[51F] Experiencing back pain, abdominal pain, chest pain, and anxiety

Patient Description

A 51-year-old female reports suffering from a constant dull ache in the middle of the right side of her back, approximately 2 inches from the spine, for over 5 years, with a current pain severity of 10 out of 10. The pain is exacerbated by sleeping or laying down and is somewhat alleviated by walking. Additionally, she has been experiencing a sensation of tightness or a knot in the upper abdomen and chest pain described as tightness or pressure for the past 2 years and 1 year, respectively, with both pains rated at a severity of 4 out of 10. She also reports anxiety, which has been affecting her sleep for 2 years, and rapid hair thinning at the top front of her head for the same duration. The patient has a family history of celiac disease and lupus. She has not reported any recent injuries, changes in bowel or bladder control, numbness, tingling, sudden weight loss, or night sweats. No current medications or known allergies were reported.

Arora's Assessment

What might be happening

Based on the information you've provided, there are several possibilities that could explain your symptoms:

Gallbladder Disease: Your right-sided back pain and upper abdominal pain could be due to gallbladder disease, such as gallstones or cholecystitis (inflammation of the gallbladder). This condition is common in middle-aged women and can cause severe pain in the upper right abdomen and back, often after meals.
- Diagnostic tests include an abdominal ultrasound or a HIDA scan. Treatment can range from dietary changes to surgery, depending on the severity and cause of the disease.
Hyperthyroidism: Your high free T4, anxiety, and hair loss could be symptoms of hyperthyroidism, a condition where the thyroid gland produces too much thyroid hormone. This can speed up your body's metabolism, causing unintentional weight loss and a rapid or irregular heartbeat.
- Diagnostic tests include blood tests to measure thyroid hormone levels. Treatment can include medication, radioactive iodine, or surgery.
Autoimmune Hepatitis: Given your family history and your high albumin and bilirubin levels, autoimmune hepatitis could be a possibility. This is a disease in which the body's immune system attacks liver cells. This can lead to inflammation and liver damage.
- Diagnostic tests include blood tests and a liver biopsy. Treatment usually involves medications to suppress the immune system.
Anxiety Disorder: Chronic anxiety can cause a variety of physical symptoms, including chest pain and gastrointestinal issues. It can also interfere with sleep and overall quality of life.
- Treatment typically involves a combination of therapy and medication.

What you can do

Given the severity and duration of your symptoms, it's important to seek medical attention. Here are some steps you can take:

Schedule an appointment with your primary care provider. They can perform a physical examination and order necessary tests to help diagnose your condition.
Keep a symptom diary. Note when your symptoms occur, their severity, and any potential triggers. This can be helpful information for your doctor.
Practice good sleep hygiene. This includes maintaining a regular sleep schedule, creating a relaxing bedtime routine, and making your sleep environment comfortable.
Try relaxation techniques, such as deep breathing, meditation, and yoga, to help manage your anxiety.

What you should look out for

Please seek immediate medical attention if you experience:

Severe abdominal pain
Yellowing of the skin or eyes (jaundice)
Rapid heartbeat or palpitations
Severe anxiety or panic attacks
Any other symptoms that concern you

Remember, while I can provide information based on your symptoms, I'm not a doctor. Please consult with a healthcare professional for a formal diagnosis and treatment.

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1 yr ago

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