January 29, 2011
““Doc, my stomach hurts.” These are dreaded words. The abdomen, variously called stomach, gut or bowels is a perilous place to work. In a previous article, I talked about the concept of a differential diagnosis (1/18/11). In most areas of the body, the differential diagnosis is limited to a few items. When dealing with the abdomen, there are so many possibilities that making an accurate diagnosis can be maddening.
I have often discussed the unique nature of my patients and their illnesses. It seems no one ever reads the textbook and comes in with a textbook description of an illness. After 27 years of practicing medicine, I finally saw a patient who presented with exactly what the textbook states a typical case of appendicitis should have. She gave a verbatim history of how an acute appendicitis progresses. Her physical exam demonstrated every finding listed in Harrison’s Principals of Internal Medicine, the bible of medicine. She even had pain at McBurney’s point, a famous landmark associated with appendicitis. There was only one marker missing, an elevated white blood cell count. I arranged for her to be admitted and seen by the surgeon. To make a long story short, she did not have appendicitis. I actually don’t know what she had; she just got well!
The moral of the story is that, when you are dealing with any abdominal complaints, no matter how textbook they may be, you can be fooled. The other point I want to make is that, if a physician with 27 years of experience can be fooled, then certainly a lay person, suffering with abdominal symptoms, should be cautious and consult his doctor. There are too many times when my patients stay home with what they believe to be indigestion, while they are having a heart attack, or they think they have the “stomach flu” and have diverticulitis. The patient with the heart attack, if lucky, goes to the cardiac intensive care unit. The person with diverticulitis goes to surgery. Both sets of consequences can be avoided with early, proper diagnosis.
The abdomen contains your gastroesophageal junction, stomach, liver, gallbladder, spleen, pancreas, bile and pancreatic ducts, kidneys, ureters, small and large intestines, adrenals, aorta, vena cava, nodes and lymphatics. Pain emanating from any of these organs can mimic any other organ.
Typical diagnoses involving the contents of the abdomen include esophagitis, reflux, gastritis, pancreatitis, cholecystitis, hepatitis, colitis, gastroenteritis, diverticulitis, appendicitis, assorted cancers, kidney stones and many others. Many of these illnesses, if caught early, can be cured. If caught late, many of these illnesses can be devastating.
Warning signs are increasing pain, fever, chills, pain with cough or bearing down to have a BM or while walking, bleeding, persistent vomiting or diarrhea, constipation, and sudden onset. Be sensible, see your doctor early. Abdominal pain should not be taken lightly. Remember, the life you save may be your own.