If you are a doctor what would you have me do?

[sparklins]

I posted under a different username a few weeks ago about my visit to A&E.

Basically I woke up with abdominal pain/midriff pain one morning. It got much worse an hour in, pain located just under my rib on the left side and also similar on the right but not as bad in addition, also pain radiating across my abdomen between these two points. This was accompanied by some milder abdominal pain lower down but it was background noise compared to the pain closer to my ribs. Never had this type of pain before. I couldn't get dressed, was in tears.
I've given birth twice with no pain relief whatsoever and I found labor hurt less than whatever this was.
By the time I got to A&E it subsided within 15 minutes or so after being intense for almost 3 hours. But the areas where the pain was feel sore and tender.
White blood cell count raised. Everything else normal. No UTI or anything of that sort.

I ended up getting an ultrasound primarily to check the appendix and any cysts around the ovaries but they did not find anything, I was discharged with no diagnosis.

I thought it was a one off but for the past couple of days I have been having a general pain around my midriff, nothing debilitating but more uncomfortable and feels quire tender especially if I do any energetic movement. Also radiating around my sides at the front like before. At times it almost feels like I'm at the very beginning of getting a stitch but it never comes.
I'm 28 and with a healthy BMI (not sure if this matters) and I am concerned as this is not my normal.

Getting a GP appointment is impossible at the moment and obviously this does not warrant a trip to A&E unless it gets worse like last time. I have 2 young DCs and can't be stuck like this as I need to be able to keep up with them without being so uncomfortable all the time.

If I did manage to get an appointment do you think they would suggest any further tests considering I already had an ultrasound?
Or would I be wasting time and should I just sit on it an see how it progresses?

I’ve had exactly the same! Flares up and goes away and the pain is agonising, to the point of vomiting. Again like you OP I’ve been through labour with no pain relief and would gladly chose that every day over this pain.

I saw surgical consult with it because I actually had it 14 weeks pregnant, they were 97% it was an appendicitis. They said what they thought I had was a grumbling one that’s going to go at one point. Like you, scans don’t tend to pick anything up, but my scans have always been a few days later, but they said it’s rare that appendicitis gets picked up on an ultra sound as ultra sounds aren’t the best for picking up anything bowl related. Apparently appendicitis is a clinical diagnosis, so pain in the ‘right place’, vomiting, elevated white blood cell count etc.

If you do get an answer would you update me, this has been a once a year occurrence for me for 5 years now x

Lots of comments mentioning gallstones - if you went in with abdo pain, they would have done liver function tests which would show some derangement if you had any obstructing stones. Your white cell count was likely raised because of pain. I would see GP about this, it may just be one of those things that disappears as quickly as it appears. If you can, try taking ibuprofen regularly for a few days - it could be costochondritis which can take a few weeks to settle down

Keep trying your own GP

You say you can't get through to the GP on the phone. Since covid my surgery has an online triage system where you say what's wrong with you and generally they call you back within a few days depending how serious/urgent it is. I've found it much easier than before to get appointments, the calls fit around work better and they are more efficient as they have an idea of what's up before they call.

If your surgery doesn't have that and you can't get through on the phone then you 100% need to walk over and ask them what the secret is because nobody should be unable to get appointments to speak to their GP.

[quote sparklins]@speckledcat thanks so much for all your input.
I might try to call the hospital and ask if the scan also included the gallbladder.

@RAFHercules I will be extremely lucky if I manage to get in touch with my GP practice any time soon. At the moment you end up on hold for hours and cut off half the time before anyone picks up the phone.[/quote]
Hi OP, I've been suffering with gallstones for 6 years. Only I didn't know this until a few weeks ago where I ended up with jaundice and my liver not functioning correctly. I have been suffering pains on and off for years, ended up in A&E a few times, they always mentioned but dismissed gallstones as I was young and not particularly overweight. I'd ask to be referred by your GP for a scan to look specifically for this issue. It's not going to be quick and the wait time for removal is long unless you're unfortunate enough to develop really serious side effects, so it's worth starting the process asap really. Keep an eye out for more serious complications (all over itching, bright orange urine, yellowing around the edge of your eyeballs etc.)

It sounds like gallstones, I agree with the others. I get these pain attacks when I've had a day or two of eating foods particularly high in fat. Greasy food definitely sets it off. If I eat healthily, I'm fine.

