
What Causes Intense Pain In The Right Side Of Abdomen?

Posted on
Fri, 10 Apr 2015
Medically reviewed by
Ask A Doctor - 24x7 Medical Review Team


Question : My daughter, Liv, has had intense pain in her right belly area since March 24. She has been to the ER three times and seen three different ER doctors, her family doctor and two different GI doctors.
Liv woke up a little after midnight on March 24 with extreme pain in her right abdomen. When the pain got worse over the course of the next few hours, she went to the ER in the wee hours on Tuesday, March 24 when she was in XXXXXXX Falls, XXXXXXX visiting. That ER doc gave her some IV pain meds and IV antibiotics. He did the standard blood and urine tests, two pelvic exams and a CT scan. The ER doc said the CT scan was clear and all the other tests were within normal ranges. He conjectured that Liv had pelvic inflammatory disease, gave her a prescription for antibiotics and said there was nothing else he could do. Liv continued to be in severe pain. When she arrived home in on XXXXXXX Tuesday afternoon, she went straight to the ER. Another CT scan was performed. The XXXXXXX ER doc said that the appendix was a very small organ and sometimes hard to see. He said that Liv's appendix WAS inflamed but not to the point of needing an appendectomy. The XXXXXXX ER doctor thought it might be an ovarian cyst. Liv had seen her gynecologist within the last month. Liv called her family doctor on Wednesday because the pain was a consistent level 8 with stabbing pain that reached a 10. (Liv is not one to complain.) The family doctor referred her to a GI doctor who saw her on Thursday, March 26. Based on a manual palpitation of Liv's abdomen, the GI doctor put Liv on antibiotics for e coli and said she had an overgrowth of bacteria. That did nothing to relieve her pain and increased the nausea and caused a yeast infection. She called the GI doctor back on Saturday March 28. The PA who returned the call told Liv to go to the ER if she didn't get any better. Liv did better from Sunday, March 29 through Tuesday, March 31 with a pain level of about 5. With the pain meds she had, the pain was more manageable. Liv had just started a new job and was worried about being off for a week already so she returned to work on Wednesday, April 1. But standing on her feet proved to be too much and the pain came back with a vengeance. Liv called her family doctor back on Friday, April 3 as she was in worse pain. The family doctor then did xrays and saw that Liv's colon was impacted. Liv had lost nine pounds in a week and she was a size 2 before this all started. The family doctor gave Liv some kind of laxative pill in the office and sent her home with instructions to use laxatives and enemas to get her colon moving. That did work to help her poop but did not help the pain much at all. Liv called the family doctor back on Monday, April 6. The family doctor said to quit taking the antibiotic. The family doctor then referred Liv to another GI doc who put her on Linzess last Monday, April 6. Her pain increased and she started throwing up. She called the GI doc back on Tuesday, April 7. The GI doctor advised her to quit taking the Linzess and call him if things got worse. She then developed burning on urination, nausea and low grade fever. Liv got some Tramadol for the pain. The chronic pain was still constantly at 5-6, but the sharp 9-10 pain started happening more frequently and lasting up to an hour. The sharp pains have moved left to right and right to left and sometimes localize in different areas but mainly the right lower abdomen. The GI doc scheduled a biopsy for next Tuesday, 04.14.15.3 The pain increased yesterday (Thursday) to the point where Liv was frightened. She was aslo throwing up and had a low grade fever. She called the GI doctor but did not hear back from him so she went to the ER as he had instructed. The GI doctor staff advised the ER doctor that GI doctor was not in. However, according to the ER doctor, the GI doctor's associate said that since Liv already has a colonoscopy scheduled for Tuesday, he would not approve one as an ER procedure. In the ER, Liv had a blood test and urine test. All were reported to be within normal ranges. She was given a shot of Bentyl and IV Levsin. The ER doctor said that since "nothing was wrong", there was nothing further that could be done and Liv was summarily dismissed. Liv grew increasingly worse and was in screaming pain last night for over an hour. She said it felt like she was being stabbed. When that subsided, she fell asleep and slept five hours. She feels better this morning. I am worried that something might have burst and there may be infection leaking into her gut. She does not want to go back to the ER because her pain level is about 7 right now. She is dizzy and nauseated and has a headache. Liv felt like the doctor thought she was a hypochondriac and doesn't want to go through that shaming again. She wants to wait and see what happens. Meanwhile, we are waiting for the GI doctor to call us back. I am frantic with worry and hoping to get some realistic advice from a different perspective. I would appreciate an answer as quickly as possible as I am afraid something terrible might be happening.
