Discussions By Condition: I cannot get a diagnosis.

Right upper abdominal pain

Posted In: I cannot get a diagnosis. 13 Replies
  • Posted By: Anonymous
  • August 27, 2009
  • 03:26 AM

My boyfriend has had pain in the right upper region of his abdomen for almost 3 years now. The first onset of pain was acute, it only lasted about an hour then went away. The pain started occuring more frequently, and always at night. Now it is constant. He describes it as a dull pain that can get so bad we've nearly had to go to the emergency room.
The tests he has had:
CAT scan, multiple CBC's, abdominal x-ray, colonoscopy, STD test, allergy tests, and a biopsy of the colon. The doctors have done tests for Chron's disease, Celiac disease, and most recently say he has IBS. * Is it just me or is IBS a fallback diagnosis that docs use when they can't figure out what is going on? At any rate, the meds they gave him for IBS don't work and his symptoms don't really match.
Along with the pain he has abdominal distention (his belly is slowly getting bigger) and more firm. Recently he has had increased constipation, and allergy symptoms, difficulty breathing with the slightest exertion, nausea, and general malaise.

He takes Aleve daily and that has seemed to control the pain until recently. Now the pain is moving to the right chest/ribs area. It gets worse when he drinks alcohol.
I am an RN and for the life of me cannot figure it out. But that is the doctor's job and they aren't doing anything either. All of this is compounded by the fact that he can no longer get health insurance due to a "previous medical condition". I am fearing some sort of cancer (I am a Hospice nurse, I see it too often), or a rare, untreatable disease.
We just want an answer!

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  • My boyfriend has had pain in the right upper region of his abdomen for almost 3 years now. The first onset of pain was acute, it only lasted about an hour then went away. The pain started occuring more frequently, and always at night. Now it is constant. He describes it as a dull pain that can get so bad we've nearly had to go to the emergency room. The tests he has had:CAT scan, multiple CBC's, abdominal x-ray, colonoscopy, STD test, allergy tests, and a biopsy of the colon. The doctors have done tests for Chron's disease, Celiac disease, and most recently say he has IBS. * Is it just me or is IBS a fallback diagnosis that docs use when they can't figure out what is going on? At any rate, the meds they gave him for IBS don't work and his symptoms don't really match.Along with the pain he has abdominal distention (his belly is slowly getting bigger) and more firm. Recently he has had increased constipation, and allergy symptoms, difficulty breathing with the slightest exertion, nausea, and general malaise. He takes Aleve daily and that has seemed to control the pain until recently. Now the pain is moving to the right chest/ribs area. It gets worse when he drinks alcohol.I am an RN and for the life of me cannot figure it out. But that is the doctor's job and they aren't doing anything either. All of this is compounded by the fact that he can no longer get health insurance due to a "previous medical condition". I am fearing some sort of cancer (I am a Hospice nurse, I see it too often), or a rare, untreatable disease. We just want an answer!Hi,I am replying to your post as a fellow sufferer with simular symptoms, they may or may not be caused by the same illness, so please follow up with your GP.I would be looking to the liver as many of the symptoms could be related to that. Things that stick out are the location of the pain, the type of pain, nausea but very characteristic of liver disease abdominal distension.One thing you could try is to find out if this is in fact fluid in his stomach area, pop him on something like the kitchen table, this is the correct hight, and with your three middle fingers work you way around his stomach area, make sure he is relaxed fist. His stomach should feel soft all over, any hard swelling is most likely fluid.OK has he had a liver scan in the last couple of months, start with an US, they will pick up most things, at least you could then rule out a mass. Often with liver problems you get other gastro problems nausea, gerd, acid reflux, does he suffer any of these?You mention that alcohol can make matters worse again common if the liver is diseased, how does it make him worse by the way.LFTs can be normal even if the liver is sick, mine are slightly elevated but not everyone has this.How old is your bf?Ask the Dr if his liver is normal size, sometimes it can swell and cause this pain.You need to rule out any mass first, then you need to rule out infections like hep, and things like Wilson's, then you are left with NASH or cirrhosis.Please let me know what you think as I need help with my illness too,Ian PS NSAIDs are not good for the liver.
