[22F] Experiencing upper quadrant pain, dizziness, tachycardia, and numbness

Patient Description

A 22-year-old female presents with severe intermittent upper right quadrant pain that has been occurring for the past three months. The pain is described as sharp and stabbing, and it is so severe that it prevents her from walking or standing up straight, also causing difficulty with breathing. She experiences dizziness described as choppy vision and lightheadedness, rated 4/10 in severity, which occurs any time of day when the side pain is present. The patient reports a resting heart rate of 100 bpm that increases to 120 bpm upon standing, correlating with episodes of pain. Additionally, she experiences numbness in her pinky and ring fingers and forearm, but only when lying on her back, a symptom present for the past six years. She also reports constant vaginal bleeding four months postpartum. No jaundice, chest pain, shortness of breath, or changes in urine or stool color were reported. The patient has a medical history of depression and borderline personality disorder, with diagnoses made six years and two months ago, respectively. She is not currently on any medications and does not have any known drug allergies. Her mother had her gallbladder removed, suggesting a possible familial predisposition to gallbladder issues.

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Arora's Assessment

What might be happening

Based on your symptoms, the following conditions may be considered:

  • Gallbladder Disease: The severe, sharp, stabbing pain in your upper right abdomen, along with the fact that your mother had her gallbladder removed, could suggest a gallbladder issue such as gallstones or cholecystitis (inflammation of the gallbladder). These conditions can cause severe abdominal pain, often associated with meals.

    • Treatment often involves dietary changes, pain management, and in some cases, surgery to remove the gallbladder.

  • Postural Orthostatic Tachycardia Syndrome (POTS): This condition is characterized by a rapid increase in heart rate upon standing. Symptoms can include lightheadedness, fainting, and rapid heartbeat, which you have described.

    • Treatment typically involves lifestyle modifications like increasing fluid and salt intake, wearing compression stockings, and sometimes medication.

  • Cubital Tunnel Syndrome: This condition is caused by increased pressure on the ulnar nerve, which can cause numbness and tingling in the ring and small finger, pain in the forearm, and/or weakness in the hand. Your description of numbness in your pinky and ring fingers and forearm when you lay on your back aligns with this condition.

    • Treatment can include avoiding pressure on the elbow, wearing a splint, or surgery in severe cases.

  • Postpartum Hemorrhage: Constant vaginal bleeding four months postpartum is not typical and could be a sign of postpartum hemorrhage, which is excessive bleeding following childbirth.

    • Treatment can involve medication, a procedure to remove remaining placenta, or surgery in severe cases.

Please note that these are potential explanations based on your symptoms, but only a healthcare professional can provide a definitive diagnosis.

What you can do

  1. Seek immediate medical attention. The combination of your symptoms, particularly the severe abdominal pain and constant postpartum bleeding, is concerning and should be evaluated by a healthcare professional as soon as possible.
  2. Try to avoid laying on your back to minimize the numbness in your fingers and forearm.
  3. Keep a record of your symptoms and their severity to share with your healthcare provider.

What you should look out for

Seek immediate medical attention if you experience:

  • Intense, worsening abdominal pain
  • Increased vaginal bleeding or passing large blood clots
  • Fainting or loss of consciousness
  • Chest pain or difficulty breathing

Remember, while I strive to provide accurate information, I'm not a doctor and this advice should not replace a consultation with a healthcare professional.

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9 mo ago

People Also Ask

What are the common symptoms of gallbladder disease?

Common symptoms of gallbladder disease include severe abdominal pain, especially in the upper right quadrant, nausea, vomiting, and sometimes fever. The pain often occurs after eating fatty meals and can radiate to the back or right shoulder.

How is Postural Orthostatic Tachycardia Syndrome (POTS) diagnosed and managed?

POTS is diagnosed through a tilt table test or active stand test, which measures heart rate and blood pressure changes upon standing. Management includes lifestyle changes like increased fluid and salt intake, wearing compression garments, and sometimes medications to help regulate heart rate and blood pressure.

What causes numbness in the pinky and ring fingers, and how can it be treated?

Numbness in the pinky and ring fingers is often caused by cubital tunnel syndrome, which involves pressure on the ulnar nerve. Treatment includes avoiding activities that put pressure on the elbow, using a splint, and in severe cases, surgery to relieve nerve compression.

What are the potential causes of prolonged postpartum bleeding?

Prolonged postpartum bleeding can be caused by retained placental tissue, uterine atony (where the uterus doesn't contract properly), or hormonal imbalances. It requires medical evaluation to determine the cause and appropriate treatment, which may include medication or surgical intervention.

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