[33M] With severe abdominal pain, spleen swelling, and gastrointestinal issues
Patient Description
A 33-year-old male presents with severe abdominal pain, swelling of the spleen, and gastrointestinal symptoms for the past two weeks. The pain fluctuates between a 7 and 9 on a pain scale and worsens with movement. The swelling has been present for about three months, is painful, and makes the patient feel full, worsening with activity. The patient reports that the spleen feels like it's 'flopping like a fish,' which started after a recent gastrointestinal appointment. Bowel movements have been inconsistent, ranging from watery stools to difficulty passing stool, and all foods seem to exacerbate the diarrhea. The patient experiences episodes of sweating when the pain and movement are at their worst but has not had a fever. There has been an 80-pound weight loss over the past three months, with associated nausea and occasional vomiting after meals. Appetite has decreased, but there is no yellowing of the skin or eyes. The patient has a history of fatty liver disease and diabetes and is currently taking pantoprazole, dicyclomine, Lantus, and Novolog as prescribed. There is a family history of diabetes, liver disease, cancer, and chronic kidney disease. Additionally, the patient has fluid buildup in the lungs, a nodule in the left lung, a cyst on the left kidney, and a hernia near the navel, all being monitored by a regular doctor. The patient is scheduled for a gastrointestinal appointment to check for cirrhosis. Recently, the spleen pain has extended from just under the rib to the shoulder area over the last four days.
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Arora's Assessment
What might be happening
Based on the symptoms and history you've provided, here are some possible explanations for what might be happening:
Enlarged Spleen (Splenomegaly)
- Symptoms: Pain in the upper left side of the abdomen, pain radiating to the shoulder, feeling full quickly, and swelling.
- Rationale: Your description of the spleen "flopping like a fish" and the pain radiating to your shoulder are indicative of an enlarged spleen. This can be caused by various conditions, including infections, liver diseases, and blood disorders.
- Typical Treatments/Testing: Blood tests, imaging studies like an ultrasound or CT scan, and possibly a biopsy to determine the underlying cause.
Liver Disease
- Symptoms: Swelling, pain, nausea, weight loss, and fluid buildup in the lungs.
- Rationale: Given your history of fatty liver disease and the upcoming appointment to check for cirrhosis, liver disease could be contributing to your symptoms.
- Typical Treatments/Testing: Blood tests to check liver function, imaging studies, and possibly a liver biopsy.
Gastrointestinal Issues
- Symptoms: Diarrhea, nausea, vomiting, and abdominal pain.
- Rationale: The onset of symptoms after a gastrointestinal appointment suggests a possible link. Conditions like irritable bowel syndrome (IBS) or inflammatory bowel disease (IBD) could be considered.
- Typical Treatments/Testing: Stool tests, blood tests, and possibly a colonoscopy or endoscopy.
Kidney Issues
- Symptoms: Swelling, pain, and changes in bowel movements.
- Rationale: Your GFR of 39 indicates reduced kidney function, which could contribute to fluid retention and swelling.
- Typical Treatments/Testing: Blood tests to check kidney function, urine tests, and imaging studies.
What you can do
Enlarged Spleen
- Seek Medical Attention: Given the severity of your symptoms, it's crucial to see a healthcare provider as soon as possible. They may perform imaging studies and blood tests to determine the cause.
- Avoid Physical Activity: Limit activities that could exacerbate the pain or cause injury to the spleen.
- Monitor Symptoms: Keep track of any changes in your symptoms and report them to your healthcare provider.
Liver Disease
- Follow Up with Your Doctor: Attend your upcoming appointment to check for cirrhosis and discuss your symptoms in detail.
- Diet and Lifestyle: Follow a liver-friendly diet, avoid alcohol, and maintain a healthy weight.
- Monitor Symptoms: Keep a journal of your symptoms, including any changes in swelling, pain, and bowel movements.
Gastrointestinal Issues
- Hydration: Ensure you stay hydrated, especially with ongoing diarrhea.
- Dietary Adjustments: Consider a bland diet to ease gastrointestinal symptoms. Avoid foods that trigger your symptoms.
- Medication Review: Discuss your current medications with your healthcare provider to ensure they are not contributing to your symptoms.
Kidney Issues
- Monitor Fluid Intake: Keep track of your fluid intake and output.
- Follow Up with Your Doctor: Discuss your kidney function and any necessary adjustments to your treatment plan.
- Lifestyle Changes: Follow a kidney-friendly diet and avoid medications that can harm your kidneys.
What you should look out for
Given the complexity and severity of your symptoms, it's important to seek medical care as soon as possible. Reasons to seek care even more urgently include:
- Severe Pain: If the pain becomes unbearable or significantly worsens.
- Fever: If you develop a fever, which could indicate an infection.
- Shortness of Breath: If you experience difficulty breathing or worsening fluid buildup in your lungs.
- Changes in Consciousness: If you feel faint, dizzy, or experience confusion.
Remember, while I can provide information and suggestions, it's crucial to consult with a healthcare professional for a formal diagnosis and appropriate treatment. You can also use MDandMe to journal your symptoms, track progress, get insights, and share longitudinal medical notes with your provider.
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5 mo ago