    Anonymous 42789 Replies
    • August 27, 2009
    • 11:58 AM
    • 0
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  • I would have to agree that he needs to, if he hasn't yet, stop the NSAID therapy and alcohol use. It does sound like a liver problem. It would be good the know the "prior medical condition" that got him removed from his insurance or any other medical conditions or medications he could be on. Is he overweight?
    Anonymous 42789 Replies
    • August 27, 2009
    • 04:01 PM
    • 0
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  • Well, firstly let me clarify that IBS is not used as a "fallback" diagnosis, but rather the sydrome is among what we define as diagnosis of exclusion. It simply means that once the known organic causes have been eliminated, then IBS in this case would be the most likely underlying cause. In particular, the nature and symptoms of Irritable Bowel Syndrome can oftentimes mimic the characteristic signs of certain GI disorders and diseases, so it's important to first rule out the presence of disease. While much research is underway to better determine the nature of IBS, it is basically a dysregulation of water reuptake at the level of the colon, but can produce symptoms throughout the GI tract. It presently exists as more of a functional disorder, meaning that the symptoms are most often encountered in the presence of psychogenic factors relating to stress, anxiety or depression. This is not to suggest that the actual ailment is "all in the patient's head" so to speak, but rather that such factors can either precipitate or exacerbate the nature of the syndrome. Therefore, based upon the array of diagostic studies mentioned, a likely candidate could be IBS. Due to persistent pain specifically in the upper right abdomen, however, it is quite likely that he could be suffering from duodenal stasis and while I've been throttled several times by the younger medical community for use of such an "archaic" term, it literally represents a type of dysfunction in the relative performance of the duodenum as a consequence of gastric dilation that produces a sort of negative pressure, resulting in abdominal distension. Pain in the upper right quadrant is a frequent complaint.The symptoms have characterized by many names, including dyspepsia for lack of a more targeted diagnosis. Duodenal stasis itself, is a rather general term as well. Relief is often gained by eructation, or belching, which provides a rather rapid but temporary reduction in discomfort. Patients sometimes have difficulty being able to belch and experience a sort of colicky discomfort. The cause is thought to be related to psychogenic factors, thus resulting in consistent negative test results for certain diseases and disorders which produce similar symptoms. The additional fact that the pain has been persistent X3 years would tend to also strongly argue against an organic disease or disorder, which generally grow worse with time with no remission. This is particularly true regarding oncological concerns. Cancer would really be last on the list due to the circumstances. The difficulty breathing is not likely due to respiratory compromise of any kind, but rather consistent pressure against the diaphragm from the abdominal distension which makes most patients feel as though they can never draw a deep or inspirational breath. Patients complain of feeling winded even in the absence of exertion. Also note that the symptoms of mild nausea, fatigue and rhinitis all are regularly manifested in persons suffering from anxiety or stress. My suggestion would be to discuss some gastric emptying and motility studies with a gasteroenterologist. Again, based upon your description and the patterns being demonstrated, I would suspect duodenal stasis to be the underlying cause. Best regards, J Cottle, MD
    JCottleMD 580 Replies
    • August 27, 2009
    • 04:14 PM
    • 0
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  • My boyfriend has had pain in the right upper region of his abdomen for almost 3 years now. The first onset of pain was acute, it only lasted about an hour then went away. The pain started occuring more frequently, and always at night. Now it is constant. He describes it as a dull pain that can get so bad we've nearly had to go to the emergency room. The tests he has had:CAT scan, multiple CBC's, abdominal x-ray, colonoscopy, STD test, allergy tests, and a biopsy of the colon. The doctors have done tests for Chron's disease, Celiac disease, and most recently say he has IBS. * Is it just me or is IBS a fallback diagnosis that docs use when they can't figure out what is going on? At any rate, the meds they gave him for IBS don't work