How to Identify Digestive Issues: A Guide for Patients

Q: How to Identify Digestive Issues: A Guide for Patients

Hello, Miss： Please first visit the gastroenterology outpatient clinic (you may bring a small sample of "black stool" for examination) to confirm any issues related to the intestines, stomach, pancreas, or kidneys. <br>Changhua Hospital cares about your health. <br>Chen Shidian

How should it be determined?

Hello Dr.
Chen,
I would like to ask you about a 53-year-old woman who has not had her menstrual period for about a year.
Approximately one to two years ago, she experienced pain in the upper left abdomen after dinner and had black stools.
She underwent an upper gastrointestinal endoscopy, which revealed slight gastric bleeding and ulcers (stool occult blood test was normal).
She recovered after medication.
However, recently, she has been experiencing sharp pain in the upper left abdomen after dinner again, and there was a small amount of black stool.
Strangely, the next day, she also felt pain in the back behind the right abdomen.

I have a few questions:
1.
Which organ might be problematic?
2.
Which specialty should she consult?
3.
What examinations should be performed? (Upper endoscopy, colonoscopy, abdominal ultrasound, etc.)
Thank you for your guidance.

Varina, 30~39 year old female. Ask Date: 2010/11/01

Dr. Chen Shidian reply Gastroenterology and Hepatology

Hello, Miss: Please first visit the gastroenterology outpatient clinic (you may bring a small sample of "black stool" for examination) to confirm any issues related to the intestines, stomach, pancreas, or kidneys.
Changhua Hospital cares about your health.
Chen Shidian

Reply Date: 2010/11/01

More Info

Identifying digestive issues can be a complex process, especially when symptoms are recurrent and involve multiple areas of the abdomen. In the case of the 53-year-old woman you mentioned, her symptoms of left upper abdominal pain, black stools, and now right abdominal and back pain warrant a thorough evaluation. Here’s a guide to help understand potential issues, the appropriate medical specialties to consult, and the necessary diagnostic tests.

Potential Organ Involvement
1. Stomach: Given her history of gastric ulcers and previous episodes of upper abdominal pain, the stomach could still be a primary concern. The presence of black stools (melena) often indicates upper gastrointestinal bleeding, which could be due to a recurrent ulcer or gastritis.

2. Pancreas: The left upper quadrant pain could also suggest issues with the pancreas, such as pancreatitis, especially if the pain radiates to the back.
3. Spleen: Located in the left upper quadrant, splenic issues (like splenomegaly or splenic infarction) could also cause pain in this area.

4. Gallbladder: Although typically associated with right upper quadrant pain, gallbladder issues can sometimes present with referred pain to the left side.

5. Colon: Given the history of gastrointestinal symptoms, issues in the colon, such as diverticulitis or colitis, could also be considered, especially if there is any change in bowel habits.

Recommended Medical Specialties
1. Gastroenterology: This is the primary specialty for digestive issues. A gastroenterologist can provide a comprehensive evaluation of her symptoms and history.

2. Internal Medicine: An internist can also be a good starting point, especially if there are systemic symptoms or if the patient has other medical conditions that need to be considered.

3. Pain Management: If the pain becomes chronic or debilitating, consulting a pain management specialist may be beneficial.

Suggested Diagnostic Tests
1. Upper Endoscopy (EGD): Given her history of gastric ulcers and current symptoms, an upper endoscopy is crucial to visualize the esophagus, stomach, and duodenum for any lesions, ulcers, or signs of bleeding.

2. Colonoscopy: If there are concerns about the lower gastrointestinal tract, especially with any changes in bowel habits or the presence of blood, a colonoscopy is warranted.

3. Abdominal Ultrasound: This non-invasive test can help assess the liver, gallbladder, pancreas, and kidneys for any abnormalities.

4. CT Scan of the Abdomen: If the ultrasound is inconclusive or if there is a need for a more detailed view of the abdominal organs, a CT scan can provide valuable information.

5. Laboratory Tests: Blood tests, including a complete blood count (CBC), liver function tests, and possibly tests for pancreatitis (like lipase), can provide additional insights into her condition.

Conclusion
In summary, the symptoms described suggest a potential issue with the upper gastrointestinal tract, possibly related to her previous history of ulcers. It is essential for her to consult a gastroenterologist who can perform the necessary evaluations and recommend appropriate diagnostic tests. Early diagnosis and treatment are crucial to managing her symptoms and preventing further complications. If she experiences worsening symptoms, such as increased pain, fever, or changes in bowel habits, she should seek medical attention promptly.

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