Q. I have abdominal, back, and joint pain with vaginal discharge. What could be the cause?

Hello,

Welcome to icliniq.com.

I can understand that you must be very upset regarding your ongoing undiagnosed abdominal pain. The description of pain, joint pain, younger age, and weight loss with the absence of menstruation suggest some common disorders. Celiac disease, Crohn's disease vascular causes such SMA (superior mesenteric artery) artery syndrome, celiac artery syndrome pancreatitis idiopathic or genetic, and some chronic infections (since you have splenectomy), such as TB (tuberculosis), fungal infections, may be a cause of unreasoned sepsis. And lastly, functional abdominal pain syndromes (FAPS) and one of which is IBS. SIBO seems less likely a reason for recurrent abdominal pain. Now, first of all, I would like to know details about your abdominal pain. Then I would need you to upload all testing that has been done.

Only then would I be able to guide you to the next best step in managing your condition.

1. Where exactly do you feel the pain?
2. Are this like a cramp or stabbing or piercing sharp pain?
3. How would you score this pain on a scale of 1 to 10?
4. Does this pain bother you in the middle of the night?
5. Does this pain go to the back?
6. Do meals or water intake worsen this pain?
7. Do you ever notice blood in stools?
8. Or any change in the color of stools?
9. Does this come in episodes?
10. What are the times when you think the pain is in remission?
11. Does any family members have a history of celiac disease?
12. Do you have any history of allergies?
13. Do you have any history of abdominal cancers?
14. Do you have pets at home?
15. Do you have any invasive procedures like gastroscopy or colonoscopy performed or suggested?
16. Are you sexually active?
17. Do you smoke or take alcohol?
18. Did any ultrasound, CT (computed tomography), or MRI (magnetic resonance imaging) abdomen are performed for these symptoms before?

I would need all the above information and all your testing if available before I can recommend what you should do now. This is a tedious list of questions, but I am sure we would be at some conclusion at the end of this conversation. If you would like to talk to me via phone or video consultation, I would be happy to do that. We probably wrap things faster.

As mentioned above.

Hello,

Welcome back to icliniq.com.

They are not yet uploaded. Kindly upload it again. And I would appreciate it if you could provide answers to the above questions.

Hello,

Welcome back to icliniq.com.

Thanks for providing the further information.

I was unable to read some of your reports, which are not written in English. These are probably CT, MRI reports, and biopsy reports, or colonoscopy or gastroscopy reports. And some of the doctor's notes, I guess, which I could not read. I have seen the other tests which you uploaded (attachment removed to protect patient identity). Acute intermittent porphyria (AIP), and C1 esterase deficiency, are two important causes of abdominal pain, which are essentially ruled out by investigations. After all my assessment (however little compromised by the absence of English), I want you to do the following things. Kindly arrange CT, MRI, biopsy, endoscopies report, and doctor notes in English and upload.

The pain you describe, which is continuous, severe, radiating to back, and bother you in the middle of the night, suggest two to three possibilities.

Pancreas related are, Sphincter of Oddi dysfunction (SOD), functional abdominal pain syndrome (FAPS), and lastly, irritable bowel syndrome constipation-predominant (IBS-C) are functional causes of abdominal pain. Meaning there is no structural abnormality that can be observed or picked on CT scan or blood tests.

Your calprotectin is high, a stool test that determines inflammation in the large bowel (colon). And I also see that your colonoscopy report showed chronic inflammation. However, as I could not interpret the whole report, so not sure what this high calprotectin is exactly mean in your case.

From a treatment point of view, I think of giving you some low-dose antidepressant medications, namely Tricyclic antidepressant (TCA), which are pain modulators which modulate pain arising from the abdomen in functional conditions as mentioned above. Have you tried such medicines before? I want to know your opinion about starting you on TCA. I used many patients with irritable bowel syndrome and FAPS and improved their pain and quality of life.

Kindly arrange the reports in English as I have asked.

Same symptoms doesn’t mean you have the same problem. Consult a doctor now!

Dr. Ajeet Kumar

Experience: 13 + Yrs

Medical Gastroenterology

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