Medical City Healthcare - December 31, 2020

Abdominal pain is the single leading reason for emergency room visits in the U.S. according to the U.S. Department of Health and Human Services, accounting for more than 12 million of the nearly 139 million annual ER visits. Most people call it stomach pain, but it's not always a stomach problem. Your abdomen holds many other organs, too, including your intestines (colon and bowels), pancreas, liver, gallbladder, kidneys, spleen and appendix.

So it’s not surprising that, just as with chest pain or a headache, it can be difficult to tell what’s really going on in there when your tummy's not feeling well. Add in other vague symptoms such as nausea and vomiting and you could have the stomach flu, food poisoning, gallstones, kidney stones or any number of other conditions.

Here are some ways to tell what the source of your pain is and when you should seek medical care.

Three things to look for with stomach pain

Suhail Sharif, MD, a general surgeon at Medical City Fort Worth and Medical City Alliance says there are three things you should look for that can help diagnose the source of abdominal pain, including:

  • Type of pain: Is it a dull, achy, constant pain? Or more of a sharp, stabbing pain that comes and goes? This can tell doctors a lot about what might be going on.
  • Location of pain: Pinpointing the exact location can be difficult, but try to narrow it down to the upper abdomen, the lower abdomen, the right side or the left. “The abdomen has multiple organs,” Dr. Sharif says, “and as such any organ can cause abdominal pain.”
  • Additional symptoms: Are there other symptoms associated with your abdominal pain, such as nausea, vomiting, diarrhea, constipation, bloating or indigestion? Your doctor will take all of these into account when making a diagnosis.

When to go to the ER with stomach pain.

You should seek immediate medical attention or go to the ER if you have:

  • Constant or severe abdominal pain
  • Pain associated with a high fever
  • Changes in pain intensity or location, such as going from a dull ache to a sharp stab or starting in one area and radiating to another
  • Pain accompanied by other serious or unusual symptoms, such as difficulty breathing or change in behavior
  • Pain localized to one particular area
    • Right lower quadrant could indicate appendicitis
    • Right upper quadrant could indicate cholecystitis or a gallbladder infection
    • Left lower quadrant could indicate diverticulitis or a colon infection

The Big D.

Is there ever a good time to have diarrhea? You may not think so, but diarrhea can be a clue to help you and your doctor rule out a more serious issue.

"Diarrhea with vomiting is a good indication that you have a viral or bacterial infection and not a surgical emergency," says David Hanscom, DO, an emergency medicine physician at Medical City Fort Worth. "Viral infections are more common, but you could have a bacterial infection, such as from food poisoning. You'll know pretty quickly after eating contaminated food — within a half hour to an hour."

“It’s important to not get dehydrated, especially for infants, children and older adults," Dr. Hanscom says. "If you have any of the above symptoms, come on down to the ER and we'll assess your need for IV fluids. We can also give you an antiemetic—a drug to prevent nausea and vomiting. It's not really something that you can get without a prescription."

Could it be norovirus?

Christopher Ramos, MD, a gastroenterologist at Medical City Alliance and Medical City Fort Worth, says that the difficulty when dealing with stomach pain—especially in the upper abdomen—is knowing whether it's heartburn or something more serious.

Dr. Ramos has seen many norovirus cases in North Texans returning from cruises.

"Norovirus is the leading cause of gastroenteritis in the U.S., so it's very common but sometimes hard to diagnose," he says. "Members of the same family can have the same disease process but different symptoms and duration."

Dr. Hanscom agreed, adding that there is no point-of-care test for norovirus.

"We don't have a test for norovirus in the ER," he says. "Diagnosis is done by looking at the patient's symptoms and other clues, such as if there's a local outbreak, if the patient has been on a cruise or if it's during the colder parts of the year when people congregate indoors and spread germs."

Signs of passing a kidney stone

David Cameron, DO, an emergency medicine physician at Medical City Lewisville and Medical City McKinney, says that you will know immediately if you are passing a kidney stone, with pain in the side of your back or abdomen.

“This is the worst pain of your life that you're experiencing,” Dr. Cameron says. “It's so profound that it's beyond a 10. You'll be incapacitated with the pain, quite often. It'll lead to nausea and vomiting, the pain is so severe.”

Poison prevention.

Some GI issues are not caused by viral or bacterial invaders, but from an overdose of toxic substances.

"In children, the weekly pill reminders can be problematic because they are easy to access and can contain large amounts of medication," says Dr. Hanscom. "It's important to keep them where kids can't get to them."

Dr. Ramos sees a different problem in his adult patients.

"There are a lot of over-the-counter medications used for valid reasons," he says, "but if they're not used properly they can cause toxicity and poisoning. It's a very common problem."

One of the biggest culprits is one of the most commonly used drugs.

"Acetaminophen is used in almost everything," Dr. Ramos says. "Overuse—4 x 2 extra strength doses of Tylenol a day—can easily lead to liver damage and possibly even become an indication for a liver transplant. Taking that dose alone can cause toxicity, but adding something like NyQuil for a virus can further increase the amount of acetaminophen. And depending on how long the virus lingers and you continue taking the meds—your liver tests can definitely be elevated."

Unfortunately, someone with liver inflammation from substance toxicity will likely not have any symptoms other than fatigue until they're at the point of liver failure and they need emergency medical intervention. Liver function tests are not a random screening and are typically ordered to rule out other conditions such as hepatitis C, fatty liver and gallbladder disease.

The only way to know for sure if you're overdosing yourself or your children is to read all medicine labels and know the ingredients.


The post Gut Feeling: How to Know if Stomach Pain is Serious appeared first on LifeSigns on March 21, 2017.