I second biliary colic. I had similar pain on a few occasions, like you say worse than childbirth with no painkiller! Made me curl up in fetal position thinking I was going to die but couldn't do anything about it. I finally twigged it was when I was dieting and not eating any fat, research enlightened me that this makes the bile go thick and sticky as it isn't being used so stays in the gall bladder/bile duct. I also discovered if I took ibruphren (anti-inflammatory) as soon as it started to come on then it shortened the episodes. Once the pain had gone the area was very tender/sore for a couple of days. I stopped the very low fat dieting and haven't had an episode again............. Am fat though🤷😁

When I had my ultrasound for my gallstones, he had to really press down very hard under my rib cage to get it to show on the scan. It was quite unpleasant! But just scanning over the area gently didn't show it. It was definitely a dig deep type of scan.

Please just persist with getting a GP appointment. Generalised abdominal pain has a wide variety of differential diagnoses.

Gallbladder pathology is best seen on ultrasound. It is likely that they just concentrated on ruling out things like appendicitis and rupture ovarian cysts on your trip to A&E which could be reasonable with your symptoms at the time. Usually presents with right sided pain under the ribs.

Gynaecological conditions would be good to rule out and I would want my GP to refer me to a gynaecologist for further investigations in your position. Things like pelvic inflammatory disease, endometriosis, fibroids etc… most require a hysteroscopy to get a certain diagnosis.

Colonic conditions like IBS etc would be down my list of differentials if no altered bowel habit etc.

@Mantlemoose

Gallbladder I would say. Often stones don't show up on an ultrasound so an endoscopy is required.

An ultrasound is the best way to detect gallstones. An endoscopy although I think you might mean ERCP is used to retrieve gallstones in the common bile duct.

@Justheretoaskaquestion91

Did the ultrasound show intestines? A doctor once told me you’d be amazed how often debilitating tummy pain in women is actually constipation/impacted bowel. You can be pooping every day and still have it

Absolutely this. I've been told this exact thing today after having similar pain, hospital admission, ultrasound, xray, ct scan all to check pancreas, gall bladder etc.

Hi OP, please tell your GP all of your symptoms, and if you can't do this through a face to face or even a telephone appointment in the next few days, then please email your named or favourite Dr, and very importantly, copy it to the practice manager. Then if you still haven't heard anything from anyone, contact the practice manager directly - they are usually very good at giving a Dr a boot up the backside sorting things out quickly.
Even if your symptoms are mild at the moment, it is imperative that your GP starts logging them, but he should really be sending you for certain tests and scans anyway. If he doesn't send you for any further tests at the moment you must keep on letting him know every time you get a new, changed or recurring symptom, and particularly if the pain gets worse. If you have any further debilitating pain, and the GP surgery is open, I think you should just take yourself down there, and ask politely, but firmly, to see a Dr. If it isn't open go straight to A&E, which is probably the preferable option.

I would start from the beginning Taking a history and then give an abdominal squishing to find which bit still hurt.
I'd suggest more water and fibre in your diet.
I might run some bloods again.

I had appendicitis, had a grumbling appendix for a while and it was how you described , also raised white blood cell count and nothing seen on ultrasound but did eventually have it removed.

I think you need to get your self a decent dose of perspective here. You have what sounds like a debilitating medical condition. You need to listen to your doctor, who went to medical school for many years, has examined you and has access to the tests (all of them) you have had. You don’t need to listen to a bunch of randoms on mumsnet telling what dr amateur thinks is the problem.
Please just try and trust your doctor, or if you don’t, get one you do trust. Your health is too important to be taking advice from unqualified strangers.

First, you must push for a GP appointment who can refer for further testing.

Gallbladder pain tends to be in the upper right side of the abdomen, though it can radiate, so it could be something else. Have you any swelling or a lump?

Sorry I haven't been back to this thread for a couple of days.

I'm not in as much discomfort anymore but it's quite hard to explain. Every now and then my abdomen just feels uncomfortable/borderline painful but definitely more discomfort than pain. Sometimes it's a few mins sometimes less than a minute.
I was wondering if anything in particular is triggering it so I am trying to keep an eye on when it happens at the moment.

@Tonyschoco no swelling or lump at the moment.

I was worried when I initially posted as the discomfort felt like the beginning of another episode like last time but it's eased for now.
However I am kind of instinctively finding myself eating smaller portions of food at the moment.

I will see if I can get an appointment at some point but as mentioned before at the moment it's a struggle to even get through.

Sorry I just realized that post was just a lot of ''at the moments'' .