[25F] With sudden rib cage pain and difficulty sleeping

Patient Description

A 28-year-old female presents with a sudden onset of dull pain behind the rib cage, rated 6 out of 10 in severity, which worsens with breathing in. The pain began after not drinking water or eating for 13 hours and then consuming a large amount of alcohol (12 shots). The patient reports extreme worry and difficulty sleeping. She has experienced similar episodes of pain after drinking alcohol in the past, lasting for a day and accompanied by extreme fatigue and an inability to eat. The patient denies shortness of breath, cough, nausea, vomiting, abdominal pain, fever, chills, or jaundice. She has had watery diarrhea and a lack of bowel movements. The patient has a history of asthma (diagnosed at age 12), anxiety, depression, and panic attacks (diagnosed at age 9, better understood at age 19). She is currently taking milk thistle, iron, and probiotics, but no prescription medications or other supplements. No known drug allergies.

Arora's Assessment

What might be happening

Based on the information you have provided, here are some possible explanations for your symptoms:

Gastritis or Peptic Ulcer Disease: The pain behind your rib cage, especially after consuming a large amount of alcohol, could be due to inflammation of the stomach lining (gastritis) or a peptic ulcer. Alcohol can irritate the stomach lining and exacerbate these conditions.
- Treatment: Typically involves medications to reduce stomach acid, such as proton pump inhibitors (PPIs) or H2 blockers. Avoiding alcohol, spicy foods, and NSAIDs (like ibuprofen) can also help.
Pancreatitis: Acute pancreatitis can be triggered by heavy alcohol consumption and can cause pain in the upper abdomen that radiates to the back, which may worsen with breathing.
- Treatment: Often requires hospitalization for IV fluids, pain management, and sometimes antibiotics. Avoiding alcohol is crucial.
Costochondritis: This is an inflammation of the cartilage that connects a rib to the breastbone, which can cause pain that worsens with breathing.
- Treatment: Typically involves pain relief with NSAIDs and rest.
Alcohol-Induced Hangover: The combination of dehydration, lack of food, and heavy alcohol consumption can lead to a hangover, which can cause various symptoms, including pain, fatigue, and gastrointestinal issues.
- Treatment: Hydration, rest, and over-the-counter pain relievers can help alleviate symptoms.

What you can do

While it's important to consult a healthcare provider for a formal diagnosis and treatment plan, here are some steps you can take to manage your symptoms:

Hydrate: Drink plenty of water to rehydrate your body. Avoid caffeinated and sugary drinks.
Eat Light: Stick to bland, easy-to-digest foods like toast, crackers, and bananas until your stomach feels better.
Avoid Alcohol: Refrain from drinking alcohol until you have consulted with a healthcare provider and your symptoms have resolved.
Rest: Ensure you get plenty of rest to help your body recover.
Over-the-Counter Medications: Consider taking antacids or acid reducers if you suspect gastritis or an ulcer. Avoid NSAIDs if you suspect a gastrointestinal issue.
Track Symptoms: Use MDandMe to journal your symptoms, track your progress, and share your notes with your healthcare provider.

What you should look out for

Seek medical attention if you experience any of the following:

Severe or worsening pain
Blood in your vomit or stools (black or tarry stools)
Persistent vomiting or inability to keep fluids down
High fever or chills
Shortness of breath or chest pain
Yellowing of the skin or eyes (jaundice)

Remember, while I can provide guidance based on your symptoms, it's essential to consult a healthcare professional for a formal diagnosis and appropriate treatment. If you have any more questions or need further assistance, feel free to ask.

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6 mo ago

Top picked over-the-counter products for Gastroesophageal Reflux Disease