[29F] Experiencing severe abdominal pain and neurological symptoms

Patient Description

A 29-year-old female presents with severe, sharp abdominal pain in the upper right quadrant that radiates to the navel and up to the shoulder and arm. The pain has been persistent for over two weeks and worsens upon eating, with a severity rating of 9 out of 10. Accompanying symptoms include dizziness, nausea, vomiting, hot sweats, shortness of breath, irritability, and migraines. The migraines are described as severe, with a pain rating of 10 out of 10, and are associated with nausea, light sensitivity, noise sensitivity, and dizzy spells. The patient reports that the irritability is exacerbated by hunger and somewhat alleviated by consuming sweet foods. There is a family history of gallbladder disease, and the patient has had her gallbladder removed. She has allergies to sulfa, amoxicillin, Zofran, tramadol, and Lortab, and is not currently on any medications. The patient has had a previous surgery for hernia repair in the lower right abdomen. No recent injuries, trauma, or changes in stool color or consistency have been reported, and there is no indication of jaundice.

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Arora's Assessment

What might be happening

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

  • Gallstones or Biliary Colic: Given your family history and the location and nature of your pain, gallstones or another gallbladder issue could be causing your symptoms. Even though you've had your gallbladder removed, it's still possible to develop gallstones in the bile ducts. These can cause severe pain in the upper right abdomen that can radiate to the back or shoulder, nausea, and vomiting.

    • Treatment typically involves pain management and potentially surgery to remove the stones.

  • Gastroesophageal Reflux Disease (GERD): This condition, in which stomach acid backs up into the esophagus, can cause upper abdominal pain, heartburn, and nausea. Your mention of pain worsening with eating could be a clue towards this.

    • Treatment typically involves lifestyle changes and over-the-counter or prescription medications to reduce stomach acid.

  • Panic Disorder or Anxiety: Your symptoms of shortness of breath, dizziness, and feeling clammy could be related to panic attacks or anxiety. Additionally, stress and anxiety can exacerbate many physical symptoms.

    • Treatment typically involves a combination of therapy and medication.

  • Migraines: Your description of severe, moving headaches accompanied by sensitivity to light and noise, as well as nausea, fits the typical presentation of migraines.

    • Treatment typically involves a combination of lifestyle changes, over-the-counter pain relievers, and potentially prescription medications.

Please note that these are just possibilities, and the true cause of your symptoms could be something different. It's important to seek care from a healthcare provider to get a formal diagnosis.

What you can do

  1. Seek immediate medical attention. Your symptoms, particularly the severe abdominal pain and shortness of breath, are concerning and warrant urgent evaluation.
  2. Try to avoid foods and drinks that trigger your symptoms. This might include fatty or spicy foods, caffeine, and alcohol.
  3. Try to manage stress. Techniques such as deep breathing, meditation, and yoga might help.
  4. Keep a symptom diary. Note when your symptoms occur, what you're doing at the time, and what foods you've eaten. This could help identify patterns or triggers.

What you should look out for

Seek immediate medical attention if you experience:

  • Intense pain that lasts for more than a few hours
  • Difficulty breathing or chest pain
  • Blood in your stool or vomit
  • Yellowing of your skin or eyes
  • Sudden, severe headache unlike any you've had before

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

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9 mo ago

People Also Ask

Can you still have gallstones after gallbladder removal?

Yes, even after gallbladder removal, it's possible to develop gallstones in the bile ducts, which can cause similar symptoms to those experienced before the gallbladder was removed.

What are common triggers for migraines and how can they be managed?

Common triggers for migraines include stress, certain foods (like chocolate, cheese, and processed meats), caffeine, alcohol, and changes in sleep patterns. Management often involves avoiding known triggers, maintaining a regular sleep schedule, staying hydrated, and using prescribed medications as needed.

How can GERD be distinguished from other causes of abdominal pain?

GERD is often characterized by a burning sensation in the chest (heartburn), regurgitation of food or sour liquid, and difficulty swallowing. It can be distinguished from other causes of abdominal pain by its association with meals and relief with antacids. A healthcare provider may perform tests like an endoscopy or pH monitoring to confirm the diagnosis.

What are some non-medication strategies to manage anxiety-related symptoms?

Non-medication strategies for managing anxiety-related symptoms include practicing relaxation techniques such as deep breathing, meditation, yoga, regular physical exercise, maintaining a healthy diet, and ensuring adequate sleep. Cognitive-behavioral therapy (CBT) is also effective in managing anxiety.

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