Liv woke up a little after midnight on March 24 with extreme pain in her right abdomen. When the pain got worse over the course of the next few hours, she went to the ER in the wee hours on Tuesday, March 24 when she was in XXXXXXX Falls, XXXXXXX visiting. That ER doc gave her some IV pain meds and IV antibiotics. He did the standard blood and urine tests, two pelvic exams and a CT scan. The ER doc said the CT scan was clear and all the other tests were within normal ranges. He conjectured that Liv had pelvic inflammatory disease, gave her a prescription for antibiotics and said there was nothing else he could do. Liv continued to be in severe pain. When she arrived home in on XXXXXXX Tuesday afternoon, she went straight to the ER. Another CT scan was performed. The XXXXXXX ER doc said that the appendix was a very small organ and sometimes hard to see. He said that Liv's appendix WAS inflamed but not to the point of needing an appendectomy. The XXXXXXX ER doctor thought it might be an ovarian cyst. Liv had seen her gynecologist within the last month. Liv called her family doctor on Wednesday because the pain was a consistent level 8 with stabbing pain that reached a 10. (Liv is not one to complain.) The family doctor referred her to a GI doctor who saw her on Thursday, March 26. Based on a manual palpitation of Liv's abdomen, the GI doctor put Liv on antibiotics for e coli and said she had an overgrowth of bacteria. That did nothing to relieve her pain and increased the nausea and caused a yeast infection. She called the GI doctor back on Saturday March 28. The PA who returned the call told Liv to go to the ER if she didn't get any better. Liv did better from Sunday, March 29 through Tuesday, March 31 with a pain level of about 5. With the pain meds she had, the pain was more manageable. Liv had just started a new job and was worried about being off for a week already so she returned to work on Wednesday, April 1. But standing on her feet proved to be too much and the pain came back with a vengeance. Liv called her family doctor back on Friday, April 3 as she was in worse pain. The family doctor then did xrays and saw that Liv's colon was impacted. Liv had lost nine pounds in a week and she was a size 2 before this all started. The family doctor gave Liv some kind of laxative pill in the office and sent her home with instructions to use laxatives and enemas to get her colon moving. That did work to help her poop but did not help the pain much at all. Liv called the family doctor back on Monday, April 6. The family doctor said to quit taking the antibiotic. The family doctor then referred Liv to another GI doc who put her on Linzess last Monday, April 6. Her pain increased and she started throwing up. She called the GI doc back on Tuesday, April 7. The GI doctor advised her to quit taking the Linzess and call him if things got worse. She then developed burning on urination, nausea and low grade fever. Liv got some Tramadol for the pain. The chronic pain was still constantly at 5-6, but the sharp 9-10 pain started happening more frequently and lasting up to an hour. The sharp pains have moved left to right and right to left and sometimes localize in different areas but mainly the right lower abdomen. The GI doc scheduled a biopsy for next Tuesday, 04.14.15.3 The pain increased yesterday (Thursday) to the point where Liv was frightened. She was aslo throwing up and had a low grade fever. She called the GI doctor but did not hear back from him so she went to the ER as he had instructed. The GI doctor staff advised the ER doctor that GI doctor was not in. However, according to the ER doctor, the GI doctor's associate said that since Liv already has a colonoscopy scheduled for Tuesday, he would not approve one as an ER procedure. In the ER, Liv had a blood test and urine test. All were reported to be within normal ranges. She was given a shot of Bentyl and IV Levsin. The ER doctor said that since "nothing was wrong", there was nothing further that could be done and Liv was summarily dismissed. Liv grew increasingly worse and was in screaming pain last night for over an hour. She said it felt like she was being stabbed. When that subsided, she fell asleep and slept five hours. She feels better this morning. I am worried that something might have burst and there may be infection leaking into her gut. She does not want to go back to the ER because her pain level is about 7 right now. She is dizzy and nauseated and has a headache. Liv felt like the doctor thought she was a hypochondriac and doesn't want to go through that shaming again. She wants to wait and see what happens. Meanwhile, we are waiting for the GI doctor to call us back. I am frantic with worry and hoping to get some realistic advice from a different perspective. I would appreciate an answer as quickly as possible as I am afraid something terrible might be happening.
Brief Answer:
more options can be tried
Detailed Answer:
Hi
Welcome to Healthcare magic.
You have given a very beautiful summary of Liv.
Such fluctuating right side abdominal pain may be due to Gall bladder or bile duct stone, Ureteric calculi or appendicitis. Rarely diverticulitis may manifest like that.
She should get an ultrasound of whole abdomen, an LFT,CRP,ESR and a Urine routine test on the sample collected at the time of peak pain episode.
I hope this work up should give some clues to the diagnosis.
If still it remains unclear the Endoscopic Exploratory Laparotomy should be considered.
I hope the advise will be helpful for you.
more options can be tried
Detailed Answer:
Hi
Welcome to Healthcare magic.
You have given a very beautiful summary of Liv.
Such fluctuating right side abdominal pain may be due to Gall bladder or bile duct stone, Ureteric calculi or appendicitis. Rarely diverticulitis may manifest like that.
She should get an ultrasound of whole abdomen, an LFT,CRP,ESR and a Urine routine test on the sample collected at the time of peak pain episode.
I hope this work up should give some clues to the diagnosis.
If still it remains unclear the Endoscopic Exploratory Laparotomy should be considered.
I hope the advise will be helpful for you.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar

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