Episode 60: August 24, 2010
by Rob Lamberts, MD
In previous articles I’ve given mystery symptoms and shown how doctors make the diagnosis. But something needs to happen before the doctor can make a diagnosis: the patient has to come in. Deciding when to worry about symptoms is one of the hardest decisions. One one side, you don’t want to feel foolish coming in for something small; on the other side, you don’t want sit at home with a serious problem.
When to Worry About Abdominal Pain
So I am starting a series called, “When to Worry….” I’ll try to give you guidelines as to when a symptom is worrisome, and when it is OK to wait. Let me emphasize, however, that this is general advice that doesn’t apply to all circumstances. It is far better to be seen for a problem that ends up not being serious than to sit at home with a dangerous condition.
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It’s two in the morning and you wake up with pain in your abdomen, or perhaps it is your child that wakes you up with a stomach ache. When should you seek immediate help, when should you make a doctor’s appointment, and when is it OK to wait?
Anatomy of the Abdomen
The abdomen is divided up into five sections. The location of the pain can sometimes help in determining whether pain is worrisome or not. Here are the main regions:
Upper right quadrant: The right upper quadrant contains the liver and gallbladder, which are protected by the lower right part of the ribcage. The large intestine, or colon, also spends a little time in this section.
Upper left quadrant: The left upper quadrant contains part of the stomach and the spleen. The colon spends time here as well.
Upper middle section: Between these two sections, in the upper middle of the abdomen, is a section known as the epigastrium. This is an important section because it contains the most of the stomach, part of the small intestine, and the pancreas--all of which can cause pain.
Right lower quadrant: This quadrant contains more colon and the last part of the small intestine, where the appendix resides. In women, one of the ovaries is in this section.
Lower left quadrant: The other ovary lives in the left lower quadrant, along with the last part of the colon.
What Causes Abdominal Pain?
There are a few common problems that are caused by certain troublemakers in the abdomen. I’ll give you the list of the “abdomen’s most wanted,” and where they tend to hang out.
The appendix: This is a small tube that can become infected and cause a dangerous problem. Appendicitis pain usually starts around the naval, but then settles in the right lower quadrant. This is true the majority of time, but not all the time. More on this later.
The gallbladder: This organ is a sack that collects a digestive juice called bile. It can get infected or get stones, and usually causes pain in the right upper quadrant.
The stomach and first part of the small intestine: Ulcers can form in these organs, causing bleeding, pain, and occasionally a perforation, leaking stomach acid into the abdominal cavity. Ulcers usually cause pain in the middle above the belly button.
The pancreas: This organ puts out strong digestive juices. These juices are so strong that they can actually digest abdominal organs if the juice gets in the wrong place.
The colon: Pain from the colon can occur at nearly any place in the abdomen, although the most serious condition, an infection called diverticulitis usually causes pain in the left lower quadrant.
When Should You Worry About Abdominal Pain?
It’s better to get checked out by a doctor for nothing than to stay at home with something more serious.
Location is important, but the nature of the pain itself is even more so. Here are some of the things that make stomach pain more worrisome:
Severity: Pain that wakes you up out of your sleep or stops you in your tracks is always worth worrying about.
Persistence: Pain that’s continuous or lasting more than 10 minutes is more worrisome than intermittent, brief pain.
Tenderness: Doctors use the term tenderness to signify pain that results when the body part is pressed upon. From a patient’s perspective, tenderness is when movement makes the pain worse.
Loss of appetite: When a serious problem happens in the abdomen, the body shuts down digestion. Things stop moving through the digestive tract and the person feels nauseated and doesn’t want to eat. It’s rare for someone with appendicitis, for example, to want to eat anything.
Vomiting: The extreme of a shut-down digestive tract happens with vomiting, which is why vomiting can sometimes be cause for concern.
Blood in bowel movements: Painless bleeding is not as big of a concern, as it’s usually from hemorrhoids. But bleeding along with abdominal pain is a bigger concern.
Melena: The word melena describes black, tarry bowel movements. That is a sign of bleeding from the gastrointestinal tract that leads from the stomach. The acid in the stomach changes the blood from red to black and tarry. If something is causing enough bleeding to cause melena, it is usually something bad, like a bleeding ulcer. Melena is serious, and people with it should go directly to the emergency room. That is true even if there is no pain.
Dizziness: If you are getting dizzy or light-headed with abdominal pain, it may mean your blood pressure is dropping. Get seen right away for this.
When Don’t You Need to Worry About Abdominal Pain?
The reassuring signs are the flip-side of the worrisome signs:
Pain isn’t worse with pressing or movement
Pain isn’t associated with a lack of appetite
Pain doesn’t interfere with regular activity
Furthermore, the passage of stool and gas shows that the digestive tract is working, which is also reassuring. That’s why surgeons ask people if they are passing gas after they perform abdominal surgery.
The Quick and Dirty Tip
The bottom line, of course, is that it’s better to get checked out by a doctor for nothing than to stay at home with something more serious.
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Let me once again remind you that this podcast is for informational purposes only. My goal is to add to your medical knowledge and translate some of the weird medical stuff you hear, so when you do go to your doctor, your visits will be more fruitful. I don’t intend to replace your doctor; he or she is the one you should always consult about your own medical condition.
Catch you next time! Stay Healthy!