Suggest treatment for terrible cramping in stomach and back
Patient: In the last month I have been constantly nauseous. I have to make myself eat. I have lost 25 lbs. It all started one day when I was walking around having a good time at a casino (no alcohol). I had a terrible cramping feeling on my right side under my rib that went all the way through my back. I broke out into a sweat. This lasted about 30 minutes. I was weak and just felt like laying down. I had eggs and sausage and pancakes for breakfast that morning. I went to the restroom, and urinated an odd orangish color. I let it go until about a week later I noticed that i was passing undigested food through my bowels and having nausea. I felt terrible like I was going to die. I then went to the E.R. 3 times in 4 days. No answers. Now my pain is pretty much constant under the right rib. If I take a pain killer like hydrocodone it actually makes the area cramp more. So.....at one of my E.R. visits they checked my urine, and it showed high bilirubin level. A blood test did not show high bilirubin. I have belching (not normal for me), diarrhea, tongue coating is usually white or yellow, passing undigested foods, especially items like beans, yellow stool color, nausea, and bloating. I also have tenderness to the touch under the right rib area. Tests I have had.....CT no dye, upper abdominal ultrasound, Hida Scan with CCK, blood tests, urine tests. The only thing that ever showed anything it shouldn t was the urine have bilirubin. The rest of the tests are showing normal. The gallbladder hida scan showed ejection fraction of 59%. How am I having all the symptoms of gallbladder problems, and the tests aren t showing it. What does this sound like to you? Please give me a suggestion as to what else it may be, or other tests you feel would be needed to find the problem. Doctor: Hi.Thanks for your query. Read and understood your history and query. You have nausea for 1 month, a long time to keep you from a proper diagnosis; lost weight, have cramping in the right side under the rib, that is referred to the back, sweating, orange urine in the beginning. This followed after 1 week with undigested food in the stools and nausea, 3 ER visits, Hydrocodone increases pain, Urine shows raised bilirubin, coated tongue, all other tests are normal,.All the history together shows that there may be a problem of hepatitis or cholangitis or Sphincter of Oddi dysfunction. Sometimes you need to undergo repeat tests as sometimes the tests may not show the problem. I would advise the following:Get the full liver profile including GGT, this may give a clue. Therapeutic trial with an antibiotic and metronidazole may help to get well. Avoid food rich in fat and oil. Get an opinion of hepatobiliary Specialist.