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Abdominal pain in night with normal ULTRASOUND, BLOOD RESULTS.

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Experiencing moderate-severe abdominal pain below rib cage and on the sides of abdomen.
The great pain prevents me from inhaling normally. The pain is most severe when I try (and fail) to inhale deeply.
Occurs only at night. This pain wakes me from sleep 2-6 times every night.
The pain subsides somewhat after I get up during the night and urinate, which I do every time the pain wakes me up. I first experienced this about 3 years ago, when it happened about twice per month. Now it is every night.

When I get up the next day, the pain is present when I awake but quickly subsides as I move around and go about my day. My breathing is not restricted during the day. However, throughout the day I feel a dull, mild pain on the lower sides of my abdomen. This pain seems to be noticeable on the right side during the day.

The pain does not result from pressing any part of my body. I can press my hand against my abdomen and feel no pain or soreness. The pain feels deep and radiates out.

The pain feels entirely different than gas, a menstrual cramp, or a sore muscle. It is affecting my sleep and quality of life and is not normal. Waking up with pain and restricted ability to breathe several times every not is not normal. I am not one to complain about every slight pain; prior to 2014 I hadn't been to any type of doctor in 7 years.

My primary Dr. has not been able to diagnose thus far after reviewing the following exam/test results. The following recent exams (within the last 2 months) and blood tests indicate a normal, healthy body:

Abdominal ultrasound normal.
Pelvic ultrasound normal.
Gyn exam & pap smear normal.
Urology exam normal, was able to fully empty bladder, although The Urologist requested my abdominal ultrasound results to see if my primary Dr. missed something, perhaps related to the gallbladder. She has not yet reviewed them.
Urinalysis normal,
Blood tests normal: Hep ABC, metabolic panel, lipid panel, direct bilirubin, vitamin D 25-OH LCMSMS, Vitamin B12 serum, ferritin, folate seum, gamma glut transpep, insulin serum, TSH, CBC Auto PLT & Diff, potassium.

My Urologist has advised me to see a gastroenterologist next, as ailments related to other parts of my body seem to have been ruled out.

I think I am physically healthy in general. I am regularly active, I get enough sleep (although my sleep has been suffering with this undiagnosed condition), I eat lots of fruits and vegetables, other high fiber foods, and unprocessed foods in general. I am of normal weight, have excellent cholesterol and normal blood pressure.

I began taking Zoloft (now at 200 mg daily) and Wellbutrin XL (now at 600 mg daily) in April 2014 for lifelong anxiety and depression.
No side effects to speak of.

I see my primary Dr.again in February. I would like to know what more I can tell her about my condition so that we can treat it. It seems serious to me (it certainly feels serious, at least), but she may disagree.

Other details of interest:
Stools twice daily. Every day for the last ~year, they are loose and light brown/mildly orange.

I am always thirsty. I drink water whenever I am thirsty, but my thirst is not quenched. I probably drink too much water every day. It seems I am able to urinate any time during the day. I can always go. This has been normal for me for the last ~15 years.

Menstrual periods are regular and normal, except for the last 4 months, during which I've had the most painful cramps of my life for 2 days out of 5. Ibuprofen normally helps but does not help with these cramps.

Did not smoke or drink alcohol for my entire life, except last year when I drank and smoked excessively for ~6 months (A pack of cigarettes a day, drunk every day, often starting in the morning or afternoon). I stopped cold turkey 4-5 months ago and don't miss it. I feel better without them.

I've had no surgeries except wisdom teeth extraction. No major illnesses.

Family history is physically healthy, except father died of lung cancer at age 72. He did not smoke and was otherwise very healthy and active. Mother is now age 73 and in excellent health.


Category: Gastroenterologist, Medical

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Category: Hepatologist
Dr. Ratnakar Kini is online now

Expert:  Dr. Ratnakar Kini replied 4 Days.

