Intermittent Abdominal Pain: When to Seek Medical Advice

Intermittent abdominal pain in different regions?

Hello Doctor, over the past few months, I have been experiencing intermittent abdominal pain in the lower left abdomen, lower right abdomen, upper left abdomen, and upper right abdomen (sometimes it hurts in the lower right abdomen, and other times in the lower left abdomen, and so on), accompanied by a cramping sensation.
Rather than just abdominal pain, it also feels like the pain radiates to the lower back area (I apologize for not being able to describe it better).
The episodes occur several times a day at times, and at other times only once every few days, lasting from several seconds to a few minutes each time.
Sometimes, the pain also triggers when I feel anxious.
The pain is mild, described as a dull ache with slight cramping.
I have noticed a slight weight loss over these months (from around 82-83 kg to about 78 kg), but I haven't been on a special diet or exercise regimen, and my appetite remains normal.
Bowel movements are regular, and there is no visible blood in the stool; everything else seems normal.
Since childhood, I have been able to burp at will (anytime, regardless of the situation), but it is voluntary burping.
I do not have uncontrollable burping.
Family medical history: my mother-in-law passed away from stomach cancer at around 60 years old.
Given this situation, what kind of examinations would be most appropriate? Should I undergo a CT scan, ultrasound, X-ray, gastroscopy, or colonoscopy? Thank you, Doctor.

Niming, 20~29 year old female. Ask Date: 2017/08/13

Dr. Chen Shidian reply Gastroenterology and Hepatology

Hello, sir.
You may be experiencing a disorder of gastrointestinal motility.
It is advisable to first test for occult blood in the stool and then take medication while adjusting your daily routine and dietary habits.
Changhua Hospital cares about your health.
Chen Shidian.

Reply Date: 2017/08/13

More Info

When it comes to intermittent abdominal pain, particularly in a patient with a complex medical history, it is essential to approach the situation with a thorough understanding of potential underlying causes and the appropriate steps for diagnosis and treatment. Given the symptoms you've described—intermittent pain in various quadrants of the abdomen, a sensation of cramping, and associated discomfort in the lower back—there are several considerations to keep in mind.

Understanding the Symptoms
1. Location and Nature of Pain: The fact that the pain alternates between different quadrants (left lower, right lower, left upper, right upper) suggests that it may not be localized to a single organ. This could indicate issues with multiple systems, including the gastrointestinal tract, urinary system, or even musculoskeletal structures.

2. Associated Symptoms: The cramping sensation and the involvement of the lower back could suggest a few possibilities:
- Gastrointestinal Issues: Conditions such as irritable bowel syndrome (IBS), diverticulitis, or even early signs of inflammatory bowel disease (IBD) could present with such symptoms.

- Musculoskeletal Problems: Given the involvement of the lower back, it’s also possible that muscle strain or spinal issues could be contributing to the pain.

- Urological Concerns: Intermittent pain could also be related to kidney stones or urinary tract infections, especially if there are any associated urinary symptoms.

3. Weight Loss and Appetite: The unintentional weight loss (from 82-83 kg to 78 kg) is concerning, especially in the context of a family history of gastric cancer. While your appetite remains normal, any unexplained weight loss should prompt further investigation.

Recommended Diagnostic Approach
Given the complexity of your symptoms and the potential for serious underlying conditions, a stepwise approach to diagnosis is advisable:
1. Initial Evaluation: Start with a comprehensive physical examination by a primary care physician or a gastroenterologist. They will assess your symptoms in detail and may perform basic tests such as blood work to check for signs of infection, inflammation, or anemia.

2. Imaging Studies:
- Ultrasound: This is a non-invasive first step that can help visualize organs in the abdomen and may identify gallstones, kidney stones, or abnormalities in the liver and pancreas.

- CT Scan: If ultrasound results are inconclusive, a CT scan of the abdomen and pelvis can provide a more detailed view and help identify issues such as appendicitis, diverticulitis, or tumors.

- X-ray: This is less commonly used for abdominal pain but can help rule out bowel obstructions or perforations.

3. Endoscopic Procedures:
- Gastroscopy (Upper Endoscopy): If there are concerns about upper gastrointestinal issues, particularly given your family history of gastric cancer, this procedure allows direct visualization of the esophagus, stomach, and duodenum.

- Colonoscopy: Given your symptoms and family history, a colonoscopy is crucial to evaluate the lower gastrointestinal tract for any signs of polyps, inflammation, or malignancy.

When to Seek Medical Advice
You should seek medical advice promptly if:
- The pain becomes severe or persistent.

- You experience any new symptoms such as fever, vomiting, or changes in bowel habits.

- There is any blood in your stool or urine.

- You notice any significant changes in your weight or appetite.

Conclusion
In summary, the symptoms you describe warrant a thorough evaluation to rule out serious conditions, especially given your family history. Starting with a visit to a primary care physician or gastroenterologist is advisable, followed by appropriate imaging and possibly endoscopic evaluations based on initial findings. Early diagnosis and intervention are key to managing any potential health issues effectively.

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