Need Diag help!! Please

[LadyJubilee8_18]

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I know I’m not supposed to post on here because I’m just a lowly pre-med, but I have a chronic health problem that no doctor seems to be very knowledgeable about. I have been sick for about one semester. When I eat meals that are high in fat or any spices, I have really bad stomach aches, vomiting, and diarrhea. Sometimes the attacks are severe and some times they are mild, but I am always very nauseated (weather or not I actually throw up). I went to a doctor today (again) for a sonogram to see if I had gallstones, but I was told that none were visible. I have been sick for the past five nights though I am only mildly nauseated tonight. Last Thursday, after having salmon (that was supposed to be grilled) I ended up throwing up for about two hours. Since then I haven’t been able to eat much. The attacks happen at night usually and last about 3 hours. It sounds a lot like gallstones, but apparently that’s not what it is. If anyone has an idea, please post here or pm me because I have been sick since Jan 26th and I’m exhausted. Thanks for the consideration.

 

[hans19]

I know I’m not supposed to post on here because I’m just a lowly pre-med, but I have a chronic health problem that no doctor seems to be very knowledgeable about. I have been sick for about one semester. When I eat meals that are high in fat or any spices, I have really bad stomach aches, vomiting, and diarrhea. Sometimes the attacks are severe and some times they are mild, but I am always very nauseated (weather or not I actually throw up). I went to a doctor today (again) for a sonogram to see if I had gallstones, but I was told that none were visible. I have been sick for the past five nights though I am only mildly nauseated tonight. Last Thursday, after having salmon (that was supposed to be grilled) I ended up throwing up for about two hours. Since then I haven’t been able to eat much. The attacks happen at night usually and last about 3 hours. It sounds a lot like gallstones, but apparently that’s not what it is. If anyone has an idea, please post here or pm me because I have been sick since Jan 26th and I’m exhausted. Thanks for the consideration.

You're pregnant.

 

[LadyJubilee8_18]

You're pregnant.

No, I took a test because they suggested that today. I'm not pregnant (thank Jesus, I don't have time for that)

 

[beyond all hope]

It sounds like you have a real problem. The differential is probably gastrointestinal (pancreatitis, gallbladder, gastric, hepatic), endocrine/metabolic (adrenal, thyroid, renal), mononucleosis, a reaction to a new food or medication.

1) Make a diet and symptom journal. This will help any doctor get a better picture of what exactly is going wrong with you. Get all of your medical history: ask your parents if you've ever had serious medical problems, and your family medical history.

2) See a good doctor with your symptom journal and a detailed history. You may need to get endoscopy for your stomach. Make sure that you get bloodwork including basic metabolic panel, adrenal function, thyroid function, EBV titers, lipase, and hepatic function. Note this is a pretty expensive panel of tests, so you'll have to have insurance and you may have to really plead your case in order to get your doctor to order them.

3) Consider that if none of this turns up positive it could be stress related, including irritable bowel syndrome, but don't jump to these conclusions until you check everything else.

Good luck

 

[Winged Scapula]

Anyone is invited to post here; the forum is not restricted to residents, so welcome.

OTOH, posts asking "what is my diagnosis" are generally not welcomed.

Consider that cholelithiasis is not the only biliary tract problem which can result in the symptoms you describe. Biliary dyskinesia can cause the same as well; a HIDA scan might be advised. However, the differential for your symptoms are broad and it sounds as if you need a further work-up. Please contact your physician and ask that a further eval be done.

 

[Gimlet]

Maybe you are being poisoned... 😱

 

[gungho]

Consider that cholelithiasis is not the only biliary tract problem which can result in the symptoms you describe. Biliary dyskinesia can cause the same as well; a HIDA scan might be advised. However, the differential for your symptoms are broad and it sounds as if you need a further work-up. Please contact your physician and ask that a further eval be done.

Agree w/Kimberli re: HIDA scan-that'd be my first test (after the U/S), followed by EGD w/possible ERCP, possibly consider upper GI w/SBFT.

 

[Goose...Fraba]

3) Consider that if none of this turns up positive it could be stress related, including irritable bowel syndrome, but don't jump to these conclusions until you check everything else.

