[54F] With right upper quadrant cramping and gastrointestinal symptoms

Patient Description

A 54-year-old female presents with right upper quadrant cramping that began suddenly two weeks ago, rated as 6 out of 10 in severity. The patient reports associated symptoms of burping 5-10 times a day, flatus, hiccups, and diarrhea with yellow to brown loose stools. There is no relief from burping, and no nausea, vomiting, fever, chills, or jaundice have been noted. The patient has a history of cholecystectomy 20 years ago and has experienced similar symptoms in the past. Chronic conditions include GERD and hypothyroidism. Current medications are Synthroid 100 mcg, Zepbound 7.5 mg, and Prilosec 20 mg as needed. No known allergies.

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Arora's Assessment

What might be happening

Based on the symptoms you've described, here are some possible explanations:

  • Bile Acid Diarrhea (BAD): After a cholecystectomy, some people experience changes in bile acid metabolism, leading to diarrhea and abdominal cramping, especially after consuming fatty foods. This is because the gallbladder, which stores bile, is no longer present to regulate bile flow into the intestine.

    • Treatment often involves dietary modifications to reduce fat intake and medications like bile acid sequestrants, which help bind bile acids in the intestine.
  • Gastroesophageal Reflux Disease (GERD): Your history of GERD could be contributing to symptoms like burping and hiccups. GERD can sometimes cause upper abdominal discomfort and cramping.

    • Treatment typically includes lifestyle changes, dietary adjustments, and medications like proton pump inhibitors (e.g., Prilosec) to reduce stomach acid.
  • Functional Dyspepsia: This is a common condition characterized by upper abdominal discomfort, bloating, and burping. It can be triggered by certain foods, stress, or other factors.

    • Treatment may involve dietary changes, stress management, and medications to help manage symptoms.

What you can do

While it's important to consult with a healthcare professional for a formal diagnosis and treatment plan, here are some steps you can take in the meantime:

  1. Dietary Adjustments: Try to avoid fried and fatty foods, as these seem to trigger your symptoms. Opt for smaller, more frequent meals that are low in fat.
  2. Hydration: Ensure you stay well-hydrated, especially if you're experiencing diarrhea. Drinking plenty of water can help prevent dehydration.
  3. Symptom Tracking: Use MDandMe to journal your symptoms, track your dietary intake, and note any patterns or triggers. This information can be valuable for your healthcare provider.
  4. Medication Management: Continue taking Prilosec as needed for GERD symptoms, and discuss with your doctor whether any additional medications might be helpful.

What you should look out for

Be aware of the following signs that may require more urgent medical attention:

  • Severe Abdominal Pain: If your pain becomes severe or is accompanied by other concerning symptoms, seek medical care promptly.
  • Blood in Stool: If you notice blood in your stool or black, tarry stools, contact your healthcare provider.
  • Persistent or Worsening Symptoms: If your symptoms persist or worsen despite dietary changes and medication, it's important to follow up with your doctor.

Remember, while this information can help guide you, it's essential to consult with a healthcare professional for a comprehensive evaluation and personalized treatment plan.

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1 mo ago

People Also Ask


What is Bile Acid Diarrhea and how is it related to cholecystectomy?

Bile Acid Diarrhea (BAD) occurs when there is an excess of bile acids in the colon, often due to the removal of the gallbladder (cholecystectomy). This can lead to diarrhea and abdominal cramping, especially after eating fatty foods. Treatment may include dietary changes and medications like bile acid sequestrants.


How can GERD contribute to symptoms like burping and hiccups?

GERD, or gastroesophageal reflux disease, can cause symptoms such as burping and hiccups due to the backflow of stomach acid into the esophagus. This can lead to irritation and discomfort in the upper abdomen.


What dietary changes can help manage symptoms of Bile Acid Diarrhea and GERD?

To manage symptoms of Bile Acid Diarrhea and GERD, it is recommended to avoid fried and fatty foods, eat smaller and more frequent meals, and stay hydrated. These dietary adjustments can help reduce symptoms and improve digestion.


When should I seek urgent medical attention for abdominal symptoms?

You should seek urgent medical attention if you experience severe abdominal pain, notice blood in your stool or black, tarry stools, or if your symptoms persist or worsen despite dietary changes and medication.


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