and his symptoms don't really match.Along with the pain he has abdominal distention (his belly is slowly getting bigger) and more firm. Recently he has had increased constipation, and allergy symptoms, difficulty breathing with the slightest exertion, nausea, and general malaise. He takes Aleve daily and that has seemed to control the pain until recently. Now the pain is moving to the right chest/ribs area. It gets worse when he drinks alcohol.I am an RN and for the life of me cannot figure it out. But that is the doctor's job and they aren't doing anything either. All of this is compounded by the fact that he can no longer get health insurance due to a "previous medical condition". I am fearing some sort of cancer (I am a Hospice nurse, I see it too often), or a rare, untreatable disease. We just want an answer!Dear Friend, This problem is a simple case of pinched nerve that is aggrevated sometimes during the sleep when toss and roll around. Hippocrates told everyone to check the back first. The most likely place of pinch is around T7 thru T9. I can troubleshoot the problem in 10 to 15 minutes. Please read my other postings. Also read this link...http://forums.wrongdiagnosis.com/showthread.php?p=193133#post193133Best of luck,Garla Arjuna.PArjuna85210@yahoo.com
    PArjuna 43 Replies
    • August 27, 2009
    • 07:26 PM
    • 0
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  • I thank you all for your responses. In seeing all the answers, all the different answers, it makes me think: no wonder he hasn't gotten a diagnosis! The body really is an amazing and complicated machine, if you will, and so many things can go wrong at the same time. I had written a good long response to Ian's comment, about how I had suspected liver disease in the beginning, but it got erased somehow. My boyfriend became jaundiced when the pain got really bad, which to me said liver involvement, but it went away within a week and he hasn't been yellow in a couple of years. All the CAT scans he had never showed liver enlargement either, although when I palpate his abdomen it is very firm, like with ascites. He no longer drinks as it causes too much pain. He takes Aleve because it is the only thing that works to control the pain, even narcotics don't work (and they won't prescribe him any without a diagnosis anyway). I know NSAIDS are bad for the liver, and everything else if taken for a long time, but that is one of the reasons I want to figure out what's wrong! Because sooner or later he is going to end up with an ulcer on top of everything else. I appreciate the response from Dr. Cottle, you gave some helpful information, and I apologize if I offended you by saying IBS is a fallback diagnosis. But it does seem to be used in so many cases, although I can see why. I do wonder though, wouldn't the colonoscopy have shown something to do with the duodenum? He did have a biopsy of the cecum (I believe, it has been so long though), and it came back negative for anything abnormal. He has not had any symptoms associated with acid refulx, other than the nausea. Your points about cancer are very well received indeed. His condition has not worsened, but has changed. I agree that a tumor would have debilitated him by now. For the longest time I would have agreed that this was caused by stress or depression or was psychogenic or psychosomatic in some way, but the fact that it has been going on for so long and that life situations have changed dramatically, I don't think that is it.I don't think it is a matter of a pinched nerve, as I have seen nerve pain in many patients and that is not what he is presenting with. Also the other symptoms he has do not match with nerve pain. And, I forgot to mention in the original post, and this may be important, that they found he has gallstones when they did the x-ray. Would this be the cause of all the problems? He went to the Kaiser doc to ask to get his gallbladder removed (he was that fed up with the pain) but they said that wasn't the problem, this is when he was diagnosed with IBS. The previous medical condition that keeps getting him denied is IBS. He was diagnosed when he had insurance, and has since lost his job and has been denied for insurance since. He is not overweight, he is on the thin side (other than his belly). The only med he takes is Aleve, he never took anything before the pain started. He is not into drugs and alcohol, is a vegetarian, exercises on a semi-regular basis. He had asthma and allergies when he was a kid, but they have recently come back. He has no family history of liver disease, his grandfather had prostate cancer and that is all we know of medical history (his mom was adopted, but she is pretty healthy).
