[33F] With abdominal pain, elevated liver enzymes, and other symptoms

Patient Description

A 33-year-old female presents with sharp and crampy abdominal pain, primarily in the right abdomen, which has been ongoing for three days. The pain is severe, rated 8/10, especially after eating, and does not improve with any measures. The patient also reports vomiting, diarrhea, and an inability to eat. Additional symptoms include high liver enzymes, sludge in the gallbladder, elevated red blood cells, and the presence of ketones and proteins in the urine. The patient has experienced a low-grade fever, amber-colored urine, and loose stools. The abdominal pain radiates to the back and shoulder. This is the first occurrence of elevated liver enzymes for the patient.

Arora's Assessment

What might be happening

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

Gallbladder Issues

Gallbladder Sludge: The presence of sludge in your gallbladder can cause pain, especially in the right upper abdomen, and can radiate to the back or shoulder. This can also lead to nausea, vomiting, and an inability to eat.
Cholecystitis: Inflammation of the gallbladder can cause sharp, crampy pain, fever, and digestive issues like vomiting and diarrhea.

Liver Issues

Elevated Liver Enzymes: High liver enzymes can indicate liver inflammation or damage. This could be due to various causes, including infections, medications, or other liver diseases.
Hepatitis: Inflammation of the liver can cause abdominal pain, nausea, vomiting, and fatigue.

Kidney Issues

Ketones and Proteins in Urine: This can indicate dehydration, kidney issues, or uncontrolled diabetes. It can also contribute to abdominal pain and other symptoms.

Blood Issues

High Red Blood Cells: This could be a sign of dehydration or a condition affecting your bone marrow. It can sometimes cause fatigue and other systemic symptoms.

Gastrointestinal Issues

Gastroenteritis: Inflammation of the stomach and intestines can cause diarrhea, vomiting, and abdominal pain.
Pancreatitis: Inflammation of the pancreas can cause severe abdominal pain, nausea, vomiting, and elevated liver enzymes.

What you can do

Abdominal Pain and Gallbladder Issues

Seek Immediate Medical Attention: Given the severity of your symptoms, it's crucial to consult a healthcare provider as soon as possible. They may recommend imaging tests like an ultrasound or CT scan to evaluate your gallbladder and liver.
Avoid Fatty Foods: Fatty foods can exacerbate gallbladder issues. Stick to a bland diet until you can see a doctor.
Stay Hydrated: Drink plenty of fluids to help manage dehydration and support kidney function.

Elevated Liver Enzymes

Follow Up with Your Doctor: Elevated liver enzymes need further evaluation to determine the underlying cause. Your doctor may order additional blood tests or imaging studies.
Avoid Alcohol: Alcohol can worsen liver inflammation and should be avoided.

Ketones and Proteins in Urine

Monitor Blood Sugar Levels: If you have diabetes, keep a close eye on your blood sugar levels and follow your treatment plan.
Stay Hydrated: Drink plenty of water to help flush out ketones and support kidney function.

High Red Blood Cells

Consult Your Doctor: High red blood cell counts need further evaluation to determine the cause. Your doctor may order additional tests to assess your bone marrow function and overall health.

What you should look out for

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

Severe Abdominal Pain: If the pain becomes unbearable or is accompanied by high fever, seek emergency medical attention.
Jaundice: Yellowing of the skin or eyes, which can indicate liver issues.
Severe Dehydration: Signs include extreme thirst, dry mouth, and reduced urine output.
Changes in Mental Status: Confusion or altered consciousness can be a sign of severe liver or kidney issues.

Remember, while I can provide information based on your symptoms, it's essential to consult a healthcare professional for a formal diagnosis and treatment plan. You can also use MDandMe to journal your symptoms, track progress, get insights, and share longitudinal medical notes with your provider.