Unexplained Chest and Abdominal Pain: A Family Medicine Perspective

Q: Unexplained Chest and Abdominal Pain: A Family Medicine Perspective

Hello： The symptoms you described are quite nonspecific, and further examination may be necessary to make a proper assessment. <br>I recommend that you visit the Family Medicine outpatient clinic for an in-person evaluation by a physician. <br>Thank you. <br>Wishing you safety an

Pain points are not always definitive?

Hello doctor, I have been experiencing symptoms for over six months.
Initially, I had unexplained pain in my left chest, and one time while sleeping, I suddenly had severe pain in my left rib cage and fainted for a moment.
After that, I frequently experienced sharp or aching pain in my left rib cage, which is noticeably protruding.
Sometimes, I also feel pain in my right rib cage, but it is less frequent.
Recently, I have started to feel unexplained sharp pain around my abdomen, and at times, my abdomen feels hard.
When sitting, it feels like there is a stick horizontally blocking my abdomen, which is very uncomfortable.
However, my abdomen does not hurt after eating.
The points of pain vary each day, but the left rib cage is the most common area of pain.
Sometimes, I feel very fatigued and often feel like vomiting.

Xiao Zhen, 30~39 year old female. Ask Date: 2016/07/18

Dr. Gao Qingyun reply Family Medicine

Hello: The symptoms you described are quite nonspecific, and further examination may be necessary to make a proper assessment.
I recommend that you visit the Family Medicine outpatient clinic for an in-person evaluation by a physician.
Thank you.
Wishing you safety and health.
Sincerely, Dr.
Gao Qingyun, Director of Family Medicine, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2016/07/18

More Info

When dealing with unexplained chest and abdominal pain, especially in a patient with a complex medical history, it is crucial to approach the situation with a comprehensive understanding of potential underlying causes. Your symptoms, which have persisted for over six months, include left chest pain, rib discomfort, and abdominal pain, warrant a thorough evaluation.

Understanding Your Symptoms
1. Chest Pain: The left-sided chest pain you describe could be related to several issues. Given your history of discomfort and the acute episode where you fainted, it is essential to rule out cardiac causes. Conditions such as angina, myocardial infarction, or pericarditis could present with similar symptoms. However, since you also mention rib pain and a noticeable protrusion of the left rib, musculoskeletal issues like costochondritis or rib fractures should also be considered.
2. Abdominal Pain: The abdominal pain, particularly the sensation of hardness and discomfort, could indicate several gastrointestinal issues. Given that you do not experience pain after eating, it may suggest that your symptoms are not directly related to food intake. Potential causes could include:
- Gastrointestinal Disorders: Conditions such as irritable bowel syndrome (IBS), diverticulitis, or even inflammatory bowel disease (IBD) could manifest with intermittent abdominal pain.

- Musculoskeletal Causes: The pain could also be referred from the thoracic region or due to muscle strain in the abdominal wall.

- Visceral Pain: Conditions affecting the organs within the abdomen, such as the spleen or pancreas, could also lead to discomfort in the left upper quadrant.

Recommended Steps for Evaluation
1. Medical History and Physical Examination: A detailed medical history, including any previous health issues, family history of diseases, and lifestyle factors, is essential. A physical examination focusing on the abdomen and chest will help identify any tenderness, rigidity, or abnormal masses.

2. Diagnostic Tests:
- Electrocardiogram (ECG): To rule out any cardiac issues, especially given your fainting episode.

- Chest X-ray: This can help visualize any rib abnormalities or lung issues.

- Abdominal Ultrasound or CT Scan: These imaging studies can provide a clearer picture of the abdominal organs and help identify any structural abnormalities.

- Blood Tests: Complete blood count (CBC), liver function tests, and markers for inflammation can provide additional insights into your condition.

3. Referral to Specialists: Depending on the findings, referrals to a cardiologist for heart-related concerns or a gastroenterologist for digestive issues may be necessary.

Addressing Anxiety and Mental Health
It is also important to consider the psychological aspect of chronic pain. Anxiety and stress can exacerbate physical symptoms and lead to a cycle of discomfort. Engaging in relaxation techniques, cognitive behavioral therapy, or even discussing your concerns with a mental health professional can be beneficial.

Conclusion
In summary, your symptoms of unexplained chest and abdominal pain require a multifaceted approach to diagnosis and management. It is vital to consult with a family medicine physician or an internist who can coordinate your care, perform necessary evaluations, and refer you to specialists as needed. Early intervention and a thorough understanding of your symptoms will be key to improving your quality of life and addressing any underlying health issues. Please ensure you seek medical attention promptly to address these concerning symptoms.

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