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What Causes Upper Abdominal Pain In Connection Between Front And Back?

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Posted on Tue, 13 May 2014
Question: 39yo Male. Pretty healthy and fairly active. Quit smoking 17 years ago cold XXXXXXX (my daughter was about to be born). Have since smoked "other things"....well, one specific thing to be certain. Drink on occasion, but not a heavy every day drinker. For the past few months, I have been trying to get to the bottom of what has been ailing me. First I thought that I had colon cancer, which made for a very stressful December when 2 out of 3 occult blood tests were positive for blood. After the colonoscopy result came back as normal, I was very relieved and thought I was out of the woods. But around that same time I started feeling dizzy every day, as well as a slight tremor in my hands. I would wake up feeling like I had a couple of beers and this feeling would last all day. The shakiness reminds me of when my blood sugar would be low. I am not diabetic, but it has happened once or twice in my life. Stress definitely makes this worse. Looking down and then up quickly also exacerbates it. I thought that this symptom was probably a "post traumatic" side-effect from all of the stress I put myself through thinking I was going to die for a month straight. So began the hunt for why I was dizzy/shaky all the time. I had my brain scanned which was ordered by my neurologist. That came back OK. Vertigo tests (VNG) did not show signs of vertigo. Then I I thought there was Cancer in my femur because of deep pain I was feeling there. Yes, I might be a hypochondriac. Since about mid February, I noticed that I had a dull ache in the left side of my back, about half way up. At that time I started reading about this complaint online (bad idea) and started to panic because of some similarities in the whole catalog of symptoms I was experiencing at the time. I noticed that my stools were lighter than normal, and tended to float more often than not. I would say my stools were roughly the same color as peanut butter....somewhere between yellow and brown....almost an orange/brown. The consistency of the stools was never that of diarrhea, usually well-formed....but soft. I would notice the smell as rather nasty as well. When I would flush, the stool would disintegrate into a cloud of fecal matter before exiting....like a puff of brown smoke. I started to look more closely at my stools in the toilet and noticed that there is a clear film of what looks like oil on the surface. My fears were growing at that point. Also, I noticed upper left/center abdominal discomfort in addition to the dull back ache. I went back to the same Gastro that handled my colonoscopy back in December, and advised him of my concerns. He ordered another round of blood work (previously also done in November). He ordered a CBC, Metabolic panel, Amylase, Lipase, Hepatic panel, CA-19, and a few others. All bloodwork came back normal. At that time he also ordered a Fecal Fat test (Quantitative - 1 sample) and it came back as "increased", which basically means...."Yes, there's fat in your stool". He ordered a "Pancreatic protocal CT scan with and without contrast". This was normal. Around this time I started to develop a weird metallic taste in my mouth. Worse after eating. Concerned about malabsorption, he ordered a blood test to check for fat soluble vitamins A, E, D, B12....I don't think he checked K. Anyway, everything was ok except for vitamin D which was a little below the low-level....25.3. (It has been a long winter here in the northeast and perhaps that is why my level is a tad low). The doctor felt maybe it would be a good idea to perform an endoscopy to check out my upper end (since the lower end was already checked). He found a mild case of "duodenitis" and prescribed Nexium. Since a couple of weeks ago, I have noticed the upper abdominal pain even more and feel the connection between my front and back as almost one in the same. Pain sometimes goes around the side too, and it seems like my left shoulder is now involved. A couple of weeks ago I noticed little lumps on the right side behind my jaw and under my ear, no larger than a pencil eraser. They are pretty hard / painless lumps. So my concern is, is it possible for the CT scan to miss something? My impression is that if you have pain that is coming from something sinister within your pancreas, it would certainly be large enough to be detected on a CT scan designed to look at the pancreas. I feel a lot more fatigued over the past couple of weeks. I have been experiencing fatigue for a while now, but it seems to be worse. Coupled with the dizziness it is unpleasant to say the least. All symptoms still exist. The Bad: • Lighter stools (sometimes they float and other times they sink all the way down) • Persistent oil film on surface. It's clear and sometimes hard to see. It's not like a bottle of Wesson was dumped in there, but its definitely an oil slick. • Pain in upper left abdomen / side / back / shoulder. Seems worse lately and definitely worse after eating, usually a 1/2 hour or so after....not sure if fat content has anything to do with the pain. It might. • Indigestion after meals, sometimes hours afterwards- burping, hiccups, gas... • Metallic taste (I have no idea why, but have read some pretty alarming causes for this) • Dizzy / buzzed feeling • Tired a lot • Serious anxiety • Depression • Obsessed about what is wrong with me. Can't think of anything else. The good: • No loss in weight • No loss in appetite • No nausea • No jaundice • so far lab results have been favorable. • Dr is confident it is not cancer. I wish I was confident too.... Just wanted to get some thoughts on what I might be looking forward to.....
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Answered by Dr. Ashish Verma (54 minutes later)
Brief Answer: can be pancreatitis with gastritis due to alcohol Detailed Answer: Hi, Thanks for writing to HCM. At your age cancer is a very uncommon and we usually dont think of it. Also your ct scan, endoscopy and colonoscopy are all normal, so no chance of that. Now, as per your history and symptoms the first thing that comes to my mind is pancreatitis, given you are having pain in the front and that is going to the back too along the side and even the shoulder. This is classical presentation in pancreatitis. The things that add more to it are your malabsorption and history of chronic alcohol intake. The things against it are your normal lipase and ct scan. But these tests are not 100% sensitive and specific. Other possibilities are gastritis and bowel infection and worm infestation. The symptoms of gas and burping are due to gastritis only, that is for sure. And your occult blood in stools can be due to that. So in my opinion you are having both gastritis and pancreatitis. And the first thing that you need to do is to cure that is to stop your alcohol intake completely. I guess that you had tried to leave this habbit recently following your illness when you got your colonoscopy done. I am saying this because, those tremors, dizziness and that feeling of hangover are all signs of alcohol withdrawal. And this goes on to show how much addicted you are to it. So you can guess how much damage to your pancreas has already been done by it. And no matter what treatment you take, unless you completely stop it, nothing is going to improve. And you need to stop smoking "all the other things" as well as these both act synergistically to cause more damage. Hope i have been helpful. Regards Dr. Ashish Verma
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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Follow up: Dr. Ashish Verma (54 minutes later)
Thank you for your response. Please understand though, that I am NOT, nor have I ever been, a chronic drinker of alcohol. When I was drinking, I would have the occasional beer or two on weekends, but rarely anything more than that. My alcohol consumption is nearly zero since December. I know people who are heavy drinkers, every day drinkers, I am not in that category. I never was. A normal CT scan eliminates clinical suspicion of cancer entirely? Isn't it possible to miss cancer on a CT scan? Isn't pancreatitis much more painful? I would rate my pain as a 2 out of 10, at most....it would never wake me from sleep. My dr's keep saying that "according to your lab results and tests cancer is not even on the radar", but everything I read says that "lipase and amylase levels are typically normal in pancreatic cancer", "cancer can be missed on CT scan", in addition to the other symptoms I have, especially the steatorrhea.
doctor
Answered by Dr. Ashish Verma (7 hours later)
Brief Answer: its not cancer for sure Detailed Answer: Hi, One thing you need to take out of your mind completely is that you are having cancer. Its not. As told earlier, with a normal ct, endoscopy and colonoscopy, there is absolutely no chance of cancer. Second, if your pain is very less then it goes more in favour of peptic ulcer disease (the duodenitis as shown on uyour endoscopy). Then you need to continue the nexium, take it twice a day for two weeks, then you can reduce it to once daily. In addition, avoid tea, coffee, soda drinks and spicy foods, as these all increase the gastric acid production. Also deworm yourself, as that is also a possibility. Its just one tablet to be taken in the night, and easily available at the chemist. Try these all, and let me know the response. And, no more bear and smoking till this time. Regards Dr. Ashish Verma
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Above answer was peer-reviewed by : Dr. Raju A.T
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Dr. Ashish Verma

