Discussions By Condition: I cannot get a diagnosis.

Is this abdominal distention? (PICS inside)

Posted In: I cannot get a diagnosis. 9 Replies
  • Posted By: noonej
  • August 22, 2007
  • 07:48 PM

Hi, everyone!
Thanks so much for reading this thread. I need your help: I want to know if you think I have abdominal distention from the photos below.

http://s223.photobucket.com/albums/dd87/noonej/

It's VERY, VERY important that you are honest if you think I might have it. I'm a cross country runner (running about 50 miles per week), eat very nutritiously, and know I'm not fat, so in no way would you be hurting my body image by telling me. I just need a straight answer. For your reference, I'm not pushing out on my stomach. I don't walk around this way, but this is how it is when I'm not sucking it in. In one of the photos I'm pinching myself to show how much fat I can tug at. It's basically to show that I don't have a weight problem so you can rule that out. Also, I don't have a gas problem, so it's not just bloating. This photo shows how my stomach appears during a typical day. It often sticks out much more (especially at the end of the day), but I wanted to show what is most typical.

If you'd like some background about why I'm posting here then please continue reading. Be warned, though, I've attempted to make the Cliff Notes version of my case, but it's very complex and reads a bit long.

I'm a 24 year old from Oregon. I've been seriously ill for the past four years, but extensive testing has yet to yield a cause. My main problem is extreme difficulty breathing and it appears to be very closely associated with my stomach distention (for the sake of ease, I'm just going to assume that I have it for the rest of this post); the worse the distention, the harder it is to breathe. Among other things, the breathing difficulties have led to chronic fatigue, chronic insomnia, sunken eyes, depression, complete loss of hunger, and (most notably) major decreases in cognitive functioning. To elaborate on the latter for a second, I used to be quite intelligent (accomplished violinist and pianist, basically straight A's, etc.) but since becoming ill, I am hardly functional. Simple tasks have become difficult or impossible and often consume entire days. My enjoyment of books, music, and life is almost non-existent because I simply can't follow them and, therefore, can't grasp their meaning. My retention of knowledge has almost ceased, which is why I've hardly been able to take classes.

I very strongly believe the root problem of my illness is the stomach distention and feel that it's the key to a proper diagnosis. However, it's hardly been looked at. The reason why is because the first two years of my illness (which is when I had most of the testing done) were clouded by acute anorexia. It was initially believed that all I needed to do to feel better was put the weight back on. This turned out not to be true. As I mentioned earlier, I have completely lost my appetite. Actually, food and water often worsen symptoms. I have a constant pressure on my abdomen and it feels like trying to stuff something into an already overfull container. So, in some ways I felt worse after gaining the weight. Also, this was the first appearance of the stomach distention. It was MUCH worse than in these photos (10 extra pounds or so) and I had less fat, so I had this enormous belly with a six-pack on it.

When the weight gain didn't really help, I ended up having a bunch of tests conducted to see if something else was ailing me. However, during this time I relapsed on my eating disorder (recovering from anorexia is made quite a bit harder when food is actually making you feel worse) and unfortunately most of the tests ended up focusing on symptoms caused by the anorexia.

That was two years ago. It was decided then that I had psychiatric problems and I've been receiving meds and intensive psychotherapy for the past two years with zero improvement. Actually, in the last few months things have worsened and it was discovered that I have adrenal fatigue (which can result from physical or psychiatric illness) as well as being near hyponatremic, which is where the body's sodium levels are very low with respect to your fluid levels. After getting my sodium back in a healthy range, my abdominal distention flared up again, my insomnia worsened, my mood went down, and my mental functioning declined. It made me begin to think that something HAD been missed in the tests two years ago and that I should have the stomach distention looked at.

I want to have this investigated but there's two problems:
1. Doctors are reluctant to order more tests when I've already had so many done.
2. I believe people are afraid to tell me when they think I have distention, because of my former eating disorder.

