As detailed below.
Detailed Answer:
Thanks for your additional information which leads me to advise few more tests:
Review MRI of the brain .
Tests of spinal fluid removed by lumbar puncture.
Since the problem is lingering for 6 weeks a complete course of an antibiotic, Metronidazole should have been given even on empirical basis. Of course the strategies change a bit from place to place according to the local protocols and variations in geographic distribution of the diseases.
Still a proper carpet-treatment or treatment on clinical evaluation should be given, Percocet and Zofran are symptomatic medicines, not the curative one.
Since there are symptoms, there has to be a reason.
Please discuss all these points with your treating Doctors to go ahead with proper investigations and management.
Note: Revert back with your health reports to get further guidance on your gastric problems. Click here.
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
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