[81F] Experiencing severe right-sided pain, nausea, and urinary changes

Patient Description

An 81-year-old female is suffering from severe, persistent pain on the right side of her body, including tenderness under the ribs, back pain, and discomfort near the bladder. The abdominal pain is sharp and rated 7 out of 10 in severity. She experiences nausea, particularly after eating, and has a poor appetite. Her bowel movements are abnormal, with mucus and a yellowish color, and she has a history of urinary tract infections with increased frequency of urination and some pain, though her current urine output is not significantly decreased. She has a complex medical history, including atrial fibrillation, high blood pressure, cirrhosis of the liver, spinal stenosis, a nodule on her left kidney, and diabetes, for which she takes metformin, Eliquis, Losartan, amlodipine, carvedilol, rosuvastatin, and tramadol. She has not identified any allergies to medications. The symptoms have been worsening, especially towards the night, and have led to recent changes in weight.

Arora's Assessment

What might be happening

Based on the information you've provided, here are some possible explanations for your symptoms:

Gallstones or Cholecystitis: The location and nature of your pain, along with your changes in bowel movements, could suggest an issue with your gallbladder, such as gallstones or inflammation (cholecystitis). This is especially possible given your age and sex, as gallbladder issues are more common in older women.
- Treatment often involves medication to dissolve the gallstones, or surgery to remove the gallbladder if necessary.
Kidney Stones: Given your back pain and frequent urinary tract infections, kidney stones could be a possibility. These can cause severe pain in the back and sides, as well as changes in urination.
- Treatment usually involves pain relief and drinking lots of fluids to help pass the stone. In some cases, medication or surgery may be needed.
Urinary Tract Infection (UTI): Frequent UTIs can cause pain and changes in urination, as well as general discomfort and nausea.
- Treatment typically involves antibiotics to clear the infection.
Liver Disease: Given your history of cirrhosis, worsening right-sided abdominal pain could suggest progression of your liver disease.
- Treatment depends on the cause and extent of the liver damage. It may involve lifestyle changes, medication, or in severe cases, a liver transplant.

What you can do

Given the severity of your pain and your medical history, it's important to seek medical attention as soon as possible. In the meantime, here are some things you can do:

Rest and stay hydrated. Avoid any foods or drinks that seem to worsen your symptoms.
Over-the-counter pain relievers may help with your pain, but always check with a healthcare provider before starting any new medication.
Keep track of your symptoms. This can help your healthcare provider make a diagnosis.

What you should look out for

Please seek immediate medical attention if you experience any of the following:

Severe or worsening pain
Fever or chills
Vomiting or inability to keep down fluids
Blood in your urine or stool
Yellowing of your skin or eyes (jaundice)

Remember, this advice is intended to be general in nature, and specific causes may not apply to your situation. Always consult with a healthcare provider for appropriate examination, testing, and care.

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1 yr ago

Top picked over-the-counter products for Irritable Bowel Syndrome: American College of Gastroenterology Guidelines