When to be concerned about abdominal pain

Transcript

Joey Wahler (Host): It’s among the most common reasons for emergency room visits by patients that are treated and released. So we’re discussing when to be concerned about abdominal pain. This is Flourish, a podcast from Prisma Health. Thanks for joining us. I’m Joey Wahler, Our guest, Dr. Veeral Oza. He’s a gastroenterologist and interventional endoscopist and co-director of the Prisma Health Pancreatic Cancer Center. Dr. Oza, thanks for joining us.

Dr Veeral Oza: Thank you for having me.

Joey Wahler (Host): So first, simply put, how common is abdominal pain and who does it usually affect most?

Dr Veeral Oza: So that’s a great question. Abdominal pain is one of the most common reasons people visit the emergency room. It affects a wide breadth of the population. It can affect everybody from little kids to older adults, men and women. Depending on the patient, certain causes of abdominal pain are different in different genders, for obvious reasons. So, for example, in women, you might have a uterine issue or pregnancy issue, for instance, whereas that would not exist in the male gender. But depending on the age of the patient and the gender, the causes of abdominal pain vary from patient to patient. But it is a very common problem. One of the most common reasons, like I mentioned, people visit emergency room or seek care in their primary care doctor’s office or the gastroenterologist.

Joey Wahler (Host): So what are some of the most typical causes of pain in the abdomen?

Dr Veeral Oza: So one of the most benign causes of abdominal pain is something simple like gas pain. A very benign reason, but it can cause dull to cramping, achy sensation. If you’re just really gassy, you’ve had some foods that cause more gas. Another more relatively benign condition that can cause pain is eating something that is, say, old, and you might have a mild, version of food poisoning. Although that’s relatively benign itself, resolves and improves by itself, sometimes that does not improve by itself and you can have a more serious food poisoning case. So, that is also a very common reason why people present to the emergency room, saying we ate something funky and I’m just having a lot of nausea, vomiting, abdominal pain, diarrhea. But one of the key things you want to ask a patient or a patient needs to ask themselves is, is it just the pain? And what started first? Was it pain that started first? Did the nausea come first? Or is the pain associated with, something else such as diarrhea, for instance?

Are they having blood in their stools? Is there nausea or vomiting associated with abdominal pain? Those types of questions are important. Is there any fever with this abdominal pain? And then that’s very, very important for physicians to know that information.

Joey Wahler (Host): And so you’ve just gone over some of the things that are symptoms and kind of a checklist of those. So once you’ve gone over that, what do you do next in treating some of these most common causes of abdominal pain?

Dr Veeral Oza: Yeah. So the treatment really depends on what’s causing the abdominal pain. So, once you talk to the patient, go through their history, what they were doing before the pain started. Were they having pain like this before? And say you identify that, hey, this pain is associated, for example, with say, gallstones. Well then the treatment, after doing a physical exam, would entail, perhaps a ultrasound of the abdomen or doing a CT scan, doing some basic blood tests, and potentially even consulting a gastroenterologist or a surgeon depending on what the cause of the pain is. So the number one thing that the physicians will do is, obviously, talk to the patient – history and physical. Talking to the patient is easy. And in medical training during medical school, it’s drilled into us that if you talk to the patient, they will almost always tell you the diagnosis, which is wonderful. Patients know their bodies better than really anybody else, and they will tell you exactly when the pain started. They’ll give you little clues and the hints that can help us as the clinician really zero in into what may be causing the abdominal discomfort. And then go from there, like either after the physical exam was done, they may say,  my stomach hurts. Well, the stomach is just an organ on one side of the body, but for a patient who does not have any medical background, everything in the belly is stomach, so you have to do a physical exam, kind of try to identify, hey, could this be the gallbladder? Could this be the bile duct? Which is like the plumbing system of the liver. Could this be the liver? Could this be the pancreas? In women could this be the uterus? Could this be like an ectopic pregnancy or is this something more benign like a gas pain? So after doing the history and doing blood tests or doing lab tests and doing ultrasound or CT scan, can really help the clinician zero in on the exact cause of the abdominal pain.

Joey Wahler (Host): And when you mention gas, gas can be sort of the ultimate false alarm here. Where, if you’ve got some gas that’s trapped inside for whatever reason, that could cause a lot of pain. It could go on for maybe an hour or more. I know I’ve had that happen myself from time to time, and it makes you think, ooh boy, there could really be something wrong here, when in fact that gas just needs to get out and then everything’s back to normal. Right?

Dr Veeral Oza: Yeah, that’s, very, very true. But generally, if people have been having pain intermittently, that comes and goes and resolve itself, they may not seek care in the ER or seek care with their primary care. Having said that, when they do come to the office, in medical school, in residency and fellowship, we are trained to make sure that you’re not discounting patient symptoms and just saying it’s gas pain without making sure that’s nothing that we need to actually worry about. So before we chalk it up to gas pain, at least in my practice, I absolutely make sure that there’s really nothing subtle that we would have to worry about.

One of the things you mentioned in my introduction is, and I’m a co-director of the pancreatic cancer center. Well, pancreatic cancer oftentimes will not cause abdominal pain, but every now and then there will be a patient who will have pain, and it’ll be a dull, achy sensation. Nothing terrible. But that’s pain that needs to be looked into. And when we find something like that, whether it’s stomach cancer or pancreatic cancer, etcetera, that needs to be acted upon fairly quickly.

