Abdominal Pain: Possible Causes and When to Seek Further Help

Abdominal pain

Hello Doctor, my father has been experiencing abdominal pain when moving or lightly pressing on his abdomen for the past few days.
When he is still, he feels a vague discomfort.
However, his bowel movements and appetite are normal.
He previously visited a small clinic where the doctor, based on a normal X-ray and slightly elevated white blood cell count from blood tests, initially diagnosed him with appendicitis or cholecystitis and prescribed anti-inflammatory medication.
However, after two days of taking the medication, the pain persists.
Yesterday, he went to a hospital in Yilan, where the doctor also based on a normal X-ray and blood tests, initially diagnosed him with a gastric issue and prescribed medication as well.
It has only been one day since starting this new medication, and there has been no significant improvement.

Since the diagnoses from the two doctors differ, I would like to ask for your opinion.
If it is indeed a gastric issue, how long does it typically take for the medication to provide noticeable relief? If there could be other underlying causes, should he be referred to another hospital for further evaluation? Additionally, my father has a long-standing habit of drinking alcohol; while he is not an alcoholic, he consumes about half a bottle almost every day.
He only abstains from alcohol when he feels unwell.
Given that he has been drinking for nearly 26 years, could this potentially indicate a liver issue? Thank you, Doctor.

qǐ'é, 20~29 year old female. Ask Date: 2003/04/07

Dr. Yang Peizhen reply Gastroenterology and Hepatology

Hello! The question you asked is quite complex and covers a wide range of issues.
First, there are many diseases related to the abdomen, and abdominal pain can involve various organs.
Therefore, you need to specify the location of the pain and whether there is a fever.
Typically, the locations of appendicitis and cholecystitis are different; however, early appendicitis can cause pain in various locations, making it difficult to diagnose.
It is often accompanied by an increase or decrease in body temperature, and if left untreated, the symptoms will worsen.

Gastric issues usually present in the upper central abdomen.
Whether it is gastritis, peptic ulcer, or even gastric cancer cannot be distinguished based solely on symptoms.
If taking over-the-counter antacids for two to three days does not provide relief, it indicates that the issue may not be gastric, or it could be a more severe gastric condition, in which case an upper gastrointestinal endoscopy is necessary for an accurate diagnosis.

Normal bowel movements do not necessarily mean there are no intestinal issues; sometimes, there may be incomplete evacuation, and over time, accumulated stool can still cause discomfort.
A simple abdominal X-ray can help clarify this.

An important issue that has not been thoroughly explored is your father's long-standing alcohol consumption, which necessitates caution regarding liver disease.
Additionally, the risk of pancreatitis or even pancreatic cancer is higher.
One examination that is essential but has not yet been performed is an abdominal ultrasound, which can screen for issues in the liver, gallbladder, pancreas, spleen, kidneys, and even the intestines without causing discomfort.

My recommendations are: (1) abdominal ultrasound, (2) blood tests (liver function tests, amylase), and (3) an endoscopy depending on the situation.

Best wishes for your health,
Dr.
Yang Pei-Chen, Gastroenterology, Taoyuan Health Bureau

Reply Date: 2003/04/07

More Info

Understanding abdominal pain can be quite complex, as it can arise from various underlying conditions. In your father's case, the symptoms he is experiencing—pain during movement and upon light palpation, along with a general feeling of discomfort—could be indicative of several potential issues. Given that his bowel movements and appetite remain normal, it narrows down the possibilities but does not eliminate them entirely.

The initial diagnoses of appendicitis or cholecystitis (inflammation of the gallbladder) are plausible, especially considering the pain's location and nature. However, the fact that both X-rays and blood tests have returned normal results is a positive sign, as these conditions often present with more pronounced abnormalities. The slight elevation in white blood cell count could suggest some form of inflammation or infection, but it is not definitive for any specific diagnosis.

The subsequent diagnosis of a gastric issue is also worth considering. Gastritis or peptic ulcers can cause similar symptoms, particularly if there is irritation in the stomach lining. Medications prescribed for gastric issues, such as proton pump inhibitors or antacids, typically take a few days to a week to show significant improvement. If your father has been on these medications for only a day, it may be too early to assess their effectiveness.

Given your father's history of alcohol consumption, it is essential to consider the potential impact on his liver health. Chronic alcohol use can lead to liver conditions such as fatty liver disease, alcoholic hepatitis, or even cirrhosis over time. These conditions can manifest as abdominal pain, particularly in the upper right quadrant, and may also contribute to gastrointestinal discomfort. If liver disease is suspected, further evaluation through liver function tests, imaging studies like an ultrasound, or even a referral to a gastroenterologist may be warranted.

If your father's symptoms persist despite medication, or if they worsen, it is crucial to seek further medical evaluation. A gastroenterologist would be well-suited to investigate potential gastrointestinal issues more thoroughly. They may recommend additional tests such as an endoscopy or a CT scan to visualize the abdominal organs better.

In summary, while the initial diagnoses of appendicitis or gallbladder inflammation are possible, the normal imaging and lab results suggest that these may not be the underlying issues. Gastric problems could be at play, but given your father's alcohol consumption history, liver-related issues should also be considered. If symptoms do not improve with the current treatment, a referral to a specialist is advisable for further investigation and management. It is essential to monitor his condition closely and seek help if there are any changes or worsening of symptoms.

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