What is the location of the pain?
Any fever? nausea?
Any change to color of urine?
How long has pain been present?
Does anything make it better or worse?
What have you tried so far?
The pain is localized in the lower abdomen but radiates into the mid to upper abdomin
No fever, there was an initial episode of nausea but no any longer -2 week history of pain
no change in color of urine
Pain has been present for 2 weeks, initially only intermittent now constant
Sitting still sometimes makes it better but movement or jarring motion makes is wo only mild pain relievers, advil, tylenol, helped intially now after 3 hospital visits taking Vicodin for the pain. Have also tried warm baths, soft bland diet, but no real relief
Thank you for the extra information.
What examinations and investigations did you have at the hospital?
Did they tell you what problems did they rule out?
Is your entire stool white?
At the hospital they repeated the initial CT scan to rule out appendicitis (2 CT SCANS)
The only chelmistry result that was abnormal was a slightly elevated WBC 13,500
They ruled out : appendicitis, ovarian cysts, small bowell disorder with a barium swallow and small bowell test
The stool was white only once and it was after the small bowell test
White stool is entirely normal after a barium swallow/test. If it had been persistent and dark urine then I would have been worried about your gall bladder.
Did the CT scan report mention your gall bladder, pancreas or large bowel?
Did you have amylase, liver function and kidney function tests?
The CT scan only mentioned the appendix and the small bowel no mention of the gall bladder or pancreas,
We had liver function and kidney but no amylase or pancreatic function testing
For the sake of completeness then you should have pancreas and gall bladder examined. Raised white cell count indicates that there is an inflammatory process going on.
If teh Ct scan did not allow good visualization then an abdominal ultrasound should be done. I would also assume that ectopic pregnancy was ruled out when the ovaries were checked however a pregnancy test should also be done to exclude that as an option.
Menstrual cycle was present during initial hospital work up and therefore ruled out pregnancy.
Would pancreas involvement give these symptoms. and if so would it progress from intermittent to constant and from dull to sharp and more intensity without being diagnosed by palpation and physical examination.
If amylase test is negative could the pancreas still be in early stage of pancreatitis?
Is there any other possibility for such intense agonizing pain in the abdomen with the history of the test results above and the lack of any visualization of an enlarged appendix
The hospital would have a better understanding of possible diagnosis and exclusions as they would have reviewed all your bloods and looked at inflammatory markers. If amylase was not raised and CT normal then pancreas is unlikely to be cause of your problem.
As you mention that menstrual cycle had started then another possible diagnosis is endometriosis (uterine tissue outside the uterus). this can be very painful and present with intermittent symptoms. An exploratory laparoscopic surgery may be needed to investigate this as a possibility. Although there are risks of any surgery, if pain is that extreme then you may need to discuss that as an option.
Thank you so much for your help. We will take her back to the doctors and have the amylase test and a pancreatic testing to rule it out.
Dr Larry Fadjo
Thank you for using just answer. I hope she feels more comfortable soon.
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