Good luck

BINGO!!!! 😉

no actually, first thought-pregnant
second thought-need to R/O stones- though I have a feeling that the HIDA scan will show normal uptake

agree with metabolic workup and CBC with diff, and lytes-esp since been tossing cookies for so long

third thought-viral, worms, or something infectious although this has been going on for a little to long

third and a half thought- newly developed food allergy

fourth and final thought- your a premed, you probably have lots of "stress (just you wait till you get in)" so IBS seems like a very good possibility

fifth thought- your a malingerer, and your trying to come up with more ideas to keep your doctor interested in your "problems".....just kidding I know you wouldnt do that, although I have met patients that did 😱

goose

 

[la gringa]

i had some rather vague GI issues my 2nd year that my dr tried to chalk up to stress, functional dyspepsia, whatever. no v/d though and it ended up being cholesterosis of my gb and chronic cholecystitis -- showed up as biliary dyskinesia on the HIDA scan.

i had to go talk to a GI attending though to get the ball rolling and figure the damn thing out. do what you gotta do...

 

[JackBauERfan]

I know I’m not supposed to post on here because I’m just a lowly pre-med, but I have a chronic health problem that no doctor seems to be very knowledgeable about. I have been sick for about one semester. When I eat meals that are high in fat or any spices, I have really bad stomach aches, vomiting, and diarrhea. Sometimes the attacks are severe and some times they are mild, but I am always very nauseated (weather or not I actually throw up). I went to a doctor today (again) for a sonogram to see if I had gallstones, but I was told that none were visible. I have been sick for the past five nights though I am only mildly nauseated tonight. Last Thursday, after having salmon (that was supposed to be grilled) I ended up throwing up for about two hours. Since then I haven’t been able to eat much. The attacks happen at night usually and last about 3 hours. It sounds a lot like gallstones, but apparently that’s not what it is. If anyone has an idea, please post here or pm me because I have been sick since Jan 26th and I’m exhausted. Thanks for the consideration.

Celiac sprue... if gallstones r/o.

 

[Justin4563]

sounds like either food poisoning or gastritis..

try prilosec otc see if that works.. stay away from nsaids as well..

cholelithiasis wont make you have diarrhea and vomit li ke that.. not typicall also you may have appendicitis...

 

[drdvs]

=Consider that cholelithiasis is not the only biliary tract problem which can result in the symptoms you describe. Biliary dyskinesia can cause the same as well; a HIDA scan might be advised. However, the differential for your symptoms are broad and it sounds as if you need a further work-up. Please contact your physician and ask that a further eval be done.

Agreed. You don't have to have sonographic evidence of gallstones to have cholecystitis either.

 

[imtiaz]

question. she needs a CCK stimulated HIDA scan right? to r/o biliary dyskinesia?

 

[radonc]

i think the first test indicated would be plain films of the abdomen, followed by an u/s of the liver/gb and possibly even a ct scan abdomen/pelvis. i dont think any gi doc would go straight to a hida or ercp...

 

[Winged Scapula]

i think the first test indicated would be plain films of the abdomen, followed by an u/s of the liver/gb and possibly even a ct scan abdomen/pelvis. i dont think any gi doc would go straight to a hida or ercp...

I don't think anyone's advocating HIDA or ERCP as first line and she's already noted that she's had an U/S...presumably a plain film was done first.

What she gets is highly dependent on the venue in which she is seen (ie, ER vs PCP office) and their comfort level with abdominal pain.

 

[Stinger86]

We had a patient last month who came in with bad RUQ pain with all the hx/symptoms/signs of gallbladder disease, but all her ultrasounds and CTs were negative. We did a HIDA scan which also came back negative. Surgery saw her and said "there's no evidence of gb disease; refer to a pain clinic". The day she was going to get discharged a new attending came on the service and ordered a HIDA scan w/CCK and it showed a gb ejection fraction of 3%. The surgeon came back and said "definitely evidence of gb disease; will schedule surgery this afternoon".

Just goes to show you that gb disease can be tricky. Hope everything works out