Abdominal pain and hypotension episode

[Steve_m]

48 YO male with upper central abdominal pain (directly in the stomach), nausea and a history of GERD (under control with Prilosec.)Pain seems somewhat unrelated to food intake but I’m not sure as I’m taking acetaminophen. Have not seen a G.E. yet but have an appointment.

All blood work has been normal and H Pylori is negative, but GP doc says there still could be an ulcer. He says gastric cancer is very unlikely and that he would expect to see signs of metastatic tumors in the blood work (is this right?) and other organ functions are normal. How reliable an indicator is liver/ pancreas function in a case like this? He also said that stomach cancer doesn’t typically present with pain, which I found bizarre given what I have read.

I had a hypotension episode on arising (lost consciousness) that my GP thinks is unrelated and was a result of the Seroquel I’m taking. But that day I started having black stools and took  a sample in the next day and it was negative for blood. This all seems too coincidental to me. Could there have been a hemorrhage that significant that has clotted and now is not bleeding? He says a hemorrhage bad enough to cause a blackout would be easy to detect. But why the black stools?

I should also mention that I’m coming off a six week period of extreme stress, caffeine abuse and some amphetamine usage. I do also have a history of NSAID use but it’s been several weeks since I’ve had any.

[Kevin Pho, MD]

To answer your questions:
1) I am not aware of specific blood tests that can look for metastatic disease.  Typically imaging studies (i.e. CT scans or a PET scan) are needed for this.

2) If the pancreatic function tests (i.e. amylase or lipase) are elevated, it is fairly reliable in pointing towards the pancreas as a trouble spot.  

3) A stool card test is not 100% sensitive.  If you are having black stools, it may be suggestive of an upper GI bleed.  You may want to consider an upper endoscopy or upper GI series to evaluate this.  

Iron supplements and certain foods can also lead to black stools.  

I would certainly pursue further workup - in addition to the H Pylori, the upper endoscopy would be the most reasonable initial test.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
Medical Weblog:
kevinmd_b

[Inanga]

You are seeming peices of a puzzle that might fit with cancer, but might not. What other couses for the different symptoms could there be? The stool sample didn't show blood - food high in iron can cause black stools. Do you eat a particular food or change diet around that time? Are there other causes of dark stools?

Pains in the "gut" can also be caused by flora imbalance after taking antibiotics. probiotics like acidophilus can apparently help (I have suffered this myself and find it helps). Too much caffein can also cause stomach pains in my experience.

It's good to eliminate the nasty possibliities (cancer) but keep trying to identify other possible causes - you'll probably have to keep pushing this yourself - the doc might say it's nothing serious but that won't necessarilly put your mind at rest.

Do youself a favour and stop abusing your body with drugs etc.

[Steve_m]

Well I'm anxious to hear what Dr Pho has to say, but just to clarify- I don't have a history of drug abuse. This was a limited time thing where I used my son's ritalin to get through a stressful period. Probably stupid.

The thing that concerns me is the negative H-pylori combined with the fact that I was on an acid reducer makes an ulcer seem unlikely. I also wonder about some type of gastritis. I haven't been on any antibiotics, btw.

[Daltonpc]

Just wanted to let you know that Maalox Extra Strength, Bepto-Bismul and a few other stomach medicines cause very dark stools. I had the same problem after an ER visit for stomach problems and the ER doctor prescribed prevacid and maalox. Was extremly scared when the next day when I had black/Very Dark Green stools. The bottles don't tell you this, have to search ingredients online to find out.

Ingredient to watch for is Bismuth subsalicylate.

Some foods like Blackberries can cause this to.

[magillicudy]

A related discussion, H. pylori was started.