Here are some specifics:
1) Dull pain which she has had for over two years in her upper right abdomen.
2) Eating does not seem to make the pain in her right side worse. The pain does not seem to follow any eating pattern.
3) Joint pain in the hips shoulders, neck and back which is worse in the mornings. At times she classifies is as severe.
4) An Arthritis test came back as negative.
5) Red itchy rash on her arms, legs and chest when exposed to extended periods of sunlight.
6) Fatigued all the time.
7) Passed a Hida-Scan to test the gall bladder with an 87% evacuation rate. From an article online, anything > 35% would be acceptable.
Missed or late periods for almost every month for the last year.
9) Had a colonoscopy and upper GI performed last Friday with no problems detected.
10) Weight gain of almost 30 pounds in the last year. She has stopped working out due to the abdominal pain which I am certain contributed to the problem.
11) Lowgrade fever in the 99-100 range.
12) Elevated Sed Rate of 49. A subsequent test was at 35 with 20 being the max for the normal range.
13) Swollen lymph nodes in her abdomen which was detected in a CT scan (listed as mild mesenteric adentis on the report)
14) RBC and HCT count was low on 6/3/09.
She went back to her family physician today who is sending her to a Rheaumatologist for the joint pain but did not have a recommendation for the abdominal pain. Any suggestions would be greatly appreciated!.
Thank you VERY much for the question. I’m sorry to hear about your wife’s illness.
First, some philosophical points.
In medicine, things are not always what they to appear to be. This phenomenon has been born out a plethora of times dating all the way back to Dr. Osler himself.
Further, in medicine, there are two competing approaches to diagnosis. The first is Occam’s Razor: all things being equal, the simplest explanation is likely to be the correct one. That is to say, a single unifying diagnosis is the most plausible and likely the correct and only one. The second approach is entrenched in what is called Saint’s Triad: more than one disease process may be responsible for the presenting illness.
So, which philosophy do internists, pediatricians, etc., take in the process of differential diagnosis? Well, that is highly dependent on the intelligence, experience, and acumen of the individual clinician.
Without knowing all the facts, I suspect that your wife’s abdominal pain is the NOTmain problem. Her pain may simply be a manifestsation of the problem (Occam’s Razor) or problems (Saint’s Triad). Often, clincians are fooled by the fallacy that a symptom or sign MUST be originating from the geographical organ system. Not true . . . ohhhh, so not true . . .
Based on the information that you’ve provided (thank you), I suspect that the abdominal pain is not visceral per se, but is being caused by either a systemic inflammatory process, (i.e., autoimmune disease, paraneoplastic syndrome) or a metabolic syndrome (i.e., acute intermittent porphyria) or an infectious process.
There are several salient features in your wife’s case, but the one that intrigues (and worries) me the most is PHOTOSENSITIVITY, which has a limited differential diagnosis. But what immediately comes to mind is systemic lupus erythematosis and acute intermittent porphyria.
If I may ask for additional details,
1. How old is your wife?
2. Does she have any oral or canker sores?
3. Does her urine change color when the abdominal pain strikes?
4. Is her serum calcium normal?
5. Has she been evaluated for primary hyperparathyroidism?