So it’s not uncommon that we get patients who say they’ve been having gas pains and we’ll find something that is not gas pain. So before we chalk it up to something that’s relatively benign, we as physicians and clinicians need to be sure that it’s nothing we need to really worry about.

Joey Wahler (Host): So on the flip side, when should someone go to the ER? And if that’s not needed, what should they do instead?

Dr Veeral Oza: That’s a great question. The ER visits are obviously meant for exactly that – emergency. So if the pain is uncontrollable, it’s a pain that’s new, was not there before. It’s associated with fevers, nausea, vomiting, diarrhea. People cannot really keep anything down. If they’re drinking water, even, they throw that right back up. Those are all red flag symptoms that need to be addressed, whether by a primary care doctor, if it’s during, if you can get in fairly quickly, or with your gastroenterologist, or another physician. And if not, then an emergency room is the exact place where you need to be because that may require a CT scan to actually see if there’s something else going on in the abdomen. Is there any, blockage anywhere in the stomach or small intestine? Do you have appendicitis, for example, or infection of some other organ? So those types of things need to be addressed, and those are real true emergencies.

Joey Wahler (Host): How about preventing or managing chronic abdominal pain in terms of diet? Generally speaking, what are the main do’s and dont’s food wise for keeping your stomach pain in check?

Dr Veeral Oza: Chronic abdominal pain by definition is generally pain that has been present for at least three months, and we haven’t really found an obvious cause of something causing intermittent or, what we call episodic abdominal pain. Many things can cause abdominal pain that is chronic in nature. One of the things is food intolerances. But again, there’s other more serious things that can also cause chronic abdominal pain. So I won’t talk about the more serious things at the moment since the question’s mostly on the food.

But if you have food intolerances or you feel like this might be food related, then one of the things I tell my patients is keep a food log. Every time you have pain, think about what you ate the prior meal. Write it down. And after about four or five days, you will see a pattern that this specific food that I had, whether it may be, say for example, I don’t know, I’m gonna say milk. So you had cereal and then you had chocolate milk and then you had a latte and you had pain all three of those times. Well, then that might be suggestive of possible, lactose, related. So it’s easy to hone in on a particular food if we know if there’s a pattern. But generally diet-wise, there are several diets out there, depending on what’s causing the chronic abdominal pain. People who have, for example, celiac disease, they have to be in gluten-free diet. If they’re not, their body will react, and they will have abdominal pain. So for those patients, we’ll say, be on a gluten-free diet. On the other hand, if you have just food intolerances, like I mentioned, lactose intolerance. Be on a lactose-free diet.

And if you can’t pinpoint, then oftentimes I’ll try patients on something called the FODMAP Diet, which, is a mouthful. But essentially all it means is avoiding some of the more common quote unquote bad sugars.

Joey Wahler (Host): A couple of other things, especially if a pain suddenly arises. Often we think we may have food poisoning. I know, from personal experience, like many people, I’m sure that’s when a bunch of ugly symptoms all kind of meld together at once. Is there a simple way for the lay person, the non doctor, to tell if they have food poisoning as opposed to it being something else?

Dr Veeral Oza: Yeah. So if they’ve eaten something and they have nausea, vomiting, and diarrhea, or any one of those three things associated with abdominal pain, then it’s very possible they may have food poisoning. Particularly if there’s other people in your group that have the same meal and have the same symptoms. Now there are certain types of bugs that can cause pretty severe food poisoning cases. I do suggest usually if you have symptoms like that, you should seek care, especially if you have more than one person in a group who is reacting and having abdominal pain or food poisoning like symptoms and that should be looked into.

Joey Wahler (Host): And finally, when, if at all, are there times that physicians simply can’t pinpoint the cause of abdominal pain? And what can patients do in those do in those situations?

Dr Veeral Oza: So if you cannot pinpoint the cause, despite multiple labs and endoscopies and CT scans, etcetera, and you still can’t pinpoint, then like I said before, having a food log or food diet really helps. Trying the FODMAP diet is also helpful. There are certain diets out there called elimination diet where you can remove certain things, and then slowly add things on back. These diets are actually fairly difficult to do on a day-to-day or a week to week basis because they start off kind of strict and then you’re slowly adding stuff in. So it’s not easy to do these diets. But that might be very helpful.

Another very common cause of abdominal pain where we can’t pinpoint is something called irritable bowel syndrome. there’s two different types of, IBS or irritable bowel syndrome. There’s a diarrhea type and a constipation type. And that is a diagnosis of exclusion and it’s a very common diagnosis in the gastroenterology world. But there are medications out there depending on what subtype you have. There are some anti-spasmodic options in terms of medications that we can try and that can really make a difference in people’s symptoms, especially if it’s IBS. But that is a diagnosis of exclusion, so we have to really be sure that it’s nothing bad, nothing obvious that’s causing the abdominal pain.

Joey Wahler (Host): Gotcha. Well, folks, we trust you’re now more familiar with when to be concerned about abdominal pain. Dr. Veeral Oza, thanks so much again.

Dr Veeral Oza: Thank you for having me.

Joey Wahler (Host): And for more information, please visit PrismaHealth.org. Again, that’s PrismaHealth.org. If you found this podcast helpful, please do share it on your social media. And thanks again for listening to Flourish, a podcast from Prisma Health, hoping your health is good health. I’m Joey Wahler.