<s>[INST] Hi im 31 very healthy excercise about 2 hours a day.  I eat very clean with lots of fiber and protien.  I have abdominal distension right below my rib cage middle.  Dosnt hurt but puffy.  I have been bound up really bad for the last wek or so.  I had an enemaat the ER yesterday.  They couldnt see any organs in the x-ray.  Ive been taking laxatives to try and get it to move. Im afraid their is something elso going on.  Also they diagnosed my as being anemic with a 9.1 hemagloben. [/INST] HI. X-ray is not a good investigation for diagnosis of abdominal conditions, although it is best for intestinal obstruction, xenoliths and a great corroborative evidence to go for further tests. You have a problem for abut a week, distension right bellow the rib cage middle. This is more indicative of a stomach problem or a problem related to the transverse colon. I would advise you the following:Upper GI and Lower GI (colonoscopy) endoscopy. CT scan of the abdomen. Blood, urine and stool tests. Anemia typing to determine the cause of anemia and get treated accordingly. These investigations will lead to a proper diagnosis, and we can then plan a proper treatment. </s>