Mysterious severe right upper quadrant abdominal pain........please help
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Mysterious severe right upper quadrant abdominal pain........please help
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I know of a 29 yo caucasian female of otherwise good health who developed acute,severe onset of right upper abdominal pain always localized to right under ribs as if gall bladder and occasional s
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Mysterious severe right upper quadrant abdominal pain........please help
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Mysterious severe right upper quadrant abdominal pain........please help
posted at 21/6/2012 5:06 AM BST
on bmj.com
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Posts: 2
First: 21/6/2012 Last: 22/6/2012 |
I know of a 29 yo caucasian female of otherwise good health who developed acute,severe onset of right upper abdominal pain always localized to right under ribs as if gall bladder and occasional severe pain in back , most of the time nausea, vomiting occasionally.This individual has had this persistant pain for over two months now. Since her first visit to emergency dept. she has had an ultrasound,endoscopy, CAT scan, Hida Scan, MRI, blood work up with no indication that gallbladder,pancreas, stomach,intestine,kidney,liver is functioning abnormally. Finally a surgeon, is refering her to a gastro enterologist with much hesitation. He really was going to just abandon the whole problem and suggested to just manage the pain...that was his solution. To just have her continue on taking morphine....not even wanting to pursue the challenge of finding a solution. She continues to suffer every minute of every day.... Does anyone out there know of a solution?? She desperately needs medical attention |
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Re: Mysterious severe right upper quadrant abdominal pain........please help
posted at 21/6/2012 12:07 PM BST
on bmj.com
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Posts: 339
First: 17/12/2011 Last: 15/5/2013 |
Is pain constant or does it ever go? Is there any association with digestion? Can She cope without opiate analgesia, opiates without diagnosis a problem. Lots of pains are unexplained. Any pain relief technique that does not involve risk of addiction. I presume not pregnant no alcohol or drug problems and blood tests, inflamatory markers ,amylase etc are normal. I presume no obvious psychological stresses other than 2 months constant pain. |
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Re: Mysterious severe right upper quadrant abdominal pain........please help
posted at 21/6/2012 12:46 PM BST
on bmj.com
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Posts: 2034
First: 12/3/2010 Last: 17/5/2013 |
I think she desperately needs a proper clinician, not a special investigation pusher, someone to examine her thoroughly with eyes, hands and ears. I suspect that this is abdominal wall pain, not visceral. Pain front to back in dermatome distribution? Tenderness or 'just' pain? Where? Investigate neurological cause, or other local irritant cause to nerve root or intercostal nerve. Herpes infection - shingles? Cord lesion? Asking an anaesthetist or pain specialist to block the intercostals one by one could localise it to the nerve. A selective block of spinal nerve roots by thoracic epidural could show if those are involved - again the same specialist can help. See: http://www.aafp.org/afp/2001/0801/p431.html for extensive list of possible diagnoses. See also Carnett's Sign: http://en.wikipedia.org/wiki/Carnett's_sign John |
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Re: Mysterious severe right upper quadrant abdominal pain........please help
posted at 21/6/2012 1:30 PM BST
on bmj.com
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Posts: 11
First: 17/6/2012 Last: 21/6/2012 |
Given the symtom picture and the clinical findings the case seems ideally suited for homeopathy. Which part of the world is the patient located? I could suggest good practitioner. |
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Re: Mysterious severe right upper quadrant abdominal pain........please help
posted at 21/6/2012 9:30 PM BST
on bmj.com
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Posts: 3031
First: 27/3/2012 Last: 11/5/2013 |
The strange thing, as I wonder, why an ECG was not done? If the ECG does not reveal signs of inferior wall MI or unstable angina, the only other alternative diagnosis would be psychosomatic manifestation. |
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Re: Mysterious severe right upper quadrant abdominal pain........please help
posted at 22/6/2012 3:51 AM BST
on bmj.com
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Posts: 2
First: 21/6/2012 Last: 22/6/2012 |
The psychologist that is seeing her does not think the pain is of psychosomatic origin. |
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Re: Mysterious severe right upper quadrant abdominal pain........please help
posted at 22/6/2012 11:06 AM BST
on bmj.com
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Posts: 339
First: 17/12/2011 Last: 15/5/2013 |
Avoiding all fatty foods for a few days will do no harm. If it is cholecystitis, and if not allergic to amoxycillin then that might be worth consideration. |
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Re: Mysterious severe right upper quadrant abdominal pain........please help
posted at 17/7/2012 12:33 AM BST
on bmj.com
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Posts: 1
First: 17/7/2012 Last: 17/7/2012 |
I experienced severe UQ abdo pain. GP wasn't convinced it related to gall bladder, and organised an internal scan of my ovaries. Diagnosis was confirmed to be multiple left sided ovarian cysts and endometriosis. Ironically the acute pain was 'referred pain' transferred up the? Sheath (a stretch of muscle). I underwent immediate Surgery to remove the left ovary and tube and to clean up the endometriosis. My god the relief was immediate! |
Forums » Open clinical » General clinical » Mysterious severe right upper quadrant abdominal pain........please help
