instruction: hello doctor I am a 31 year old male for the past four months I have periodically experienced severe pain in my lower right abdomen and lower right back regions the pain comes quickly and can last for a few hours and is so severe that all I can do is lay down and writhe I have never passed any stones that I am aware of the pain is usually accompanied by the feeling of needing to urinate as well as some diarrhea when the pain begins to set in I make a point to drink lots of water I do not have health insurance so I have not had any imaging done I would greatly appreciate any input or recommendations
output: hello welcome to icliniq com well I understand you have pain with diarrhea and pain that lasts a few hours before it goes away listening to your history it seems a few possibilities the pain of intestinal loops affecting the cecum a part of large bowel or terminal ileum which is small bowel the causes are many but given your age there are possibilities of crohn yersinia infection or whipple and lastly uncommon is intestinal tuberculosis the other possibility is renal stones it is not necessary to have stones in urine in person with renal stones thirdly functional abdominal pain syndrome which is basically hypersensitivity of the intestine to food stools water etc this pain cannot cause weight loss however the causes mentioned above can cause fever and weight loss the third often overlooked cause of pain is nerve entrapment pain this is because of the compression of the nerve in between the muscles you see the list of differentials can be shrunken after a good history I want you to tell me more about your symptoms in context to the above mentioned conditions as we then target the one or two and investigate specifically and then can suggest treatment for the underlying cause do not get afraid it is completely possible that you may not have any of those but this has to be excluded from close questioning particular to these conditions I hope this helps intestinal inflammation functional hypersensitivity nerve entrapment pain renal stones follow up to discuss in detail and formulate a plan of action for management of the problem