Abdominal Pain: When to Seek Medical Advice - Gastroenterology and Hepatology

Q: Abdominal Pain: When to Seek Medical Advice

Hello： 1. The type of examination should be determined by a clinical physician. If there are no abnormalities in the stool test, dietary adjustments should be made. If there is no improvement, a consultation with a gastroenterologist is necessary. 2. It is rec

Gastrointestinal issues

Hello, I have been experiencing a dull pain in the upper left part of my abdomen, near the ribs.
Sometimes it occurs in the upper right or in the middle, but for the past couple of days, it has mainly been concentrated in the upper left area.
The pain is not severe, but it comes and goes intermittently.
When I press on the area, I can feel some sensation, but it doesn’t hurt when I'm not experiencing pain.
Recently, my bowel movements have been irregular; sometimes they are formed, and sometimes they are not.
However, in the past few days, I have noticed that the frequency of my bowel movements is relatively normal, but the stools are formed, darker in color, and about twice as thick as before.
About three years ago, I had a positive fecal occult blood test and underwent a colonoscopy.
Although the doctor mentioned that the quality of the examination was not very good (there was some residual stool), no issues were found, and it was suggested that the occult blood might be related to hemorrhoids.
My appetite has not been great lately, but my weight has remained stable, with no significant gain or loss.
Additionally, I had gastroesophageal reflux disease (GERD) last Mid-Autumn Festival, and around October to November, I underwent an endoscopy and was prescribed medication.
No problems were found at that time, and the doctor only prescribed antacids.
Recently, I have been feeling like the reflux might be returning, as sometimes when I burp, I feel something coming up, but I don’t actually vomit; I just swallow it back down and don’t feel nauseous.

I would like to ask:
1.
What kind of tests should I undergo for my abdominal issues? What can X-rays or ultrasounds reveal? What could be the possible problems?
2.
Is there a connection between my abdominal issues and my bowel habits? Do I need to undergo another colonoscopy or similar examination?
3.
Regarding my stomach issues, should I return for a follow-up to get more stomach medication, or can I just take over-the-counter antacids? Is there a method for selecting the right antacid? Thank you.

q, 30~39 year old female. Ask Date: 2017/05/30

Dr. Cai Anshun reply Gastroenterology and Hepatology

Hello: 1.
The type of examination should be determined by a clinical physician.
If there are no abnormalities in the stool test, dietary adjustments should be made.
If there is no improvement, a consultation with a gastroenterologist is necessary.
2.
It is recommended to return for a follow-up visit, where the physician can prescribe medication; self-medication is not advisable.
Changhua Hospital cares about your health.
Dr.
Tsai An-shun.

Reply Date: 2017/05/30

More Info

When experiencing abdominal pain, especially when it is localized to specific areas like the upper left quadrant near the ribs, it is essential to consider various potential causes and the appropriate steps to take in seeking medical advice. Given your symptoms, including intermittent pain, changes in bowel habits, and a history of gastrointestinal issues, it is crucial to approach this systematically.

1. Understanding Your Symptoms
The pain you describe in the upper left quadrant could be related to several conditions. Common causes of left upper quadrant pain include:
- Gastric Issues: Conditions such as gastritis, peptic ulcers, or gastroesophageal reflux disease (GERD) can cause discomfort in this area. Given your history of GERD, it is possible that your symptoms are related to this condition, especially if you are experiencing a sensation of regurgitation or heartburn.

- Splenic Problems: The spleen is located in the left upper quadrant, and issues such as splenomegaly (enlargement of the spleen) or splenic infarction could cause pain.

- Pancreatic Conditions: The tail of the pancreas is also situated in the left upper quadrant, and pancreatitis can present with pain in this area.

- Musculoskeletal Issues: Sometimes, pain can arise from muscle strain or rib-related issues, especially if the pain is exacerbated by movement or palpation.

2. Investigating Your Bowel Habits
Your changes in bowel habits, including the consistency and frequency of your stools, are significant. The fact that you have experienced both formed and unformed stools could indicate a functional gastrointestinal disorder, such as irritable bowel syndrome (IBS), or it could be related to dietary changes or stress.
- Connection to Abdominal Pain: Yes, your abdominal pain could be related to your bowel habits. Conditions like IBS can cause abdominal pain and changes in bowel habits. Additionally, if there is an underlying issue with the colon, such as diverticulitis or polyps, it could also manifest as abdominal pain.

- Need for Further Testing: Given your history of occult blood in the stool and the previous colonoscopy, it may be prudent to discuss with your healthcare provider whether a repeat colonoscopy is necessary, especially if your symptoms persist or worsen.

3. Addressing Gastric Concerns
Regarding your gastric symptoms and the potential recurrence of GERD, it is advisable to consult your healthcare provider for a thorough evaluation.
- Medication: If you are experiencing symptoms of GERD again, it may be beneficial to resume your prescribed proton pump inhibitors (PPIs) or H2 blockers. Over-the-counter medications can be effective, but it is best to consult with a healthcare professional to ensure they are appropriate for your situation.

- Choosing Over-the-Counter Medications: When selecting over-the-counter medications for gastric issues, consider the active ingredients. Antacids can provide quick relief for heartburn, while PPIs and H2 blockers are better for longer-term management. Always read labels and consult with a pharmacist or doctor if unsure.

4. Recommended Actions
- Seek Medical Evaluation: Given your symptoms, it is advisable to schedule an appointment with a gastroenterologist. They can perform necessary evaluations, including imaging studies like ultrasound or CT scans, and potentially repeat a colonoscopy if indicated.

- Document Symptoms: Keep a diary of your symptoms, including the timing, duration, and any associated factors (like food intake or stress), which can help your doctor in diagnosing the issue.

- Lifestyle Modifications: Consider dietary changes that may alleviate your symptoms, such as avoiding spicy foods, caffeine, and alcohol, which can exacerbate GERD.
In summary, your abdominal pain and gastrointestinal symptoms warrant a thorough evaluation by a healthcare professional. By addressing these concerns systematically, you can work towards identifying the underlying cause and receiving appropriate treatment.

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