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Lisa, MSN, FNP-BC, CCRN, Nurse Practitioner
Category: Health
Satisfied Customers: 890
Experience:  Board Certified Family Nurse Practitioner
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I have been having pain in my stomach, about 2 inches to the

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I have been having pain in my stomach, about 2 inches to the left of center, just below my ribs. At times it is more like a dull ache, and occasionally more sharp, but never unbearable. It comes and goes, but I haven't noticed any connection to what I eat. It was about 6 months ago when I first noticed it. Any ideas what this could be?

Do you have heartburn, acid reflux, bloating, gas, constipation?
Any significant past medical illness or surgery?
Do you have diabetes, high blood pressure, obesity?
Do you smoke or drink alcohol regularly?
Any family history?

Dr. Arun
Customer: replied 5 years ago.

Hello Dr. Arun,

I have no heartburn, acid reflux, bloating or constipation. Occasional gas, but not a problem,

No surgeries.

no diabetes, i'm 115 lbs. 5'5'', bp normal to low

have never smoked and don't drink

no family history

eat a healthy diet - mostly whole foods

Hello Marian,

A dull ache of 6 months with occasional sharp will need following investigations to ascertain the cause;

1) CT scan of abdomen
2) Upper gastrointestinal endoscopy.
3) Tests for helicobacter pylori

Following can be the possibilities;

1) a gall bladder stone
2) mild hiatal hernia
3) gastritis

You may try following, meanwhile;

a) Bismuth subsalicylate
b) Prilosec
c) Simethicone; (Maalox, Mylanta)
d) Beano; contains an enzyme (alpha-galactosidase), which helps to breakdown certain complex carbohydrates.

All are available without prescription.

Avoid foods that appear to aggravate symptoms. These may include milk and dairy products, certain fruits or vegetables, whole grains, artificial sweeteners etc. But this is based on the personal observation for the aggravating food.

Please feel free for your follow up questions.

I would be happy to assist you further, if you need any more information.

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Customer: replied 5 years ago.

Family dr. ordered abdominal ultrasound and x-rays at the time I first noticed this. x-ray showed "A small amount of feces is scatter throughout the colon. Several pockets of intestinal gas are noted without disproportionate gaseous distension. No radiographic evidence of free air. No abnormal calcifications or soft tissue masses."

Ultrasound showed "Liver is normal in size without focal abnormality. Gallbladder is well distended with no shadowing gallstone, gallbladder wall thickening or pericholecystic fluid. There is however a 7 mm intraluminal echogenicity at the neck of the gallbladder which is not mobile. Although this may merely be related to a septation, this does appear to be a focal rounded abnormality on multiple images. Question then the possibility of a small gallbladder polyp or sludge ball. There is no biliary ductal dilatation with the common duct measuring 2 mm. Visualized portions of the pancreas are unremarkable."

Dr. was not concerned about this - should I be? Not sure if this is the source of the pain as gallbladder is on the right side? My pain is more on the left.

Pain is in a specific spot and sometimes there is pain when I push on it with my fingers.

I see a hiatal hernia could be related to pregnancy? 2 pregnancies, last one 2.5 years ago.

Customer: replied 5 years ago.
Relist: Other.
no follow-up
Thank you for writing in tonight. The previous expert has relished your question, so I will be helping you from here. Now this's right below your ribs on the right side? Do you have any aggravating symptoms or patterns? Any symptoms you haven't mentioned? Did anything significant change 6 months ago, like diet change, injury, etc, when this first started? How have you been treating this? What have you tried? Has anything helped? Do you take any medications or supplements?
Please let me know.
Customer: replied 5 years ago.

It is on the left side, not the right. It is an inch or so to the left of center, maybe an inch below my ribs. I have tried some vitamins and probiotics, but haven't noticed any difference. Dr. did tests as mentioned above, but no treatment. No symptoms or patterns. Occasionally I also have slight cramps on the left side under the ribs, but doesn't seem related. Have some back pain/left shoulder pain from auto accident 6 years ago. Also not sure if that's related. Not on any medications. No significant changes.

Thank you for responding. First of all, I apologize. I did type right side. That was my error. I meant left.
Anyway, here are my thoughts on your case. First of all abdominal problems can be more of a challenge to diagnose clinically. Generally, abdominal issues require diagnostic work up. You have already had an X-ray and ultrasound, which is a good start. However, you may want to talk to your doctor about getting a referral to a gastroenterology specialist for an upper endoscopy. That would be my recommendation if you were my patient. I will get back to this in a minute.
Judging from the location of your pain and the characteristics of your pain, I suspect this is likely something that can be diagnosed and treated fairly easily. You mentioned hiatal hernia. It is possible that you have a hernia, many people have a hiatal hernia that has never been diagnosed. However, I don't suspect this is the cause of your discomfort. Generally, hiatal hernias cause discomfort when the hernia is protruding through the diaphragm; therefore, the pain is usually at the level of the ribs or even felt under the sternum. Also, you didn't mention anything about difficulty swallowing or feeling like there is a lump. At this point, I suspect you may have some reflux disease, or possibly some ulceration. Reflux is very common. It doesn't always present as heartburn. If you do have some silent acid reflux, it could be irritating the lining of your stomach, causing some gnawing discomfort. Now, this is what I suspect, but obviously, an upper endoscopy would be most helpful to really diagnosis this problem. Even though reflux may not seem like a significant concern, it can actually lead to significant complications down the road. Ulcerations too can cause problems if left untreated.
As for that ultrasound. Yes, the gallbladder is on the right side. In general, gallbladder pain is on the right side; however, it is possible for gallbladder pain to manifest as referred pain in another area, such as the back. One thing I don't hear from you is any pattern regarding food intake. Usually people with acute gallbladder discomfort tend to have more pain after large, fatty meals. I don't really feel that this is gallbladder related, but, based on your ultrasound, I would just monitor for any gallbladder problems in the future. I do think the ultrasound is enough to keep an eye on it. I respect the opinion of your doctor, but I would also recommend you show your report to the gastroenterologist.
These are my thought. If you have any additional questions, concerns, thoughts, please feel free to email me back. I will be online for a bit.
Customer: replied 5 years ago.

I mentioned before that I can find the "pain spot" by pushing on it with my fingers. Would this be true for reflux?

I will check with dr. about gastroenterology. Testing is expensive - how urgent do you think this is?

You are thin. When you press on that area, you could be pressing on your stomach. If there is inflammation withing the stomach, just pressing the area could cause some discomfort. I have found this to be the case in a few of my patients, those with reflux and also ulcers.
As for urgency, I guess it depends on how comfortable you are waiting to get this evaluated. I can't see you or examine you, so there are some limitations to the advise I can provide online. As providers, sometimes we may notice something during an exam that you just wouldn't notice and report. In addition, I don't feel this is anything too ominous; however, there is always a risk of something more significant.
My official position would be to get this evaluated whenever possible. However, if you feel like waiting a bit or heading in if it gets worse, those are options too. Also, you may choose to take an over the counter medication like Prilosec or Pepcid for two weeks. Generally, people will see some improvement in symptoms within 2 weeks. I feel that you were seen by your provider. He wasn't overly concerned. Therefore, if you choose to wait and try the over the counters for a couple of weeks, I think that would be reasonable if you choose that approach. I would recommend doing what makes you feel most comfortable.
Lisa, MSN, FNP-BC, CCRN, Nurse Practitioner
Category: Health
Satisfied Customers: 890
Experience: Board Certified Family Nurse Practitioner
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