Abdominal Pain: Causes and When to Seek Help - Internal Medicine

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Abnormal abdominal pain


Hello, doctor.
I am 29 years old and I have ankylosing spondylitis and chronic anemia (with an average hemoglobin level of about 20).
I'm not sure if this is related to the events I've experienced.
The first incident occurred when I was around 20 years old.
While working, I suddenly felt severe pain in my upper abdomen.
Since it wasn't colicky pain, I stood still to rest for a moment, and after about a minute, the pain subsided.
I thought everything was fine and was about to continue working when I suddenly felt dizzy, and everything went black.
I collapsed but immediately regained consciousness after falling.
However, the colors I saw were different, and I couldn't hear any sounds.
I sat there resting for about an hour before slowly returning to normal.

The second type of incident occurs about 2-3 times a year (it has happened right after waking up, during work, and just after getting off work).
It also involves upper abdominal pain, but again, it's not colicky.
The duration of the pain is longer, lasting about 30 minutes to an hour, and it is accompanied by heavy sweating.
The pain is so intense that I feel like I might faint, and I have no strength to make any sounds.
It's difficult to call for help in the restroom.

I would like to ask what might be causing these symptoms.
If I want to undergo examinations, what areas should I focus on, and which specialties should I consult?

Iris, 20~29 year old female. Ask Date: 2023/07/28

Dr. Zheng Weijun reply Internal Medicine


Hello, thank you for your detailed description.
First, regarding your mention that "the average hemoglobin does not exceed 20," this value is within the normal range; the normal hemoglobin level for women is 12–16 g/dL, so your current hemoglobin level may not be abnormal.
However, hemoglobin is not the only criterion for diagnosing anemia; other indicators such as red blood cell count and hematocrit are also important.

Concerning the severe upper abdominal pain you described, accompanied by altered consciousness, I am very concerned that this may be related to cardiovascular disease.
Particularly, the symptoms you mentioned—upper abdominal pain, profuse sweating, dizziness, and even transient loss of consciousness—could be signs of myocardial infarction, arrhythmia, or other heart-related issues.
Additionally, syncope refers to a temporary loss of consciousness due to a brief reduction in blood flow to the brain.
There are many causes of syncope, some of which can be quite serious, such as arrhythmias.
Based on your description, this situation has occurred more than once and is accompanied by upper abdominal pain, which increases the likelihood of cardiovascular disease as a potential cause.
I recommend that you first schedule an appointment with a cardiologist for a thorough evaluation, which may include tests such as an electrocardiogram (ECG) or echocardiogram.
If heart-related diseases are ruled out, you should then consider consulting a neurologist or a gastroenterologist to explore other potential causes, such as neurogenic syncope, gastroesophageal reflux disease, or other gastrointestinal disorders.
Finally, I must remind you that according to Article 11 of the Medical Practitioners Act: a physician must personally examine a patient before providing treatment, prescribing medication, or issuing a diagnosis.
Based on the symptoms you described, I strongly advise you to seek medical attention in person as soon as possible for appropriate evaluation and testing.
Wishing you good health!

Reply Date: 2023/07/28

More Info


Understanding abdominal pain can be complex, especially when it is accompanied by other symptoms such as dizziness and fainting. Your situation, particularly with a history of ankylosing spondylitis and chronic anemia, adds layers to the potential causes of your abdominal pain.
First, let's break down the symptoms you described. You mentioned experiencing sudden upper abdominal pain that is not colicky in nature, followed by episodes of dizziness and fainting. The fact that the pain resolves relatively quickly (within minutes) but is accompanied by significant sweating and weakness suggests that it may be related to a visceral response, possibly involving the autonomic nervous system.

There are several potential causes for your symptoms:
1. Gastrointestinal Issues: Conditions such as gastritis, peptic ulcers, or even gallbladder disease could lead to upper abdominal pain. The pain you experience could be due to irritation or inflammation of the stomach lining or gallbladder, especially if it is related to meals or stress.

2. Vasovagal Syncope: The fainting episodes you described could be a vasovagal response, which is a sudden drop in heart rate and blood pressure leading to fainting. This can be triggered by pain, stress, or even standing up too quickly. The sweating and weakness you experience during these episodes could be part of this response.

3. Anemia: Chronic anemia can lead to fatigue and weakness, which may exacerbate your symptoms. If your hemoglobin levels are consistently low, it could affect your overall energy levels and tolerance to pain.

4. Musculoskeletal Issues: Given your history of ankylosing spondylitis, it’s possible that the pain could also be related to musculoskeletal factors, especially if there is any involvement of the thoracic spine or ribs that could refer pain to the abdomen.

5. Cardiovascular Concerns: Although less likely given your age, any sudden onset of abdominal pain accompanied by dizziness should prompt consideration of cardiovascular issues, such as aortic dissection or other vascular problems.

Given the complexity of your symptoms and their potential overlap with various systems in the body, it is crucial to seek a comprehensive evaluation. Here are some recommendations on how to proceed:
- Primary Care Physician: Start with your primary care physician, who can perform a thorough history and physical examination. They can assess your symptoms in the context of your medical history and may refer you to specialists as needed.

- Gastroenterology: If gastrointestinal issues are suspected, a referral to a gastroenterologist would be appropriate. They may recommend tests such as an upper endoscopy, abdominal ultrasound, or CT scan to evaluate for any underlying conditions.

- Neurology/Cardiology: If the fainting episodes continue or worsen, a neurologist or cardiologist may need to evaluate you for potential neurological or cardiovascular causes.

- Blood Tests: Given your history of anemia, regular blood tests to monitor hemoglobin levels, as well as tests for other potential causes of abdominal pain (such as liver function tests, pancreatic enzymes, etc.), would be beneficial.

In conclusion, while your symptoms may seem alarming, they can often be managed effectively with the right diagnostic approach. It is essential to communicate all your symptoms clearly to your healthcare provider, including the timing, duration, and any associated factors. This will help them to narrow down the potential causes and guide you toward the appropriate treatment. Remember, timely medical evaluation is key to addressing any underlying issues effectively.

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