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What Causes Upper Abdominal Pain In Connection Between Front And Back?

Brief Answer: can be pancreatitis with gastritis due to alcohol Detailed Answer: Hi, Thanks for writing to HCM. At your age cancer is a very uncommon and we usually dont think of it. Also your ct scan, endoscopy and colonoscopy are all normal, so no chance of that. Now, as per your history and symptoms the first thing that comes to my mind is pancreatitis, given you are having pain in the front and that is going to the back too along the side and even the shoulder. This is classical presentation in pancreatitis. The things that add more to it are your malabsorption and history of chronic alcohol intake. The things against it are your normal lipase and ct scan. But these tests are not 100% sensitive and specific. Other possibilities are gastritis and bowel infection and worm infestation. The symptoms of gas and burping are due to gastritis only, that is for sure. And your occult blood in stools can be due to that. So in my opinion you are having both gastritis and pancreatitis. And the first thing that you need to do is to cure that is to stop your alcohol intake completely. I guess that you had tried to leave this habbit recently following your illness when you got your colonoscopy done. I am saying this because, those tremors, dizziness and that feeling of hangover are all signs of alcohol withdrawal. And this goes on to show how much addicted you are to it. So you can guess how much damage to your pancreas has already been done by it. And no matter what treatment you take, unless you completely stop it, nothing is going to improve. And you need to stop smoking "all the other things" as well as these both act synergistically to cause more damage. Hope i have been helpful. Regards Dr. Ashish Verma