[30F] With lower right abdominal discomfort and nausea

Patient Description

A 30-year-old female has been experiencing lower right abdominal discomfort that started suddenly and has been ongoing for the past 9 days. The pain is described as sharp, cramping, and aching, with a severity of 3 out of 10. It comes and goes, but sometimes it is constant. The patient also reports nausea and a loss of appetite, but no vomiting or fever. She feels the need to go to the bathroom more often but has not noticed any pain when pressing on her lower right abdomen and then quickly releasing it (rebound tenderness). There is no history of gastrointestinal issues or surgeries. The patient vapes and has not made any recent changes to her diet, eaten any unusual foods, or traveled recently. She is on depo for birth control. Family history includes diabetes, IBS, and psychiatric illness. The patient has not experienced similar symptoms in the past or been evaluated for IBS before. Past medical history includes diabetes, diagnosed at age 24, and asthma, present since infancy. The patient is allergic to penicillin. Current medications include Metformin 1000mg twice daily, Lisinopril 10mg once daily, and Trulicity 3mg once weekly, all taken for the past 2 years. She also takes Omega 3, D3, Vitamin C, Biotin, and Magnesium supplements daily.

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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:

  1. Appendicitis:

    • Rationale: Sudden onset of sharp, cramping, and aching pain in the lower right abdomen that has been ongoing for 9 days could be indicative of appendicitis. Although typically more severe and often accompanied by fever, nausea, and loss of appetite are common symptoms.
    • Typical Treatments/Testing: Diagnosis usually involves a physical examination, blood tests, and imaging studies like an ultrasound or CT scan. Treatment often requires surgical removal of the appendix.
  2. Irritable Bowel Syndrome (IBS):

    • Rationale: Given your family history of IBS and the symptoms of abdominal discomfort and changes in bowel habits, IBS could be a possibility. IBS often causes cramping, abdominal pain, bloating, and changes in bowel habits.
    • Typical Treatments/Testing: Diagnosis is usually based on symptoms and ruling out other conditions. Treatment may include dietary changes, stress management, and medications to manage symptoms.
  3. Ovarian Cyst:

    • Rationale: Lower right abdominal pain that comes and goes could be due to an ovarian cyst, especially since you are on depo, which can sometimes cause ovarian cysts.
    • Typical Treatments/Testing: Diagnosis typically involves a pelvic exam and ultrasound. Treatment may include watchful waiting, pain management, or surgical intervention if the cyst is large or causing significant symptoms.

What you can do

For Appendicitis:

  • Seek immediate medical attention: Appendicitis can be a medical emergency. If you experience worsening pain, fever, or vomiting, go to the emergency room immediately.

For IBS:

  • Dietary changes: Consider a low-FODMAP diet, which can help reduce symptoms of IBS. Avoid foods that trigger your symptoms.
  • Stress management: Techniques such as mindfulness, meditation, and regular exercise can help manage stress, which can exacerbate IBS symptoms.
  • Medications: Over-the-counter medications like anti-diarrheal agents or fiber supplements may help. Consult your doctor for specific recommendations.

For Ovarian Cyst:

  • Monitor symptoms: Keep track of your symptoms and any changes in your menstrual cycle.
  • Pain management: Over-the-counter pain relievers like ibuprofen can help manage pain. Avoid heavy lifting or strenuous activities that may exacerbate the pain.

General Tips:

  • Stay hydrated: Drink plenty of water, especially if you are experiencing nausea.
  • Eat small, frequent meals: This can help manage nausea and loss of appetite.
  • Use MDandMe: Journal your symptoms, track your progress, get insights, and share longitudinal medical notes with your provider.

What you should look out for

Given the severity and duration of your symptoms, you should seek medical care as soon as possible. Reasons to seek care even more urgently include:

  • Worsening abdominal pain or pain that becomes severe and constant
  • Fever, vomiting, or signs of infection
  • Changes in bowel habits that persist or worsen
  • Unexplained weight loss or severe loss of appetite

Remember, while I can provide information and suggestions, it's important to consult with a healthcare professional for a formal diagnosis and appropriate treatment.

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5 mo ago

People Also Ask


What are the common symptoms of appendicitis?

Common symptoms of appendicitis include sudden onset of sharp abdominal pain, usually starting around the navel and then moving to the lower right abdomen, nausea, vomiting, loss of appetite, and sometimes fever. The pain often worsens with movement or coughing.


How is Irritable Bowel Syndrome (IBS) diagnosed and managed?

IBS is typically diagnosed based on symptoms and by ruling out other conditions. Management includes dietary changes like a low-FODMAP diet, stress management techniques, and medications to alleviate symptoms such as antispasmodics or laxatives.


Can ovarian cysts cause abdominal pain, and how are they treated?

Yes, ovarian cysts can cause abdominal pain, especially if they rupture or become large. They are often diagnosed with a pelvic exam and ultrasound. Treatment may involve watchful waiting, pain management, or surgery if necessary.


What lifestyle changes can help manage symptoms of abdominal discomfort and nausea?

Lifestyle changes that can help manage symptoms include eating small, frequent meals, staying hydrated, avoiding trigger foods, practicing stress management techniques like meditation, and engaging in regular physical activity.


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