[47F] Experiencing severe upper abdominal pain with nausea

Patient Description

A 47-year-old female has been experiencing severe upper abdominal pain for several months, described as intermittent cramping that tightens, feels like a knife stabbing for about 10-20 seconds, and then releases. The pain is unrelated to eating habits or bowel movements and radiates through to her back. The pain severity is 10 out of 10, accompanied by nausea but does not worsen after eating or when lying down. The patient has also experienced unexplained weight loss. She has a medical history of lupus, a major stroke at age 36, and is prone to adhesions. Current medications include Topamax (100mg twice daily), oxycodone (15mg four times daily), Zofran (8mg as needed), and Excedrin for migraines. She has allergies to codeine, compazine, and cipro.

Arora's Assessment

What might be happening

Based on the information you've provided, possible diagnoses include:

Gastritis or Peptic Ulcer Disease: These conditions are characterized by inflammation or erosion of the stomach lining, which can cause severe upper abdominal pain. The pain is often described as a burning or gnawing sensation and can radiate to the back. However, these conditions often worsen with eating, which you have not reported.
- Treatment typically involves medications to reduce stomach acid and protect the stomach lining. In some cases, antibiotics may be needed if a bacterial infection is present.
Gallstones or Cholecystitis: Gallstones are hard deposits in the gallbladder that can cause severe pain if they block the bile ducts. Cholecystitis is inflammation of the gallbladder, often caused by gallstones. The pain is usually in the right upper abdomen and can radiate to the back or right shoulder. However, these conditions often worsen after eating fatty meals, which you have not reported.
- Treatment can range from dietary changes to medications to dissolve gallstones, to surgery to remove the gallbladder.
Pancreatitis: Inflammation of the pancreas can cause severe upper abdominal pain that often radiates to the back. It can be chronic (long-term) or acute (sudden and severe). Chronic pancreatitis can cause weight loss. However, pancreatitis often worsens after eating, which you have not reported.
- Treatment typically involves hospitalization for pain control and fluid replacement, followed by dietary changes and sometimes surgery.
Lupus flare: Lupus is an autoimmune disease that can affect many parts of the body, including the digestive system. A lupus flare can cause a variety of symptoms, including abdominal pain.
- Treatment typically involves medications to control inflammation and suppress the immune system.

What you can do

You should seek immediate medical attention given the severity and duration of your pain. A healthcare professional can provide a formal assessment and order relevant tests if necessary.