Abdominal Discomfort: When to Seek Medical Help

Abdominal issues?

I visited a gastroenterologist on February 1st.
I had an upper endoscopy in November 2019, which revealed gastritis and severe gastroesophageal reflux disease.
However, for the past three weeks, I have been experiencing discomfort in my lower abdomen.
I previously had a hepatic angiomyolipoma that was treated with radiofrequency ablation, so I mentioned this to the doctor.
The doctor performed an ultrasound that lasted four minutes and only noted a 2 cm lesion on the right liver, which may be a scar from the previous ablation.
The doctor did not provide an explanation for the lower abdominal discomfort.

I have a few questions:
1.
If there is an issue with the intestines in the lower abdomen, can it be detected through an ultrasound?
2.
During the ultrasound, the doctor only instructed me to inhale and did not ask me to hold my breath.
Is this method accurate? (In the past, at Kaohsiung Veterans General Hospital, the doctors would instruct me to take a deep breath, hold it, and then breathe normally after a moment.) I am confused about when I can breathe normally, as I ended up breathing when I couldn't hold it any longer.

3.
If the discomfort persists, which specialty should I consult?

jojo, 40~49 year old female. Ask Date: 2020/02/05

Dr. Hong Yuanbin reply Internal Medicine

Hello,
1.
Ultrasound primarily examines solid organs, including the liver, gallbladder, pancreas, spleen, and kidneys.
The intestines are generally not visible unless there is a large tumor.

2.
It is important to hold your breath during the ultrasound to avoid blurriness caused by breathing.
However, exhaling is only a concern if the patient holds their breath for too long, which could lead to hypoxia; it is not a necessary part of the examination process.

3.
Based on the situation you described, it still falls within the realm of hepatobiliary and gastroenterology.
Regarding your discomfort, vascular, muscle, and lipomas are benign tissues and are unlikely to be the cause.
It is more probable that intestinal inflammation is the issue.
I recommend that you continue to have regular check-ups at a gastroenterology clinic.
Thank you for your inquiry.

Reply Date: 2020/02/05

More Info

When dealing with abdominal discomfort, especially in the context of a complex medical history, it is crucial to approach the situation methodically. Your concerns about the ongoing discomfort in your lower abdomen, especially after having a history of gastrointestinal issues, warrant careful consideration and possibly further investigation.

1. Understanding Ultrasound Limitations: Ultrasound is a valuable diagnostic tool for assessing various abdominal organs, including the liver, gallbladder, kidneys, and parts of the intestines. However, it has limitations. While it can detect abnormalities such as masses, fluid collections, and organ enlargement, it may not always provide a complete picture of the intestinal tract. Conditions like inflammatory bowel disease, small bowel obstructions, or certain types of tumors may not be fully visualized on an ultrasound. If your lower abdominal discomfort persists, and the ultrasound did not yield conclusive results, further imaging studies such as a CT scan or MRI may be warranted to evaluate the intestines more thoroughly.

2. Breathing Techniques During Ultrasound: The technique used during an ultrasound can affect the quality of the images obtained. Typically, patients are instructed to hold their breath at certain points to minimize movement and improve image clarity. However, if the technician did not instruct you to hold your breath, it may still be possible to obtain adequate images, especially if the area of interest is not significantly affected by breathing motion. If you have concerns about the quality of the ultrasound, it is reasonable to discuss this with your physician, who can explain the rationale behind the technique used and whether it may have impacted the results.

3. Next Steps in Seeking Medical Help: Given your ongoing discomfort, it is advisable to follow up with your primary care physician or a gastroenterologist. They can review your symptoms in the context of your medical history and the recent ultrasound findings. If necessary, they may recommend further diagnostic tests, such as a colonoscopy, especially considering your history of gastrointestinal issues. A colonoscopy can provide direct visualization of the colon and rectum, allowing for the assessment of potential causes of abdominal pain, such as polyps, inflammation, or other abnormalities.

In addition to seeking further medical evaluation, it is essential to monitor your symptoms closely. Keep a record of any changes in your discomfort, including its intensity, duration, and any associated symptoms such as changes in bowel habits, weight loss, or appetite changes. This information can be invaluable for your healthcare provider in determining the next steps in your evaluation and management.

Lastly, if you experience any alarming symptoms such as severe pain, fever, vomiting, or changes in consciousness, seek immediate medical attention. These could indicate a more serious underlying condition that requires urgent intervention.

In summary, while ultrasound is a useful tool, it has limitations, and persistent symptoms warrant further investigation. Engaging in open communication with your healthcare provider about your concerns and symptoms will help ensure that you receive the appropriate care and management for your abdominal discomfort.

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