Finding the Right Specialist for Complex Abdominal Symptoms

Finding the right physician for treatment?

My mother is currently 73 years old and has diabetes, heart disease, and hypertension, which she manages with regular doctor visits and medication.
This year, she has experienced discomfort in two areas of her body.
The first issue is that she often feels tightness on both sides of her abdomen (near the thigh area), which causes pain while walking, as if something is stuck there.
She frequently feels hungry but can only eat a small amount before feeling full.
In July and August, she underwent an upper gastrointestinal endoscopy, which showed mild inflammation, and an abdominal ultrasound, which indicated fatty liver.
In mid-August, she suddenly experienced cold sweats, fever, and general discomfort, leading to a visit to the emergency room, where she was diagnosed with a urinary tract infection, with a white blood cell count of 12,500.
She was hospitalized for one day for treatment, but her abdominal symptoms persist.
Could these symptoms be related to issues with the rectum (colon) or uterus? Which specialist should she see?
The second area of concern is a sharp pain above her navel, approximately the width of a hand, which sometimes radiates upward.
Could this symptom indicate a heart issue, or is it related to her abdomen? In June 2005, she had a history of hematuria and was evaluated by a physician who suspected bile duct stones, bleeding, and a blockage in one ureter causing a kidney infection.
After arranging for anesthesia and surgery, the stones and source of bleeding could not be located, and she was hospitalized for eight days for treatment.

kevin, 30~39 year old female. Ask Date: 2006/09/10

Dr. Xiao Jingqin reply Internal Medicine

The patient's primary pain is located in the lower abdomen, and it worsens with walking.
They also experience loss of appetite and a tendency to feel bloated, which may not necessarily indicate a gastric issue.
If we narrow down the problem to the lower abdomen, potentially affecting both sides, the related organs would include the colon, part of the small intestine, uterus, bladder, and both ovaries.
A gynecological ultrasound can help rule out gynecological issues, while urinalysis and abdominal X-rays can generally differentiate urinary tract problems.
If the only remaining concern is the colon and it cannot be confirmed whether there is an issue, it is advisable to consult a gastroenterologist or colorectal surgeon to consider scheduling a colonoscopy or a barium enema to exclude colon problems.
Additionally, some rare symptoms of intestinal ischemia are more common in patients with diabetes and hypertension, and these can also be addressed in a gastroenterology consultation.

Reply Date: 2006/09/10

More Info

Finding the right specialist for complex abdominal symptoms, especially in an elderly patient with multiple comorbidities, can be a challenging task. Your mother’s case involves a combination of gastrointestinal symptoms, potential gynecological issues, and a history of urinary tract infections, which complicates the diagnostic process. Given her age and existing health conditions such as diabetes, heart disease, and hypertension, it is crucial to approach her symptoms methodically.

Understanding the Symptoms
1. Abdominal Pain and Discomfort: Your mother experiences tightness and pain in the lower abdomen, particularly near the thighs, which worsens with movement. This could indicate several underlying issues, including gastrointestinal problems (like diverticulitis or bowel obstruction), gynecological issues (such as ovarian cysts or uterine fibroids), or even musculoskeletal pain.

2. Nausea and Appetite Changes: The sensation of fullness after eating very little can be associated with gastrointestinal disorders, such as gastroparesis (delayed gastric emptying), which is common in diabetic patients. Given her recent endoscopy showing mild inflammation, it’s also possible that gastritis or peptic ulcers could be contributing to her symptoms.

3. Pain Above the Navel: The sharp pain above the navel that radiates could be related to several factors. It might be gastrointestinal, such as issues with the stomach or small intestine, or it could be referred pain from the heart, especially considering her cardiovascular history.

Recommended Specialists
Given the complexity of her symptoms, I recommend the following specialists:
1. Gastroenterologist: Since your mother has ongoing abdominal symptoms and a history of gastrointestinal issues, a gastroenterologist should be the first point of contact. They can perform further diagnostic tests, such as a colonoscopy, to evaluate for conditions like diverticulitis or colorectal cancer, which are more common in older adults.

2. Gynecologist: Given her age and the possibility of gynecological issues, a gynecologist should evaluate her for any reproductive system-related problems. An ultrasound may be necessary to assess the ovaries and uterus for any abnormalities.

3. Urologist: Since she has a history of urinary tract infections and related complications, a urologist can help rule out any urinary tract issues that might be contributing to her abdominal pain.

4. Cardiologist: If there are concerns about the pain above the navel being related to her heart condition, a cardiologist should evaluate her cardiovascular health. This is particularly important if she experiences symptoms like shortness of breath, chest pain, or palpitations.

Diagnostic Approach
1. Comprehensive Evaluation: It’s essential to gather a complete medical history and perform a thorough physical examination. This should include a review of her medications, as some can cause gastrointestinal side effects.

2. Imaging Studies: Depending on the findings from the initial evaluations, imaging studies such as an abdominal ultrasound, CT scan, or MRI may be warranted to visualize internal organs and identify any abnormalities.

3. Laboratory Tests: Blood tests, including a complete blood count (CBC), liver function tests, and metabolic panel, can provide insights into her overall health and help identify any underlying issues.

4. Symptom Diary: Keeping a diary of her symptoms, including when they occur, their severity, and any associated factors (like food intake or activity level), can help her healthcare providers make a more accurate diagnosis.

Conclusion
In summary, your mother’s symptoms warrant a multidisciplinary approach involving gastroenterology, gynecology, urology, and possibly cardiology. It’s crucial to ensure that her healthcare providers communicate effectively to piece together the puzzle of her symptoms. Given her age and medical history, timely and thorough evaluation is essential to prevent complications and improve her quality of life. Encourage her to seek these consultations promptly, as early intervention can lead to better outcomes.

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