Abdominal Pain and Gas Evaluation

Abdominal pain (belly ache or stomach ache) is a common symptom.  Everybody experiences some level of abdominal pain at various times in life.  Often the pain is self-limited and resolves on its own within hours or a few days.  Abdominal pain can be brought on by indigestion, intolerance to a particular food in the diet, infection, constipation, a pulled muscle or strain of the abdominal wall, stress, or weather changes.  In addition, many people experience gas pain and bloating.  Often the gas is related to food ingestion.   The pain can be short-lived (acute) or can last several weeks or longer (chronic).   While most patients with abdominal pain and gas have self-limited conditions, the symptoms can be related to diseases that require medical and/or surgical treatment.

What causes abdominal pain?

Abdominal pain has many potential causes, some more serious than others.  The location, duration, pattern of abdominal pain can provide important information to make a diagnosis.   The list of conditions that can cause abdominal pain is long and complex.  The following categories are listed to provide you with some basic information and are not intended for self-diagnosis.  Furthermore the following is not a substitute for a formal medical evaluation:

• Abdomen
  • Cancer or inflammation of lymph nodes
  • Strained muscles
• Appendix
  • Appendicitis (inflammation of the appendix)
  • Tumor or cancer of the appendix
• Bladder and kidneys
  • Bladder infection
  • Kidney stones or infection
• Colon
  • Cancer and polyps
  • Colitis
    • Infection related to bacteria, viruses, or parasites
    • Inflammatory bowel disease such as ulcerative colitis or Crohn’s Disease
    • Ischemia (lack of blood flow to colon)
  • Colon blockage or twisting
  • Constipation
  • Diverticulitis (inflammation of pockets inside the colon)
  • Irritable bowel syndrome
• Esophagus and stomach
  • Acid reflux and heartburns
  • Gastritis and stomach ulcers (inflammation of the stomach)
• Gallbladder and liver
  • Gallbladder inflammation (cholecystitis) and gallstones
  • Gallbladder or liver cancer
  • Liver inflammation (cholangitis or hepatitis) or infection
• Gynecologic disorders
  • Cysts of the ovaries
  • Ectopic (abnormal) pregnancy in the fallopian tubes
  • Endometriosis
  • Pelvic inflammatory disease (PID)— infection of the female reproductive organs
  • Tumors of the cervix, ovaries or uterus
• Hernia
• Pancreatitis
  • Inflammation from alcohol consumption or gallstones
  • Tumor or cancer of the pancreas
• Small intestine
  • Bowel obstruction from adhesions (scars from previous surgery)
  • Celiac disease and gluten allergy
  • Duodenitis and ulcers (inflammation of the first part)
  • Infections
  • Intolerance or allergies to food items that contain substances like lactose or fructose
  • Tumors or cancer of the small intestine
• Spleen
  • Infection or tumor
• Vascular conditions
  • Aneurysms of the blood vessels in the abdomen
  • Blood clots of the blood vessels of the intestine
  • Sickle cell anemia

When should you be concerned about the pain and bloating?

While abdominal pain often resolves on its own, it is important to seek immediate medical care if you have any of the following during an episode of acute abdominal pain (pain that lasts a few hours to more than a day duration):

• Bloody stools, especially if loose stools
• Darkening of the urine
• Distended, bloated abdomen that is sensitive to the touch
• Fever
• Inability to pass gas
• Pain that is worse with coughing or moving around
• Persistent nausea with vomiting and inability to keep food down
• Severe pain, especially if it is associated with cramping
• Sudden onset of severe abdominal pain
• Yellow skin or change in the color of the white of the eyes

In addition, if you have chronic pain (pain for days, weeks, or months) with any of the following symptoms, you should seek medical care:

• Bloating and gas regardless of what you eat
• Blood in the stool with or without defecation (bowel motion)
• Change in bowel habits (constipation, diarrhea, loose stools)
• Fatigue
• Pain that does not go away and is present on most days
• Weight loss

What tests are needed to evaluate abdominal pain?

When you visit the clinic of Dr. Maher Abbas, he will take a complete history and perform a physical examination to determine the tests that are needed.  Often the history and physical examination are sufficient to formulate a diagnosis and treat you.  It is important that you bring with you the reports of any previous tests and a list of medications you have used.  Depending on the location, duration, type of abdominal pain, and associated symptoms, one or more tests may be needed.  Dr. Maher Abbas will customize your tests in order to provide you with the highest quality of care.  Tests that are useful to assess abdominal pain include but are not limited to the following:

• Blood tests: CBC (complete blood count to assess for anemia or infection), liver function test, renal (kidney) function test, CRP (C reactive protein) and/or ESR (erythrocyte sedimentation rate) to check for inflammation, thyroid test, calcium level, urine analysis, celiac disease serology, helicobacter pylori bacteria serology, pregnancy test in women of reproductive age
• Breath tests: urea breath test for helicobacter pylori bacteria, lactose intolerance test, fructose intolerance test
• Endoscopic procedures: Colonoscopy and Gastroscopy to check inside the colon and stomach
• Radiologic examinations: CT scan (computed tomography), MRI (magnetic resonance scan), or ultrasound of the abdomen
• Stool tests: useful tests include ova and parasites, Calprotectin level (to check for inflammation), guaiac or the FIT test (fecal immunochemical test) to check for blood in the stool, helicobacter pylori bacteria toxin for bacterial infection, stool cultures, Gastrointestinal Multiplex panel (to test for various infection), clostridium difficile toxin
• Other tests: in rare cases, other types of tests are available to evaluate your condition

If you would like to schedule a consultation with Dr. Maher Abbas, click here. If you have previously undergone any testing, kindly bring all outside reports and imaging studies for Dr. Maher Abbas to review the day of your consultation.