[40F] With abdominal pain and gastrointestinal symptoms

Patient Description

A 40-year-old female has been experiencing abdominal pain for six weeks, described as dull, cramping, and occasionally gripping, with a severity of 9 out of 10 at its worst. The pain is located from the top right to the lower left of the abdomen and is relieved by cannabis, water, pressure, and rest. Two weeks ago, she noticed bright red blood in her stool and vomited bright red fluid for two days. Bowel movements have been mostly watery, with occasional blood, about once a month. She has experienced a slight weight loss of 4 pounds and decreased appetite, along with fatigue, dizziness, heartburn, and slight yellowing of the skin. There is no history of black or tarry stools, and alcohol consumption is rare. Family history includes liver disease and gastrointestinal issues. She has multiple cysts in her liver but has not been advised on follow-up. Gallbladder removal occurred 17 years ago, and a fallopian tube was removed in March due to an ectopic pregnancy. She has a history of neurofibromatosis 1, diagnosed in 1987, and cervical cancer, diagnosed in 2011. Current medications include daily Zoloft and recent use of cannabis for pain relief. Additionally, she reports a marble-like lump in the upper right abdomen, present for a few years, and a sensation of a 3-inch ball in the lower left side, causing sharp pain, heat, and faintness. Constipation has been a long-term issue, with severe episodes in the past six weeks, alternating with diarrhea. Temperature varies between 97.6 and 98.7 degrees, and lightheadedness has been present for six months, especially during bowel movements.

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Arora's Assessment

What might be happening

Your symptoms suggest a few possible conditions that could be contributing to your discomfort:

  1. Gastrointestinal Issues: The combination of abdominal pain, blood in your stool, and alternating constipation and diarrhea could indicate conditions like inflammatory bowel disease (IBD) or irritable bowel syndrome (IBS). The presence of blood and severe pain warrants further investigation.

  2. Liver Concerns: Given your family history and the presence of liver cysts, liver function issues could be contributing to your symptoms, such as the slight yellowing of your skin and abdominal pain.

  3. Neurofibromatosis Complications: This condition can sometimes lead to gastrointestinal complications, which might explain some of your symptoms.

  4. Post-Surgical Changes: The removal of your gallbladder and fallopian tube might also play a role in your digestive symptoms.

Typical evaluations might include blood tests, imaging studies like an ultrasound or CT scan, and possibly a referral to a gastroenterologist.

What you can do

Abdominal Pain and Digestive Issues:

  • Seek Medical Attention: It's important to consult a healthcare provider to evaluate your symptoms, especially given the severity and duration.
  • Dietary Adjustments: Consider a low-residue diet to ease digestion and reduce symptoms.
  • Hydration: Continue drinking water to stay hydrated, especially with diarrhea.

Lightheadedness and Fatigue:

  • Rest: Ensure you get adequate rest and avoid sudden movements that might worsen dizziness.
  • Monitor Symptoms: Keep track of when these symptoms occur and any potential triggers.

General Health:

  • Symptom Journal: Use MDandMe to journal your symptoms, track progress, and share insights with your healthcare provider.
  • Follow-Up: Regular follow-ups with your healthcare provider are crucial, especially given your medical history.

What you should look out for

Seek immediate medical attention if you experience:

  • Severe abdominal pain that doesn't improve
  • Persistent vomiting or blood in vomit
  • Significant changes in stool color, such as black or tarry stools
  • Fainting or severe dizziness

Remember, it's important to consult with a healthcare professional for a formal diagnosis and appropriate treatment.

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2 mo ago

People Also Ask

What could be causing the bright red blood in my stool and vomit?

Bright red blood in stool and vomit can be caused by gastrointestinal bleeding, which may result from conditions like hemorrhoids, diverticulosis, or more serious issues such as inflammatory bowel disease or gastrointestinal ulcers. It's important to seek medical evaluation to determine the exact cause.

How might my history of neurofibromatosis and previous surgeries affect my current symptoms?

Neurofibromatosis can sometimes lead to gastrointestinal complications, which might contribute to your symptoms. Previous surgeries, such as gallbladder and fallopian tube removal, can also affect digestion and abdominal pain. Consulting with a healthcare provider can help assess these factors.

What are the potential implications of having multiple liver cysts?

Liver cysts are often benign and asymptomatic, but they can sometimes cause discomfort or indicate underlying liver issues, especially with a family history of liver disease. Monitoring liver function and regular follow-ups with a healthcare provider are recommended.

What dietary changes can help manage my abdominal pain and digestive issues?

A low-residue diet, which includes low-fiber foods, can help ease digestion and reduce symptoms like abdominal pain and diarrhea. It's important to stay hydrated and consult with a healthcare provider or dietitian for personalized dietary advice.

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