For the record, I'm completely recovered from anorexia, have been for two years, and consider myself at zero risk of relapse. Also, while I did have a lot of testing done, it was really all over the map symptom-wise. As you can imagine, being tested for a big stomach was really the last thing on doctor's minds during this time. I believe the stomach distention was still present but was masked by the anoreixa. I also believe it's largely responsible for the anorexia as that's a common symptom of abdominal distention and goes hand in hand with the complete lack of hunger.

Anyways, like I said it's a long, complicated story. I don't care if I have a psychiatric condition or something related to the stomach distention. I just want to get better and I'm worried about overlooking this because two years of intensive psychiatric treatment have yielded nothing and I can't keep this up forever.

Again, thanks SO much for reading this. Please let me know what you think about the photos and if you think I should have the stomach distention checked out. Don't hesitate to ask if you have questions. :)

John

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9 Replies:

  • Your stomach does look distended. There are so many reasons for that. If it was a disease/disorder, other symptoms would go along iwth it...a puffy belly in and of itself does not a diagnosis make...it could simply be weight gain...which with your history of anorexia is probably seen as a good sign by your doctor(s)...With all the doctors and tests have you not mentioned your concern about the abdominal distention to any of them? If not, then you should at your next appointment and see what they have to say. With regards to psychiatric care, if after two years and meds you are not getting better or stabilized, I strongly urge you to find a new doctor. Best of Luck to you.
    Anonymous 42,789 Replies
    • August 22, 2007
    • 11:43 PM
    • 0
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  • Have you considered being tested for Celiac Disease? Sounds like it might be worth checking it out. Other names 'Gluten Enteropathy', 'Sprue'. Many useful tests, such as 72 hr Fecal Fats, Anti Gliadian Protiens, of course Small Bowel Biopsy done at a reputable medical center.
    Anonymous 42,789 Replies
    • August 23, 2007
    • 06:30 AM
    • 0
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  • AscitesSigns and symptomsMild ascites is hard to notice, but severe ascites leads to abdominal distension. Patients with ascites generally will complain of progressive abdominal heaviness and pressure as well as shortness of breath due to mechanical impingement on the diaphragm.Ascites is detected on physical examination of the abdomen by visible bulging of the flanks in the reclining patient ("flank bulging"), "shifting dullness" (difference in percussion note in the flanks that shifts when the patient is turned on the side) or in massive ascites with a "fluid thrill" or "fluid wave" (tapping or pushing on one side will generate a wave-like effect through the fluid that can be felt in the opposite side of the abdomen).Other signs of ascites may be present due to its underlying etiology. For instance, in portal hypertension (perhaps due to cirrhosis or fibrosis of the liver) patients may also complain of leg swelling, bruising, gynecomastia, hematemesis, or mental changes due to encephalopathy. Those with ascites due to cancer (peritoneal carcinomatosis) may complain of chronic fatigue or weight loss. Those with ascites due to heart failure may also complain of shortness of breath as well as wheezing and exercise intolerance. One of the treatments is sodium restriction, so you would feel better when your sodium levels were low. Look this up. There is a lot of info out there.
    rad-skw 1,605 Replies
    • August 23, 2007
    • 09:26 AM
    • 0
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  • Hi, John. I have had the same type of distension- I am a model and naturally slim, but in a matter of 30 minutes I can go from a normal flat belly to looking about 6 months pregnant. My skin gets very taut and my navel ring sticks out from the pressure. My abdomen is always very hard to the touch and tends to swell a little more on the left side than the right. It is also extremely uncomfortable- difficulty breathing as well as a distinct pulling sensation in my gut. Awful... I sympathize! My GI says it is air and is due to IBS (told me to take Gas-X!) - but I have also read up on Celiac and agree you might want to look into that as well. It is easy to test for- just a blood test called an anti-tissue transglutaminase (tTG-IgA). This screening test is commonly used when an