    Anonymous 42789 Replies
    • August 28, 2009
    • 00:03 AM
    • 0
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  • I thank you all for your responses. In seeing all the answers, all the different answers, it makes me think: no wonder he hasn't gotten a diagnosis! The body really is an amazing and complicated machine, if you will, and so many things can go wrong at the same time. I had written a good long response to Ian's comment, about how I had suspected liver disease in the beginning, but it got erased somehow. My boyfriend became jaundiced when the pain got really bad, which to me said liver involvement, but it went away within a week and he hasn't been yellow in a couple of years. All the CAT scans he had never showed liver enlargement either, although when I palpate his abdomen it is very firm, like with ascites. He no longer drinks as it causes too much pain. He takes Aleve because it is the only thing that works to control the pain, even narcotics don't work (and they won't prescribe him any without a diagnosis anyway). I know NSAIDS are bad for the liver, and everything else if taken for a long time, but that is one of the reasons I want to figure out what's wrong! Because sooner or later he is going to end up with an ulcer on top of everything else. I appreciate the response from Dr. Cottle, you gave some helpful information, and I apologize if I offended you by saying IBS is a fallback diagnosis. But it does seem to be used in so many cases, although I can see why. I do wonder though, wouldn't the colonoscopy have shown something to do with the duodenum? He did have a biopsy of the cecum (I believe, it has been so long though), and it came back negative for anything abnormal. He has not had any symptoms associated with acid refulx, other than the nausea. Your points about cancer are very well received indeed. His condition has not worsened, but has changed. I agree that a tumor would have debilitated him by now. For the longest time I would have agreed that this was caused by stress or depression or was psychogenic or psychosomatic in some way, but the fact that it has been going on for so long and that life situations have changed dramatically, I don't think that is it.I don't think it is a matter of a pinched nerve, as I have seen nerve pain in many patients and that is not what he is presenting with. Also the other symptoms he has do not match with nerve pain. And, I forgot to mention in the original post, and this may be important, that they found he has gallstones when they did the x-ray. Would this be the cause of all the problems? He went to the Kaiser doc to ask to get his gallbladder removed (he was that fed up with the pain) but they said that wasn't the problem, this is when he was diagnosed with IBS. The previous medical condition that keeps getting him denied is IBS. He was diagnosed when he had insurance, and has since lost his job and has been denied for insurance since. He is not overweight, he is on the thin side (other than his belly). The only med he takes is Aleve, he never took anything before the pain started. He is not into drugs and alcohol, is a vegetarian, exercises on a semi-regular basis. He had asthma and allergies when he was a kid, but they have recently come back. He has no family history of liver disease, his grandfather had prostate cancer and that is all we know of medical history (his mom was adopted, but she is pretty healthy).I still think it is pinched nerves causing all these problems. If you live in Phoenix, AZ area, I can troubleshoot the problem free in 20 minutes.Good luck,Garla ArjunaPArjuna85210@yahoo.com
    PArjuna 43 Replies
    • August 28, 2009
    • 00:22 AM
    • 0
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  • I am blown away by your bf's problem as I have been going thru similar symptoms with no answers as well. I feel so disappointed with the medical field.
