Unexplained Chest and Abdominal Pain: Causes and Solutions - Family Medicine

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Unexplained chest and abdominal pain can be concerning, especially when it persists for several days and is associated with specific movements or positions. Based on your description, it seems that the pain is localized and related to certain activities, such as squatting. This could suggest a musculoskeletal issue rather than a serious internal condition. However, it is essential to consider various potential causes, especially since you have undergone several diagnostic tests without finding a definitive explanation.

1. Possible Causes of Your Pain:
- Musculoskeletal Issues: Given that the pain occurs when you squat and is tender to touch, it could be related to muscle strain or tension in the abdominal wall or intercostal muscles (the muscles between your ribs). This is particularly plausible if you have engaged in physical activities like baseball practice, which may have led to overexertion.

- Gastrointestinal Issues: Although your endoscopy and colonoscopy did not reveal any abnormalities, conditions such as gastritis, peptic ulcers, or even functional gastrointestinal disorders (like irritable bowel syndrome) could still be contributors to your symptoms. The fact that you experience a "tympanic" sound upon percussion of the abdomen may indicate some degree of gas accumulation, which can cause discomfort.

- Referred Pain: Sometimes, pain in the abdomen can be referred from other areas, such as the diaphragm or even the heart. However, given your age and the absence of other concerning symptoms, this is less likely.

- Fatty Liver Disease: Your diagnosis of fatty liver (non-alcoholic fatty liver disease) can sometimes be associated with abdominal discomfort, although it typically does not cause acute pain.

2. Concerns about Pancreatic Issues:
- While you asked about the possibility of pancreatic cancer or pancreatitis, your symptoms and the results of your tests make these less likely. Pancreatitis usually presents with severe, persistent abdominal pain, often radiating to the back, and is typically associated with elevated levels of pancreatic enzymes (amylase and lipase) in the blood. Pancreatic cancer usually presents with more systemic symptoms, such as weight loss, jaundice, or changes in appetite, which you have not mentioned.

3. Next Steps and Management:
- Consultation with a Specialist: Given your ongoing symptoms and the complexity of your case, it may be beneficial to consult a gastroenterologist or a pain specialist who can provide further insights into your condition. They may suggest additional imaging studies, such as an MRI or CT scan, to rule out any structural issues that may not have been visible on previous tests.

- Physical Therapy: If the pain is indeed musculoskeletal, physical therapy may help strengthen the abdominal and back muscles, improve flexibility, and alleviate pain. A physical therapist can also provide guidance on proper body mechanics to prevent further strain.

- Pain Management: Over-the-counter pain relievers, such as NSAIDs (ibuprofen or naproxen), can help manage pain and inflammation. However, it is essential to use these medications as directed and consult your physician if you have any underlying health conditions that may contraindicate their use.

- Lifestyle Modifications: Maintaining a healthy weight through diet and exercise can help reduce the strain on your body. Since you mentioned being overweight, a structured weight loss program may alleviate some of the pressure on your abdomen and improve your overall health.

In conclusion, while your symptoms are concerning, they are more likely related to musculoskeletal issues or functional gastrointestinal disorders rather than serious conditions like pancreatic cancer. Continued follow-up with your healthcare provider is crucial to monitor your symptoms and adjust your management plan as needed.