[48F] With severe abdominal symptoms and unexplained bruising

Patient Description

A 48-year-old female presents with severe cramping stomach pain located between the bottom of the ribs, which has been constant and gradually worsening over the past hour. She reports very dark, watery diarrhea for several days, occurring more than 4-5 times a day, triggered almost immediately by eating. Additionally, she experiences dull, throbbing back pain on the left side, worsening with movement, which started yesterday evening. Unexplained bruising is noted on the top of the left foot, starting about a week ago, now yellowing and lightening, with no injuries to explain it. Nausea and vomiting have been present for several days, along with chills and sweats, but no confirmed fever. The patient has a history of lupus, with no major active issues currently. Post-gastric sleeve surgery in 2020, she has experienced malabsorption and malnutrition, currently weighing 90 pounds at 5 feet tall. Past medical history includes elevated liver enzymes and possible NASH, though unconfirmed. Allergies include penicillin and tramadol, and she avoids NSAIDs. Current medications are Celexa (10 mg once daily) and Wellbutrin (10 mg twice daily), with no over-the-counter medications or supplements.

Arora's Assessment

What might be happening

Your symptoms could be related to several issues:

Gastrointestinal Issues: The severe stomach pain, diarrhea, and nausea might be related to complications from your gastric sleeve surgery, such as malabsorption or a possible infection. Dark, watery diarrhea can also indicate bleeding or liver issues, especially given your history of elevated liver enzymes.
Liver Concerns: The unexplained bruising and history of elevated liver enzymes suggest that liver function might be compromised. NASH (Non-Alcoholic Steatohepatitis) could be a factor, as it involves liver inflammation and damage.
Lupus Flare: Although you mentioned no active lupus issues, stress on your body from other conditions can sometimes trigger a flare, potentially affecting your symptoms.

What you can do

Stomach Pain and Diarrhea:

Seek Medical Attention: It's important to contact your healthcare provider or visit an urgent care facility to evaluate these symptoms, especially given your surgical history and liver concerns.
Stay Hydrated: Drink clear fluids like water or oral rehydration solutions to prevent dehydration from diarrhea.

Back Pain:

Rest and Gentle Movement: Avoid activities that worsen the pain. Gentle stretching might help, but avoid overexertion.

Bruising:

Monitor: Keep an eye on any new bruises and report them to your doctor, especially if they appear without injury.

General Health:

Track Symptoms: Use MDandMe to journal your symptoms, track progress, and share notes with your healthcare provider.
Nutrition: Ensure you're getting adequate nutrition, possibly with the help of a dietitian, given your malabsorption issues.

What you should look out for

Seek immediate medical care if you experience:

Severe abdominal pain that doesn't improve
Signs of dehydration, such as dizziness or decreased urination
New or worsening bruising
Yellowing of the skin or eyes

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

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2 mo ago

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[48F] With severe abdominal symptoms and unexplained bruising

What might be happening

What you can do

What you should look out for

Experiencing symptoms?