    Anonymous 42789 Replies
    • August 28, 2009
    • 02:53 AM
    • 0
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  • My boyfriend has had pain in the right upper region of his abdomen for almost 3 years now. The first onset of pain was acute, it only lasted about an hour then went away. The pain started occuring more frequently, and always at night. Now it is constant. He describes it as a dull pain that can get so bad we've nearly had to go to the emergency room. The tests he has had:CAT scan, multiple CBC's, abdominal x-ray, colonoscopy, STD test, allergy tests, and a biopsy of the colon. The doctors have done tests for Chron's disease, Celiac disease, and most recently say he has IBS. * Is it just me or is IBS a fallback diagnosis that docs use when they can't figure out what is going on? At any rate, the meds they gave him for IBS don't work and his symptoms don't really match.Along with the pain he has abdominal distention (his belly is slowly getting bigger) and more firm. Recently he has had increased constipation, and allergy symptoms, difficulty breathing with the slightest exertion, nausea, and general malaise. He takes Aleve daily and that has seemed to control the pain until recently. Now the pain is moving to the right chest/ribs area. It gets worse when he drinks alcohol.I am an RN and for the life of me cannot figure it out. But that is the doctor's job and they aren't doing anything either. All of this is compounded by the fact that he can no longer get health insurance due to a "previous medical condition". I am fearing some sort of cancer (I am a Hospice nurse, I see it too often), or a rare, untreatable disease. We just want an answer!Hi again,It is nice to see that you are getting response to your post. What a pain that your original post about you suspecting liver problems got lost in the system, don't you hate that when than happens. If you get the time could you post how you changed your mind about the liver being tha cause, I am trying to rule out my liver and your bf symptoms are much the same as mine. I have even mailed my Hepatologist this afternoon with the same concerns as your bf is showing it will be interesting to see what he has to say on the matter, he is a well respected liver doctor at a liver transplant centre here in the UK.The firm stomach to me sounds like fluid but this could normally be seen on an US, how recent has one been done, has it been done while the stomach is swollen? Also I can not tolerate alcohol any more, again this sounds like a liver problem.Do you have a good GI doc you could see? We are lucky in one way in the UK as treatment is free, but we are far behind the USA in medical technology and it can take forever to get referred to a special doctor,Ian
    Anonymous 42789 Replies
    • August 28, 2009
    • 01:01 PM
    • 0
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  • Okay, realize that a colonoscopy cannot evaluate function, but merely anatomical factors relevant to his symptoms. As for the calculi identified on imaging studies, realize that stones are asymptomatic in most cases and if symptoms or diagnostic studies are inconsistent with inflammation or dysfunction, then it's unlikely to be contributory. I am somewhat confused by your statement that his life conditions having changed so dramatically could not represent a causative factor. It is dramatic changes indeed that influence such symptoms in many instances and while I naturally have not evaluated this young man directly, I would suggest that some consideration be given to whether psychogenic factors may be playing a role. With all of the tests that have already been conducted, I'm constrained to point out that little else can be responsible which hasn't been detected. I wish you the best in determining the ultimate cause. Best regards, J Cottle, MD
    JCottleMD 580 Replies
    • August 28, 2009
    • 08:28 PM
    • 0
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  • Hi again,It is nice to see that you are getting response to your post. What a pain that your original post about you suspecting liver problems got lost in the system, don't you hate that when than happens. If you get the time could you post how you changed your mind about the liver being tha cause, I am trying to rule out my liver and your bf symptoms are much the same as mine. I have even mailed my Hepatologist this afternoon with the same concerns as your bf is showing it will be interesting to see what he has to say on the matter, he is a well respected liver doctor at a liver transplant centre here in the UK.The firm stomach to me sounds like fluid but this could normally be seen on an US, how recent has one been done, has it been done while the stomach is swollen? Also I can not tolerate alcohol any more, again this sounds like a liver problem.Do you have a good GI doc you could see? We are lucky in one way in the UK as treatment is free, but we are far behind the USA in medical technology and it can take forever to get referred to a special doctor,IanThe thing that made me give up on the liver diagnosis is that the imaging studies the GI docs did did not show any signs of liver dysfunction. Also, his jaundice disappeared as suddenly as it came on, and hasn't returned for 2 years. He has not had an ultrasound, that is the last thing the doctors wanted him to do but when he was going to get one done he lost his health insurance. No health insurance in the US means no health care. I understand our medical technology may be slightly better than the UK, but at least you can see a doctor when you are sick and not have to worry about losing your entire life savings (literally) for doing so. The GI doc that he had been seeing was really great, but he could not find anything wrong. At least he was honest about it. I guess there really isn't anything to be done until he has insurance again, but it gives us some ideas of what to ask for when he does see the doc. I really think that he has fluid in his belly as well, I've seen patients with ascities many times, mainly due to liver dysfunction, and it seems similar to me. Also, his pain is pretty pinpoint. He can point it out directly, it doesn't diffuse to different areas as sometimes can be the case with liver problems. It sounds like your problems are related to your liver, especially with the LFTs being elevated. Does the doctor not say that that is what is going on with you? Have you had all the tests done? Do you have liver disease in your family? Thank you for your reply! It gives me some ideas as to what is going on.
