How to treat abdominal pain, nausea, and vomiting?

Question

Hello doctor,

Four days ago, my girlfriend developed a sore throat, which progressed to a fever. Her symptoms worsened with vomiting and diarrhea. It has been three days since she developed these symptoms and now she vomits every time she eats something. Also, she has a headache and body pain. We went to a doctor and they did some blood tests. I will attach the test results for your reference. She is still feeling nauseous and she is not able to eat anything. The fever has reduced now after taking IVs and tablet Panadol. The doctor we visited did not reveal anything. I want to know if it is a stomach bug, Salmonella infection, or some kind of ulcer. She is in a lot of pain and she is not able to sleep properly. The doctor gave her an IV antibiotic twice, but nothing is helping. In addition, she is also taking tablet Dompy. What could be the reason for her symptoms?

Kindly suggest your opinion.

Answer 1

Hello,

Welcome to icliniq.com.

I have gone through the details you provided along with the attached reports (attachments removed to protect the patient's identity). It seems to be everything started with a fever and sore throat followed by abdominal symptoms like diarrhea and vomiting. That is good if the fever is settled. But her stomach is still upset.

There can be two possibilities. One is a stomach infection due to something eating out or an unhealthy diet in the previous few days. And the other is sometimes medicine, which she was taking before, can cause drug-induced gastritis, vomiting, and loose stools.

Her lab reports are not very conclusive. It would be helpful if you could answer,

1. What is the site of abdominal pain? Is it mid-upper abdominal dull pain or diffuse abdominal pain like cramps?

2. Is her diarrhea relatively better now?

My suggestions will be

1. Use Proton pump inhibitors like Esomeprazole (proton pump inhibitor) 40 mg capsule or tablet half hour before breakfast once daily for one week.

2. Antacid syrup like Gaviscon or Mucaine - two tablespoons full after every meal and as needed at night.

3. Start some Probiotics or yogurt daily (naturally occurring probiotics).

4. Take Domperidone (antiemetic) tablet 10 mg - three times a day, half an hour before each meal.

5. Use Panadol (Paracetamol) only in case of fever. Otherwise, do not use it regularly.

6. Take a soft diet with plenty of water and rest for a few days.

7. Avoid eating out and commercially available fruit juices or products.

Take care.

Answer 2

Hello,

Welcome back to icliniq.com.

The pain in the upper mid part of the abdomen is likely due to stomach issues. It can be gastritis or acid peptic disease. So, I suggest you make her follow the instructions mentioned below,
Take a soft diet, ideally home-cooked food.
Drink plenty of water.
Avoid NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) group of painkillers like Diclofenac Sodium, Diclofenac Potassium, Ibuprofen, or Ponstan (Mefenamic Acid).
Consume commercially available probiotics or take yogurt daily, a natural probiotic.
Let her take a rest.
If her pain persists even after 24 hours, she may need an ultrasound abdomen and some blood tests.

The chances of typhoid are less if the fever is settled. And, yes, the ulcer is a possibility, but it looks more like severe gastritis rather than an extensive ulcer. Also, alarming features of ulcers are blood in vomit, blood in stools, or dark black colored stools. She needs to visit a nearby hospital if she has any of these alarming features.