Medical City Healthcare - March 21, 2017

Abdominal pain is the single leading reason for emergency room visits in the U.S., accounting for more than 12 million of the nearly 137 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.

David Cameron, DO, an emergency medicine physician at Medical City Lewisville and Medical City McKinney, discusses how to know if you have kidney stones.

The Big D.

We're not talking about Dallas. Nope... diarrhea. No one likes to have it or talk about it, but this dreaded symptom can clue you in on what your stomach pain may mean.

"Diarrhea with vomiting is a good indication that you have a viral or bacterial infection and not a surgical emergency," said David Hanscom, DO, an emergency medicine physician at Medical City Fort Worth and Medical City ER Burleson. "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."

Christopher Ramos, MD, a gastroenterologist at Medical City Alliance, agrees that the difficulty when dealing with stomach pain — especially in the upper abdomen — is knowing whether it's heartburn or something more serious. More clues to help you (or your doctor) pinpoint the cause of symptoms include:

  • Type of pain: is it sharp or dull, constant or intermittent, mild or severe?
  • Location of pain: is it right or left, lower or upper, concentrated in one spot or radiating outward toward your chest or back?
  • Onset of pain: did it come on suddenly, start after eating (maybe spicy or restaurant food) or have you felt this pain for any length of time?

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 said. "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 said. "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."

When to go to the ER with stomach pain.

You should seek medical care when stomach pain is:

  • Accompanied by a high fever
  • Accompanied by repeated vomiting
  • Accompanied by other serious or unusual symptoms, such as difficulty breathing or change in behavior
  • Severe or prolonged (lasting 24 or more hours)
  • 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

"It's important to not get dehydrated, especially for infants, children and older adults," Dr. Hanscom said. "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."

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," said 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 said, "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 said. "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.

If you suspect poisoning.

Both Dr. Hanscom and Dr. Ramos agree that your first call should be to Poison Control at (800) 222-1222.

"Toxicology is a very broad area with many different agents that can cause harm," said Dr. Hanscom. "Depending on the severity — whether your child ate one baby aspirin or a whole bottle — Poison Control will do a phone consult and let you know whether to treat at home or come into the ER for emergency treatment or testing and bloodwork."

Dr. Ramos encourages everyone to keep the number handy, even physicians.

"This is what Poison Control does," he said. "They have the expertise and are the best resource for both patients and doctors. We (physicians) view Poison Control as a valuable resource."

If someone in your family gets a gut feeling from a virus, bad food or even from their medications, one of our many Medical City Healthcare emergency locations has you covered. With average wait times posted online, if you do have an emergency, you can spend less time waiting and more time on the moments that matter most.

Find a fast Medical City ER near you or visit Medical City Virtual Care for non-emergency medical treatment from your computer or smartphone.

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Revised 4/17/2019

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