Abdominal Pain and Movable Mass: A Gastrointestinal Concern

Pain on palpation of the left side of the abdomen with a movable mass?

Hello Dr.
Chen: My husband is 38 years old, 183 cm tall, and weighs about 68-72 kg, with a medium build and a habit of exercising (cycling and hiking).
He has had gastrointestinal issues for many years.
About two years ago, I noticed a smell when he exhaled.
He has since changed his diet to primarily vegetarian, and the smell has gradually diminished.
Although he usually eats a normal amount, he tends to eat quickly and enjoys spicy food.
Occasionally, he experiences bloating, frequent belching, and flatulence, and he is prone to constipation (about every three days, which improves slightly when he drinks yogurt).
He usually does not get enough sleep (staying up late and waking up early, with occasional naps), and his eyes are often bloodshot.
Recently, he mentioned that pressing on his abdomen is painful, and he discovered a hard lump near his navel that moves when pressed.
When I asked him how long he had noticed the lump, he said it had been a long time...
probably around 10 years! However, it seems that the lump has not always been present; it has reappeared recently...
(When I pressed on his abdomen, he said the lump itself was not painful, but the left side of the navel was more painful, while the rest felt like a distending pain).

PS: My husband is reluctant to go to the hospital because he is afraid of procedures like gastroscopy, but I am very concerned about his health...
So I would like to ask Dr.
Chen:
1.
Is the smell when exhaling related to the digestive system?
2.
Why has the smell diminished after switching to a vegetarian diet? What could be the reason?
3.
Is the frequent bloating, belching, and flatulence related to his fast eating speed?
4.
Why is he still prone to constipation despite regular exercise? Besides yogurt, what other ways can he improve his constipation?
5.
Is the abdominal pain when pressed caused by long-term constipation, or could it be due to other factors?
6.
Why does the movable lump near the navel not cause pain when pressed, and why does it seem to have reappeared recently? Could it be a tumor?
7.
Is the abdominal pain and lump related to the liver?
8.
Are the yellowish, bloodshot eyes indicative of liver function issues?
I apologize for the numerous questions, and I appreciate your patience in reading and responding.
Thank you! Grateful~

Xiao Xiong Wei Ni, 30~39 year old female. Ask Date: 2013/03/10

Dr. Chen Shidian reply Gastroenterology and Hepatology

Hello Winnie the Pooh,
1.
Currently, there are no accurate diagnostic criteria for breath odor, which is mostly related to oral hygiene.

2.
For other gastrointestinal symptoms, please consult a gastroenterologist for an in-person examination and diagnosis.
An endoscopy is not necessarily required (but a painless gastrointestinal endoscopy can be chosen if necessary).
Changhua Hospital cares about your health.

Dr.
Shih-Tien Chen

Reply Date: 2013/03/10

More Info

Hello! Thank you for your detailed inquiry regarding your husband's health concerns. It’s understandable to be worried, especially when it comes to abdominal pain and the presence of a movable mass. Let’s address your questions one by one, while also providing some context based on medical knowledge.

1. Breath Odor and Digestive System: The presence of an unusual odor in breath can indeed be related to digestive issues. Conditions such as gastroesophageal reflux disease (GERD), poor digestion, or even certain dietary choices can contribute to this. When your husband switched to a primarily vegetarian diet, it’s possible that the change in fiber intake and the reduction of certain foods (like meat and dairy) helped improve his digestion, thus reducing the odor.

2. Improvement After Switching to Vegetarian Diet: A vegetarian diet often includes more fiber, which can aid in digestion and promote regular bowel movements. This dietary change may have reduced the fermentation of food in the gut, leading to less gas production and consequently less odor.

3. Bloating, Belching, and Flatulence: Eating quickly can lead to swallowing air, which contributes to bloating and increased gas. Additionally, certain foods, especially those high in fiber or certain carbohydrates, can cause gas. Encouraging your husband to eat slowly and chew his food thoroughly may help alleviate these symptoms.

4. Exercise and Constipation: While regular exercise is beneficial for digestive health, other factors can contribute to constipation, such as inadequate fluid intake, low fiber intake, or even stress. Besides probiotics like yogurt, increasing water intake and incorporating more high-fiber foods (fruits, vegetables, whole grains) into his diet can help improve bowel regularity.

5. Abdominal Pain and Constipation: Abdominal pain upon pressing could be related to several factors, including constipation, which can cause discomfort due to stool buildup. However, it’s essential to consider other potential causes, such as gastrointestinal disorders or even muscle strain.

6. Movable Mass Near the Navel: The presence of a movable mass that is not painful upon pressure could indicate a hernia, lipoma (a benign fatty tumor), or other benign conditions. However, the fact that it has been present for a long time and has only recently become noticeable warrants further investigation. While it’s less likely to be a tumor, it’s essential to have a healthcare professional evaluate it to rule out any serious conditions.

7. Connection Between Abdominal Pain, Mass, and Liver: While abdominal pain can be related to liver issues, the symptoms you've described seem more aligned with gastrointestinal or possibly hernia-related issues. However, liver function should not be overlooked, especially with the presence of yellowing in the eyes.

8. Yellowing of the Eyes and Bloodshot Sclera: Yellowing of the eyes (jaundice) can indicate liver dysfunction, bile duct obstruction, or hemolysis. The presence of bloodshot eyes may be due to a lack of sleep or other factors, but it’s essential to monitor these symptoms closely.

Given your husband’s reluctance to seek medical attention, it’s crucial to encourage him to see a healthcare provider for a thorough evaluation. A healthcare professional can perform necessary tests, such as imaging studies or blood tests, to assess his liver function and investigate the abdominal mass further.
In summary, while some of the symptoms may be benign, the combination of abdominal pain, a movable mass, and changes in eye color should not be ignored. Early diagnosis and intervention can lead to better outcomes. Thank you for your thoughtful questions, and I hope this information helps guide you and your husband toward better health!

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