Q. What is the reason for abdomen pain and poor appetite?

Hello doctor,

I am an unmarried 35-year-old male. It all started last month when I experienced mid-epigastric pain one fine morning. I took some pain relievers and got rid of that. Then, after almost a week, I got lower back pain on the right side suddenly one morning, then, upper back pain middle to the right side next day afternoon, below the right shoulder blade, which is persistent till date. I did many ultrasounds and X-rays and several blood tests. The ultrasound always said grade-1 (mild fatty liver). I got CT and MRCP first done two years ago and again last year. I then got MRCP done again thrice in the last year. Every time I am seeing the tests as 'normal'.

I experienced a bit of testicular atrophy and muscle atrophy and weight loss (I went down to 70 kg from 78 kg) and less appetite. Then, I saw my abdomen protruding a bit. I gained some weight in between. (now 80 kg). Asymptomatic urination - sometimes normal urination, sometimes no urine for three to four hours. Last year, there was a small underarm swelling on my right underarm which still persists and it is painful if I press it hard. I got severe viral infections a month and two later and lost a little weight.

Now, I have been experiencing severe back pain on my back, mostly on my middle to right side. Appetite is also very little. I have undergone several blood tests, CT, MRCP, lumbar-pelvic MRI, ultrasound, X-rays, etc, in these two years and did not get any specific diagnosis. I am not sure whether it is my liver, spine, bone marrow, lymph nodes, pancreas, gallbladder, or stomach that is causing this trouble. Early this year, I underwent upper GI endoscopy for my poor appetite, and the doctor discovered a small ulcer in my pyloric channel (caused by H.pylori). I was put on the triple therapy for the same, still no positive outcome. My liver enzymes (SGPT and SGOT are mildly elevated). This back pain and loss of appetite are killing me almost every day. I fear some kind of malignancy as my mother succumbed to gallbladder cancer and associated complications two years ago. The pain I am experiencing is as if something is pressing on my right side back, below the shoulder blade (referred pain). I am left out with more invasive procedures such as endoscopic ultrasound, liver biopsy, PET CT, FNAC, bone marrow biopsy, HIDA scan etc. My ESR and LDH are slightly elevated for almost a year. My sugar is under control. My lipid profile is a little bit abnormal, H. pylori IgG negative, vitamin D insufficient, testosterone is below the normal range, and kidney profile is normal.

Hello doctor,

My LDH is 277 and ESR is 18. These were last tested in the past one month.

Thank you.