Unexplained Symptoms: What Medical Specialty Should You Consult?

What disease issue is it?

Hello Doctor, I have been experiencing mild lower back pain, a feeling of swelling in my right abdomen, and intermittent mild pain for the past six months (pressing on my right abdomen does not cause pain).
Since I am a carrier of hepatitis B, I had liver function tests and an ultrasound a few weeks ago, both of which were normal (and I do not have fatty liver).
I also asked the nurse to specifically check my right abdomen, and the doctor said there were no issues.
Now, I am unsure which specialty I should consult.
My medical history includes: (1) the recent issue over the past six months, and (2) and (3) are both over two years ago: 1.
I had blood in my stool, and after seeing a doctor, I was diagnosed with internal hemorrhoids.
2.
I twisted my back during military service, but I applied pain relief patches and did not seek further medical attention.
3.
I previously had a right kidney stone, which was treated with extracorporeal shock wave lithotripsy to remove the small stones.

Kent, 20~29 year old female. Ask Date: 2007/06/24

Dr. Wang Zhengzhong reply Family Medicine

Hello Kent, since your liver function tests and ultrasound examinations have both returned normal results (and there is no fatty liver), and you do not experience pain when pressure is applied to the right abdomen, liver and gallbladder diseases can be ruled out.
However, it is still recommended that you consult a gastroenterologist and consider undergoing a colonoscopy and a renal ultrasound.
Additionally, if necessary, X-rays should be taken to rule out any cumulative musculoskeletal injuries related to your previous medical history.

Reply Date: 2007/06/24

More Info

When dealing with unexplained symptoms, particularly those involving abdominal discomfort and pain, it is essential to approach the situation methodically. Given your history of mild lower back pain, right abdominal swelling, and intermittent mild pain, it is understandable that you are seeking clarity on which medical specialty to consult.

Based on your symptoms and medical history, it would be prudent to consult a gastroenterologist. This specialist focuses on the digestive system and its disorders, which includes the stomach, intestines, liver, and gallbladder. Given that you are a carrier of Hepatitis B and have experienced symptoms related to your abdominal area, a gastroenterologist can provide a thorough evaluation of your liver and gastrointestinal health. They can also assess for any potential complications related to your Hepatitis B status, as chronic liver conditions can sometimes lead to abdominal discomfort.

In addition to a gastroenterologist, considering your history of kidney stones, it may also be beneficial to consult a urologist. They specialize in the urinary tract and male reproductive organs, and they can evaluate any potential kidney-related issues that might be contributing to your symptoms. Since you mentioned having had kidney stones in the past, it’s important to rule out any recurrence or complications that may not have been evident in previous imaging studies.

Furthermore, since you have experienced blood in your stool and have been diagnosed with internal hemorrhoids, it might also be worthwhile to see a colorectal surgeon or a gastroenterologist who specializes in colorectal issues. They can evaluate your rectal and colon health to ensure that there are no underlying conditions that could be causing your symptoms.

It’s also important to consider that your symptoms could be multifactorial. For instance, your mild lower back pain could be musculoskeletal in nature, possibly related to your previous injury during military service. In this case, a physiatrist or a physical therapist could help address any musculoskeletal issues through rehabilitation and pain management strategies.

In summary, I recommend starting with a gastroenterologist to evaluate your abdominal symptoms, particularly in light of your Hepatitis B status and history of gastrointestinal issues. Depending on their findings, they may refer you to a urologist or a colorectal surgeon if necessary. Additionally, if musculoskeletal pain persists, consider consulting a physiatrist or physical therapist for further evaluation and treatment.

Remember, it is crucial to communicate openly with your healthcare providers about all your symptoms and medical history. This will help them make informed decisions regarding your diagnosis and treatment plan. Don’t hesitate to ask questions during your consultations, as understanding your health condition is vital for effective management.

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