individual is in a risk group for celiac disease, and it is the most sensitive test available. IBS is harder to diagnose and requires eliminating IBD by getting a colonoscopy. Have you noticed that you flare up after eating a particular food? I kept a strict food diary and have learned that I personally cannot eat the following foods or my abdomen swells horribly: dairy/casein, fried foods, egg yolks, raw fruits or veggies, wheat/gluten, anything with small seeds or nuts, any carbonated beverages and chocolate. I would recommend keeping track of what you eat and if it triggers an attack. Doing so has not cured me, but at least my attacks are less frequent. Good luck- I hope you find help for what ails you! www.celiac.comwww.helpforibs.com
    HeatherEve 3 Replies
    • August 23, 2007
    • 03:35 PM
    • 0
    Flag this Response
  • Have you considered being tested for Celiac Disease? Sounds like it might be worth checking it out. Other names 'Gluten Enteropathy', 'Sprue'. Many useful tests, such as 72 hr Fecal Fats, Anti Gliadian Protiens, of course Small Bowel Biopsy done at a reputable medical center.Yes. I've had a food allergy test and also did an elimation diet for three weeks testing for food intolerances of nuts, dairy, and wheat. My doctor and I had high hopes it would be Celiac Disease, but no such luck.I will research the test you mentioned. Thanks.
    noonej 11 Replies
    • August 23, 2007
    • 06:14 PM
    • 0
    Flag this Response
  • AscitesSigns and symptomsMild ascites is hard to notice, but severe ascites leads to abdominal distension. Patients with ascites generally will complain of progressive abdominal heaviness and pressure as well as shortness of breath due to mechanical impingement on the diaphragm.Ascites is detected on physical examination of the abdomen by visible bulging of the flanks in the reclining patient ("flank bulging"), "shifting dullness" (difference in percussion note in the flanks that shifts when the patient is turned on the side) or in massive ascites with a "fluid thrill" or "fluid wave" (tapping or pushing on one side will generate a wave-like effect through the fluid that can be felt in the opposite side of the abdomen).Other signs of ascites may be present due to its underlying etiology. For instance, in portal hypertension (perhaps due to cirrhosis or fibrosis of the liver) patients may also complain of leg swelling, bruising, gynecomastia, hematemesis, or mental changes due to encephalopathy. Those with ascites due to cancer (peritoneal carcinomatosis) may complain of chronic fatigue or weight loss. Those with ascites due to heart failure may also complain of shortness of breath as well as wheezing and exercise intolerance. One of the treatments is sodium restriction, so you would feel better when your sodium levels were low. Look this up. There is a lot of info out there.Hmmmm. Very interesting about treatment with sodium restriction. I think that telling my doctors that my symptoms worsened with sodium was like the nail in the coffin for them taking me seriously, so I'm very glad to hear confirmation that it may be a real possibility.Can you explain what is meant by abdominal dullness exactly? I've searched for the answer, but can't find a decent definition. I found the pic below, but don't know what it's referring to where it's pointing out dullness.http://depts.washington.edu/physdx/images/illusfrnt.gifLast question, would an abdominal ultrasound reveal ascites? I've had this done and nothing turned up, but unfortunately my distention was hardly noticeable at the time. Maybe percussion is a better way to go.Thanks for all the work. I truly appreciate it.
    noonej 11 Replies
    • August 23, 2007
    • 08:17 PM
    • 0
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  • Your stomach does look distended. There are so many reasons for that. If it was a disease/disorder, other symptoms would go along iwth it...a puffy belly in and of itself does not a diagnosis make...it could simply be weight gain...which with your history of anorexia is probably seen as a good sign by your doctor(s)...With all the doctors and tests have you not mentioned your concern about the abdominal distention to any of them? If not, then you should at your next appointment and see what they have to say. With regards to psychiatric care, if after two years and meds you are not getting better or stabilized, I strongly urge you to find a new doctor. Best of Luck to you.First off, thanks so much for taking the time to read my post and responding.To answer your question about if I've had the distention looked at, yes and no. Given that it's my #1 health concern, this may seem weird but I'll explain. I first