Question: Hello
I have a long hx of kdney stones and kidney stone attacks. In September of 2013, I presented to the ER with what I thought was another attack. CT of the abd showed no stones, however the ER physician felt I may have passed the stone before the scan was taken. I was told to f/u with my urologist. What was different with that attack is that the pain to my left upper quad that radiates to my flank and back has never left me and is rated at 3-5 on a daily basis. In addition, I have been able to palpate a firm area just below my left ribcage, non-tender with firm palpation that has a "full" feeling. I f/u with my urologist in November, another CT of the abd was done that showed no hydronephrosis, only a 2 mm stone in the body of the kidney, otherwise negative. My urologist told my my pain was not kidney related and I needed to see my primary physician which I did in December. I have since had a ultrasound of the abd and pelvis, both negative and a EGD which revealed esophageal and stomach ulcers x 3. I was started on prilosec 20mg before meals. My primary physician has dx costochronditis and is reluctant to order more diagnostic work-up despite the fact that my pain in deep internal "colicky" in nature with an attack and I have no rib discomfort. I have asked for a barium swallow and he has agreed but has indicated he will order no more testing. The pain continues everyday as well as the full sensation and firm area, does not seem to be precipitated by anything, I have no nausea or vomiting, no weight loss, no change in appetite and just the occasional bout of constipation or diarrhea. I have no cardiac or resp symptoms other that the occasional dry cough associated with the reflux. Thank you, XXXX

Thank you for the response. The CT abd indicated the spleen and pancreas were unremarkable. I am very doubtful of costochronditis as the pain feels "deeper" or organ related, there is no increased pain with movement or respirations. I have not noticed increased pain associated with bowel movements. I am also feeling like this may be upper bowel related but would the upper bowel cause "colicky" attacks requiring IV pain med to control? There is no evidence of partial bowel obstruction. This has been on-going for 7 months, I do not otherwise appear ill, routine labwork has all been within normal limits. May I ask what diagnostic exam you may recommend given the symptoms I describe? I can sense the frustration from my physician as I doubt this is skeletal, yet these symptoms persist. Thank you for your time.