What Causes Flank Pain, Intermittent Nausea And Discomfort Abdomen?

Posted on Mon, 15 Aug 2016

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Mon, 15 Aug 2016 Answered on

Sat, 10 Sep 2016 Last reviewed on

Question : My question is a complex one. Symptoms: Flank Pain, nausea that comes and goes, uncomfortable abdomen, 10mm dilated lymph in groin, 4mm dilated main pancreatic duct, ammonia smelling stools combined mostly with constipation.
Nothing on CT scan. CA19.9, FBE, amylase, Lipase, CEA, ESR, LFT and UEC are all in normal range.
My only concern is my father passed with pancreatic cancer. His oncologist informed me that my father's case was an interesting one as nothing showed up on his CT or Gastroscope either. His only indicator was when his CA19:9 elevated. By then it was too late.
I am now left with ongoing symptoms and do not know which way to turn.
Oh, I also have complicated cysts in my breasts that require FNA and 3 month review, 4cm cyst on ovary too. Hashimotos treated with thyroxine.
MTHFR C677 2 Copies and 1 copy HFE gene C282Y
Do I just learn learn to live with it? I get so tired and need to sleep, it's too difficult to sustain normal day to day functions and yet my BMI is a healthy 23.

It has been 24 Hours now and I have not yet received a response.

Your statement above says "If you do not hear from us within 24-hours, you get your answer free!"

Please can you advise me of the delay in response?

Answered by Dr. Dr. Klerida Shehu (2 days later)

Brief Answer:
Please follow,,,,,

Detailed Answer:
Hi and thank you for asking.
I read carefully all your symptoms and review your medical reports.
As a result I can say as follows:
1. With regards to pancreatic issues I can say that since Ct , Ca19-9 is normal than it is unlikely to have pancreatic cancer. Otherwise If I were your treating doctor since you have had familiar history with rare pancreatic cancer form I would suggest to do EUS( endoscopic ultrasound). It is a gold standard diagnostic procedure for pancreatic issues. Apart from diagnostic skills it offers the possibility of FNA biopsy of the pancreas.
2. I would like to know to about upper endoscopy result , because your symptoms can be explained by gastric issues like ulcer and gastritis.
3. You are reporting to have been diagnosed with breast cysts that needs FNA study and follow up. At this case I would suggest to do FNA tests and follow up as by physician recommendations.
Hope it was helpful to you.
Please don't hesitate to ask me again if you have other concerns.
Dr.Klerida

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Klerida Shehu (59 minutes later)

Thank you for your feedback however, if I may repeat my question in Patient Profile - Medications Tried:

I would really like to know more about should I have a K-Ras gene test due to dad's chemical exposure or the CDKN2a melanoma gene test given we are covered in moles and they could not find dad's cancer. Any of my suggestions in regards to this question have been non responsive. What do you have to do to get a Doctor to agree to doing these gene tests? I'm happy to pay for it myself and have the piece of mind.
The XXXXXXX XXXXXXX Hospital reported that: It is known that K-ras mutations occur long before the formation of the actual cancer. They form in the precancerous stages, within lesions termed PIN, or Pancreatic Neoplasia. These are ducts with clones of early neoplastic cells which have not yet invaded through the duct wall.

Answered by Dr. Dr. Klerida Shehu (26 hours later)

Brief Answer:
Please follow....

Detailed Answer:
Hi back,
Sorry for my late but it has been due to long services on Hospital.
With regards to the fact that if you should K-Ras gene test or CDKN2a melanoma gene test, I think that yes you should have them.
My opinion is based in two reasons
1. You have a first degree relatives ( your dad) diagnosed with pancreatic cancer. It means than you risk for developing cancer is higher than the other population( different studies have different percentages of the risk).
More than the Gene tests you mentioned above I would suggest to do
-BRCA1
-BRCA2
_CDKN2A
- PALB 2 gene tests since these are four mutation genes associated more with familiar pancreatic cancer.
2. In recent time the genetic test is made even only to calculate the risk for developing breast, colo rectal or ovarian , pancreatic cancer. Without having any familiar predispose for cancer.
This is why I don't see any reason why you should have these tests, especially if you are ready to pay by yourself.
Hope it was helpful to you.
Dr.Klerida

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Klerida Shehu (34 hours later)

Thank you for your service and opinion.
When I saw my GP yesterday (that he phoned and requested for me to see him)he actually has referred me to see this gentleman in Melbourne on Monday:

A/Prof Val Usatoff is a specialist in the area of Liver(Hepatic), Pancreatic and Biliary Surgery.

I will also as per requested, be having my breasts biopsies performed in the late afternoon on the same day.
Blessings to you always.

Answered by Dr. Dr. Klerida Shehu (18 hours later)

Brief Answer:
Please follow...

Detailed Answer:
Hi my dear,
It's the best choice to consult a liver specialist.
It would be great if you can write me again and tell me what are your test results.
Wish you health
Dr.Klerida

Note: For further queries related to kidney problems Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar