[28F] With cramping pain underneath rib cage and major nausea

Question

So what is going on

Patient Description

A 28-year-old female presents with cramping pain underneath the rib cage, which has been persistent for the past two days and has worsened, waking her up at night. The pain is constant and spread across the entire rib cage area. She also reports major nausea and diarrhea. The patient has a history of kidney failure with a recent decrease in GFR from 20 to 18. She has Tuberous Sclerosis, epilepsy, and polycystic kidney disease (PKD), diagnosed at 18 months and 19 years old, respectively. She had her gallbladder removed in 2017. Current medications include Lamictal, gabapentin, iron, and B12. She has experienced heartburn or acid reflux but denies vomiting, fever, jaundice, changes in urine color, recent travel, or changes in diet. No known drug allergies.

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Arora's Assessment

What might be happening

Based on the symptoms you've described and your medical history, here are some possible explanations:

  1. Gastrointestinal Issues:

    • Gastritis or Peptic Ulcer: These conditions can cause cramping pain in the upper abdomen and nausea. They are often exacerbated by stress, certain foods, or medications.
    • Gastroesophageal Reflux Disease (GERD): This condition can cause heartburn and cramping pain under the rib cage, along with nausea.
  2. Kidney-Related Issues:

    • Polycystic Kidney Disease (PKD): Given your history of PKD and recent decrease in GFR, it's possible that your kidney function is contributing to your symptoms. Kidney issues can sometimes cause referred pain to the upper abdomen and nausea.
  3. Medication Side Effects:

    • Some of the medications you are taking, such as gabapentin, can cause gastrointestinal side effects, including nausea and cramping.
  4. Pancreatitis:

    • Inflammation of the pancreas can cause severe upper abdominal pain that radiates to the back, along with nausea and vomiting. This is less likely given the absence of vomiting, but it is still a consideration.

What you can do

Cramping Pain and Nausea:

  • See a Doctor: Given the severity and persistence of your symptoms, it is important to consult a healthcare provider as soon as possible. They may recommend blood tests, imaging studies, or other diagnostic tests to determine the cause of your symptoms.
  • Dietary Adjustments: Avoid foods and beverages that can irritate your stomach, such as spicy foods, caffeine, and alcohol. Eating smaller, more frequent meals may also help.
  • Medications: Continue taking Tylenol for pain relief, but avoid taking it in excess. Your doctor may prescribe medications to reduce stomach acid or treat any underlying gastrointestinal issues.
  • Hydration: Ensure you stay well-hydrated, especially if you are experiencing diarrhea. Drink plenty of water and consider oral rehydration solutions if needed.

Kidney Health:

  • Monitor Symptoms: Keep track of any changes in your symptoms, such as increased pain, changes in urine output, or swelling. Use the MDandMe journal to document these changes and share them with your healthcare provider.
  • Follow-Up: Regularly follow up with your nephrologist to monitor your kidney function and discuss any changes in your condition.

What you should look out for

Given your symptoms and medical history, you should seek medical care urgently if you experience any of the following:

  • Severe or worsening pain
  • Vomiting that prevents you from keeping down fluids
  • Signs of dehydration, such as dry mouth, decreased urine output, or dizziness
  • Blood in your stool or vomit
  • Jaundice (yellowing of the skin or eyes)
  • Any new or worsening symptoms related to your kidney function, such as swelling, changes in urine output, or shortness of breath

Remember, while I can provide information and suggestions, it is crucial to consult with a healthcare professional for a formal diagnosis and appropriate treatment. If you have any more questions or need further assistance, feel free to continue the conversation.

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4 mo ago


People Also Ask


What are the common symptoms of Polycystic Kidney Disease (PKD) and how can they affect daily life?

Common symptoms of PKD include high blood pressure, back or side pain, headaches, blood in the urine, and kidney stones. These symptoms can affect daily life by causing discomfort, limiting physical activity, and requiring ongoing medical management.


Can medications like gabapentin cause gastrointestinal side effects such as nausea and cramping?

Yes, gabapentin can cause gastrointestinal side effects, including nausea, cramping, and diarrhea. It's important to discuss any side effects with a healthcare provider to determine if medication adjustments are needed.


What dietary changes can help manage symptoms of GERD or gastritis?

To manage GERD or gastritis, it's recommended to avoid spicy foods, caffeine, alcohol, and large meals. Eating smaller, more frequent meals and avoiding lying down immediately after eating can also help reduce symptoms.


How does a decrease in GFR affect kidney function and overall health?

A decrease in GFR indicates a decline in kidney function, which can lead to waste buildup in the body, fluid retention, and increased risk of complications like high blood pressure and anemia. Regular monitoring and management by a healthcare provider are essential to maintain health.

2 Comments


Arora (Bot)#24147

4 mo ago

Based on your symptoms and medical history, there are a few possible explanations for your cramping pain and nausea. These include gastrointestinal issues like gastritis or peptic ulcer, gastroesophageal reflux disease (GERD), kidney-related issues due to your polycystic kidney disease (PKD), medication side effects, and possibly pancreatitis. It's important to consult a healthcare provider to determine the exact cause and receive appropriate treatment.

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Leo#17

4 mo ago

Given that you've already had your gallbladder removed, and that you're experiencing diarrhea, it's most likely that you are having a GI infection or inflammation of the pancreas. Given your history of kidney failure, it's crucial to make sure you get enough fluids. Better to play it safe and go to the emergency room. If you can't drink much because of nausea, you might need an IV, which is something typically only done in hospitals.

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