    Anonymous 42789 Replies
    • August 29, 2009
    • 04:36 AM
    • 0
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  • Has he had his liver enzymes checked?
    kermworm 81 Replies
    • August 29, 2009
    • 05:01 PM
    • 0
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  • My boyfriend has had pain in the right upper region of his abdomen for almost 3 years now. The first onset of pain was acute, it only lasted about an hour then went away. The pain started occuring more frequently, and always at night. Now it is constant. He describes it as a dull pain that can get so bad we've nearly had to go to the emergency room. The tests he has had:CAT scan, multiple CBC's, abdominal x-ray, colonoscopy, STD test, allergy tests, and a biopsy of the colon. The doctors have done tests for Chron's disease, Celiac disease, and most recently say he has IBS. * Is it just me or is IBS a fallback diagnosis that docs use when they can't figure out what is going on? At any rate, the meds they gave him for IBS don't work and his symptoms don't really match.Along with the pain he has abdominal distention (his belly is slowly getting bigger) and more firm. Recently he has had increased constipation, and allergy symptoms, difficulty breathing with the slightest exertion, nausea, and general malaise. He takes Aleve daily and that has seemed to control the pain until recently. Now the pain is moving to the right chest/ribs area. It gets worse when he drinks alcohol.I am an RN and for the life of me cannot figure it out. But that is the doctor's job and they aren't doing anything either. All of this is compounded by the fact that he can no longer get health insurance due to a "previous medical condition". I am fearing some sort of cancer (I am a Hospice nurse, I see it too often), or a rare, untreatable disease. We just want an answer!
    Anonymous 42789 Replies
    • August 30, 2009
    • 11:36 AM
    • 0
    Flag this Response
  • My boyfriend has had pain in the right upper region of his abdomen for almost 3 years now. The first onset of pain was acute, it only lasted about an hour then went away. The pain started occuring more frequently, and always at night. Now it is constant. He describes it as a dull pain that can get so bad we've nearly had to go to the emergency room. The tests he has had:CAT scan, multiple CBC's, abdominal x-ray, colonoscopy, STD test, allergy tests, and a biopsy of the colon. The doctors have done tests for Chron's disease, Celiac disease, and most recently say he has IBS. * Is it just me or is IBS a fallback diagnosis that docs use when they can't figure out what is going on? At any rate, the meds they gave him for IBS don't work and his symptoms don't really match.Along with the pain he has abdominal distention (his belly is slowly getting bigger) and more firm. Recently he has had increased constipation, and allergy symptoms, difficulty breathing with the slightest exertion, nausea, and general malaise. He takes Aleve daily and that has seemed to control the pain until recently. Now the pain is moving to the right chest/ribs area. It gets worse when he drinks alcohol.I am an RN and for the life of me cannot figure it out. But that is the doctor's job and they aren't doing anything either. All of this is compounded by the fact that he can no longer get health insurance due to a "previous medical condition". I am fearing some sort of cancer (I am a Hospice nurse, I see it too often), or a rare, untreatable disease. We just want an answer!Has he had his gallbladder checked? Any problems with fatty foods? The symptoms definitely point to that, especially with the jaundice you mentioned and the symptoms occuring at night. If he has gallstones or inflammation in his gallbladder, that could cause the bile ducts to get blocked and cause Pancreatis and or Liver problems as well. I would have them do an ultrasound to check at least...and if he can, a HIDA scan would be even better to test the functionality of the GB. I've been having GB issues for over a year my doctors just figured it out. Symptoms are similar to what I'm experiencing, URQ pain, nausea, constipation, fatigue and basically feeling like I have the flu on and off.
    Anonymous 42789 Replies
    • September 12, 2009
    • 00:59 AM
    • 0
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