Doctors Lounge - Gastroenterology Answers
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Forum Name: Gastroenterology Topics
|trace27 - Wed Jun 09, 2010 6:03 am||
i started get very bad stomach pains nearly 10 years ago when i was about six months pregnant and i was told it was my babys feet under my ribs but the pain was really bad, after i had him i still kept getting the pains n still do now 10 years later it just comes from no where i could be just watchin tv or having my dinner or even asleep and it wakes me, the pain is unbearable sometimes and i get hot and struggle to breath after it goes i feel weak and tired, the pain can come and then go half hour later and i might not get it again for a month or even 7 months then i might get it everyday for 5days and then not agen for a year. i have had it on and off fo 10 years and its really sore also my stomach where i get the pain by my ribs is always tender to touch. i have had scans xrays blood tests and nothing is showing up, no one knows what this could be im on tablets for acid and tablets for ibs and neither are working as i have the pain severel times since.
|Dr.M.Aroon kamath - Tue Jul 06, 2010 9:56 am||
It is unfortunate that you are repeatedly experiencing such distressing symptoms. If the more common causes have been excluded, then necessarily,one has to think of the more uncommon causes of "obscure" abdominal pain.
Some of these uncommon causes include,
- Abdominal angina, of which, there are several types.
One such is the 'Median arcuate ligament syndrome' wherein, the median arcuate ligament, which forms part of the opening through which the thoracic aorta enters the abdomen, compresses on the celiac trunk which supplies the stomach, duodenum and the liver. This causes severe upper abdominal pain which is frequently post-prandial.This has been reported in young individuals.
Superior mesenteric arterial occlusion(thrombosis or embolism).This generally occurs in older individuals (>60 years).
- Gastric volvulus: is twisting of the stomach upon itself. This can happen intermittently. There are two types of gastric volvulus (organo-axial and mesenterico-axial).
- Chronic abdominal wall pain: frequently unrecognized or confused with visceral pain. Often leads to extensive, expensive and futile search for a visceral cause. It is believed to be an "entrapment neuropathy" involving the lower(T 7-T 12) intercostal nerves. After coursing in between the abdominal wall muscles, these make an acute turn (90º)and pass through the posterior sheath of the rectus abdominis muscle through a fibrous opening and then via its anterior sheath.It has been postulated that the nerve compression occurs during its course through the rectus sheath.the nerve may also get entrapped in scar tissue( a neighbouring scar of previous surgery).
Pain is always very localized (patients tend to point out the site of pain with a finger tip). Diagnostic clinical test is the Carnett’s test: demonstrated by palpating the tender spot in the prone relaxed patient and looking for continuing or often increased tenderness as the patient is asked to tense the abdominal wall by elevating the head and shoulders or raising their legs (positive test). If the pain is visceral, the pain is relieved (negative test), as the muscle guarding protects the viscera.
Other causes of abdominal wall pain are abdominal wall hematomas,
occult hernias(epigastric hernias are at times difficult to see or feel-especially in the obese individuals).
In your case, Chronic abdominal wall pain needs to be excluded first among others.
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