Hello,
Thanks for posting your query at DoctorSpring.com
I am Dr.R.K and I am pleased to assist you.
Pain waking you up from sleep is definitely not normal.
You have undergone most of the essential tests which are inconclusive.
With a history of abdominal pain waking you up from sleep and loose stools, I would like to rule out inflammatory bowel disease like ulcerative colitis or Crohn's disease.
I would advise you to get a stool test, a colonoscopy and a contrast enhanced CT scan of the abdomen done to find the cause.
I hope that answers your question.
Let me know if I can assist you further.
Regards,
Dr.R.K.


Patient replied :

Thank you very much for your input, Dr. R.K.. I will raise the subject of gastrointestinal issues at my next primary appointment. My follow up question is this: I know little about bowel diseases, but I thought they are sometimes responsible for poor nutrient absorption and weight loss. As my blood tests indicate good nutrition (although I suppose not every vitamin/mineral level was tested) and I am of normal weight without any weight loss, is it likely that my problem is bowel disease?
Let me mention one more thing, in case it is a symptom of bowel disease. I forgot to mention in my previous query that my ability to think has suffered during the last 5-10 years. I experience cloudy and confused thinking every day. As a child and young adult, I recall learning and comprehending quickly and easily. I excelled at school and at my hobbies. More recently:
-My mind continually "loses its place" thoroughout every day. It goes someplace where there is nothing. I know who I am and where I am, but my mind is otherwise "empty". During these ~30-second episodes, I cannot remember what I was or should be thinking about, and I have no language. I just stand and wait until everything slowly drifts back into my head.
-My critical thinking is poor. I cannot "wrap my brain" around complex ideas, or even not so complex. I don't recall having this problem at a younger age; I have degrees and a career in engineering and natural sciences.
I don't seem to learn anymore. Things don't "stick" when trying to learn. Regarding doing a cursory math problem or making pasta, I have to re-remember and relearn each time I do something. Simple tasks (making pasta) and work-related tasks are not reflexive, spontaneous or completed from memory anymore. I can slowly walk my way through a simple math problem, such as how to calculate the interest owed on a car loan, but after I've done it, even multiplpe times, I will have to teach myself how to do it all over again each time. I have poor short-term memory. Anything I teach myself quickly exits my brain and I must teach myself all over again. I don't like to talk to people because after I say a couple sentences, I'll forget the point that I was trying to make. I have trouble finding the right words, even though I consider myself well-read and know the meaning of many words. I now work slowly and inefficiently and I am not cutting it. I feel as though I've become a dimwit, and I feel terrible about that.
Can a physical ailment such as bowel disease cause cloudy thinking? This problem began years before I started taking the medications I mentioned in my first query. I've experienced no traumatic brain injury. I've been told by several doctors that cloudy thinking can be a result of my anxiety/depression/and emotional trauma. I'll buy that to a degree, as from time to time I have felt utterly mentally burned out due to anxiety/depression/trauma. I feel I know precisely what a person means when she says "my nerves are shot." However, I can't help thinking that there is an organic cause of this problem. Or perhaps I truly am stupid and therefore depressed about my stupidity.
Anyway, my main question is: Can a physical ailment such as bowel disease cause cloudy thinking?
Thank you again.


Expert:  Dr. Ratnakar Kini replied 3 Days.

Hi,
Thanks for getting back to me with more questions.
Small bowel is very long and different nutrients get absorbed in different areas of the bowel. When there is extensive involvement of the small bowel , there will be nutritional deficiency and weight loss. When there is only patchy involvement, there may be only specific nutrient deficiency and there may not be any weight loss. For example if only the terminal ileum is involved you get vitamin B12 deficiency only and not other deficiencies.
Also if it is a large bowel issue there may not be nutritional deficiency and weight loss.
Nutritional deficiency can affect higher mental function and you can have cloudy thinking. But most often it is due to psychiatric issues.


Dr. Ratnakar Kini
Category: Hepatologist
Experience: 
Fellowship - DM - TN Dr.MGR Medical UniversityResidency - TN Dr.MGR Medical University Medical School - Stanely Medical College, TN Dr.MGR Medical University
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