Recurring Left Upper Abdominal Pain and Associated Symptoms: What to Do?

Abdominal pain lasting over three months, accompanied by swelling and pain in the left upper chest and axilla, as well as soreness in the middle and ring fingers of the hands?

Hello, doctor.
About four months ago, I started experiencing pain in my left upper abdomen, which feels like a pressure pain when food passes through.
At the same time, I have also noticed discomfort such as "swelling and pain under my left chest and armpit," as well as soreness in my middle and ring fingers of both hands and feet, although there is no swelling.
This has persisted for three months; the pain subsided in the last month, but two days ago, the same symptoms reappeared.
I have seen a family medicine physician three times, who arranged for blood tests and a cardiac ultrasound, ruling out heart problems, but my uric acid levels were found to be elevated.
After consultation and physical examination, the doctor suspected that the left upper abdominal pain was due to a muscle strain and prescribed pain medication.
However, regarding the swelling and pain under my left chest and armpit, as well as the soreness in my middle and ring fingers, the doctor did not address these issues, stating they did not seem to be related to gout and that these symptoms should not be connected.
About a month ago, due to a busy work schedule, I did not continue follow-up visits, and the symptoms seemed to improve and disappear for some reason.
Until two days ago, the same symptoms reappeared (left upper abdominal pain, swelling and pain under the left chest and armpit, along with soreness in my middle and ring fingers, but no swelling).
I would like to ask the doctor, although the family medicine physician said "the symptoms should not be related," since the same symptoms have reappeared together—pain in the "armpit," "abdomen," and "middle and ring fingers"—should I seek medical attention again? Which specialty should I consult? And what could be the potential issues?

Xiao Xiang, 20~29 year old female. Ask Date: 2021/01/25

Dr. Zeng Guosen reply Internal Medicine

Hello, based on your description of left upper abdominal pain that feels like pressure when eating, along with swelling and pain under the left chest and armpit, it is advisable to consult a gastroenterologist.
Currently, you are experiencing soreness in your hands, specifically in the middle and ring fingers, but there is no swelling, so it can be monitored for a while.
However, it is difficult to determine the exact issue based on your description.
I recommend scheduling an outpatient appointment for a step-by-step examination.
Thank you for your question.

Reply Date: 2021/01/25

More Info

Recurring left upper abdominal pain, especially when accompanied by other symptoms such as discomfort in the left upper chest, axillary swelling, and pain in the fingers, can be quite complex and concerning. Given the multifaceted nature of your symptoms, it is essential to approach this situation with a thorough understanding of potential underlying causes and the appropriate steps to take.

Firstly, the left upper abdominal pain you are experiencing could stem from various sources. Common causes include gastrointestinal issues such as gastritis, peptic ulcers, or even conditions related to the spleen or pancreas. Given that you mentioned a sensation of pressure when eating, this could indicate a gastrointestinal obstruction or motility issue. Additionally, since you have had elevated uric acid levels, it is worth considering whether gout or related conditions could be contributing to your symptoms, particularly the pain in your fingers.

The axillary swelling and pain in your fingers could suggest a systemic issue or a localized problem. For instance, lymphatic involvement could lead to swelling in the axillary region, while referred pain from the abdomen could manifest in the upper extremities. It is also possible that the symptoms are related to musculoskeletal issues, such as muscle strain or nerve impingement, especially if you have been engaging in activities that require repetitive movements or heavy lifting.

Given that your symptoms have recurred after a period of improvement, it is advisable to seek further medical evaluation. While your family physician has ruled out cardiac issues and suggested muscle strain, the persistence and recurrence of your symptoms warrant a more comprehensive investigation. You may want to consider consulting a gastroenterologist for a detailed evaluation of your gastrointestinal tract, particularly if you have not undergone recent imaging studies such as an abdominal ultrasound or CT scan. These tests can help identify any structural abnormalities or inflammation that may be contributing to your pain.

Additionally, a consultation with a rheumatologist could be beneficial, especially considering your elevated uric acid levels and the joint pain you are experiencing. They can assess whether there is an underlying inflammatory or autoimmune condition that could be causing your symptoms.

In the meantime, it is essential to monitor your symptoms closely. Keep a diary of when the pain occurs, its intensity, any associated activities, and any other symptoms that arise. This information can be invaluable for your healthcare provider in determining the underlying cause of your discomfort.

In summary, while your family physician has provided a preliminary assessment, the recurrence of your symptoms suggests that further evaluation is necessary. Consulting a gastroenterologist and possibly a rheumatologist would be prudent steps to take. It is crucial to address these symptoms promptly to ensure that any underlying conditions are identified and managed appropriately. Remember, your health is paramount, and seeking further medical advice is a proactive approach to understanding and alleviating your discomfort.

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