had it looked at shortly after recovering from anorexia. The doctor agreed that it was present but said my body was just out of whack and would return to normal.The main reason I haven't had it looked at much is because for so much of the testing period things were obfuscated by the symptoms of anorexia. The tests that were conducted were all over the map and basically dealing with the symptoms of anorexia. By the time I'd beaten anorexia, given my body time to recover from it, and realized the correlation between the severity of the distention and the severity of my symptoms, I'd pretty much been labeled a hypochondriac. I had the distention looked at around 8 months later and this time the doctor (a different one) said he didn't see it. What had changed was that at this point I'd realized how to control the distention to a degree (namely through careful water intake). The amount of distention I had at the visit was definitely visible to me (because I'm really familiar with my body shape) but not to the degree where it was totally a clearcut case. Given my history with anorexia, I think he was reluctant to say anything without being 100% certain. I feel that going to the visit with my distention somewhat controlled was a MASSIVE mistake and I largely attribute it to my poor cognitive functioning at the time.That was two years ago. Since then my distention's always been present, but controlled. Controlling it had become second nature to me so I wasn't really aware that I was doing it. I could see it, but had been told so many times that I didn't have it that I came to believe I was just seeing things....sort of. I didn't mention it again until one day I got dehydrated on a long bike ride, ended up drinking a bunch of high-sodium sports drinks, and felt way different the next day. I researched salt deficiencies, found out I was nearly hyponatremic, treated that, and saw all the weird effects the sodium had on my body. That's where I am now and from what everyone's saying, I DEFINITELY think I need to go ahead and have this looked at.Again, thank you everybody for the kindness you've shown in taking the time to read my story and reply. It means so much to me.
    noonej 11 Replies
    • August 23, 2007
    • 09:12 PM
    • 0
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  • Re: shifting dullness. Have you ever looked for a stud in a plaster wall, and heard the difference? Well, Heathereve sounds like her "taut" belly would sound like a drum and sound the same all over. Yours doesn't look that taut. I would show these pix to the docs. If we think it looks funny, there must be some doc out there who agrees. Look up the anatomy of the peritoneum and see if you can figure out where the bulge is. Your abdomen almost looked like severe weight-loss pre plastic surgery photos, but you have no other sagging skin anywhere else, so that can't be it. Though this has been on-going for quite some time, I would suggest a consult (possibly with a liver specialist or a G.I. doctor) to discuss ascites and portal hypertension and the encephalopathy...(mental changes). This is a serious problem and I would pursue this aggressively.
    rad-skw 1,605 Replies
    • August 24, 2007
    • 07:41 AM
    • 0
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  • Re: shifting dullness. Have you ever looked for a stud in a plaster wall, and heard the difference? Well, Heathereve sounds like her "taut" belly would sound like a drum and sound the same all over. Yours doesn't look that taut. I would show these pix to the docs. If we think it looks funny, there must be some doc out there who agrees. Look up the anatomy of the peritoneum and see if you can figure out where the bulge is. Your abdomen almost looked like severe weight-loss pre plastic surgery photos, but you have no other sagging skin anywhere else, so that can't be it. Though this has been on-going for quite some time, I would suggest a consult (possibly with a liver specialist or a G.I. doctor) to discuss ascites and portal hypertension and the encephalopathy...(mental changes). This is a serious problem and I would pursue this aggressively.I will definitely have this checked out. It will be in about 2 weeks because I'm in the middle of exams right now (yeah, I'm toughing it out this quarter) and I want to be VERY prepared and knowledgeable for the visit to give myself the best possible chance of getting this all resolved. Thanks again for the responses and being so charitable with your time. I'll post in this thread again once I've had my visit to tell you how it went.
    noonej 11 Replies
    • August 26, 2007
    • 10:32 PM
    • 0
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