Intermittent Abdominal Pains

[johntc]

Hello I am a 35 yr old male who has been suffering from unexplained abdominal problems for the past two months.  A little past history first, two years ago I was diagnosed with Scleroderma Morphea.  A Rheumatologist confirmed that it was not systemic this past January.  A year ago I was diagnosed with hypertension 170/100.  Prior to that I always had normal bp.  Under meds (Lotensin, Atenolol and Tricor) I have low bp  95/60.  About 8 weeks ago I was awoken by extreme pain just below the belly button which lasted roughly three hours, and I was tender for the next two days.  I have had four episodes of these night pains since.  I also have not slept thru the night in these 8 weeks and I am not sure what is waking me up.  Since the first episode I have also been having short duration, varying in severity pains along either flank and across the bottom of the abdomen.  I notice these pains only during the day, usually three to four times a day.  On two different days I had 100’s of these episodes.  During one of these episodes my face turned white as a ghost and then quickly turned red (according to one of my co-workers) and I felt really hot and my vision got blurry. My bowel movements have gone from daily and regular to every other day or third day. The consistency varies from diarrhea to pasty to rock hard.  I have almost daily nausea but no vomiting.  During meals I get filled up a lot quicker and after meals I feel very bloated (almost painful).  My family doctor has ruled out bladder infection (there was also blood in the urine) and any problem with the liver, pancreas, kidneys and gall bladder by ultrasound imaging and blood tests. My family doctor ordered a CT and referred me to a GI specialist.  Since then I found a palpable structure just below the belly button.  It varies in size from a golf ball to bratwurst dependent on when I ate last.  The GI after physical exam found nothing out of the ordinary (he didn’t notice the palpable structure and ran off to his next patient before I could tell him about it) He also said the CT was inconclusive because of “bad prep”.  This offended me because I strictly followed the instructions for the barium drink and fasting. He did say they saw what looked like a fecal mass in the ascending colon near the junction of the small and large intestines.  Because of that he said he was obligated to do a colonoscopy and upper endoscopy.  I am scheduled for one in two weeks.  My concern is what can this bad prep really be?  Is the fecal mass really cancer? If the problem is really in the small intestine where the palpable mass is, will the colonoscopy turn anything up?   Could it be systemic scleroderma afterall?  Could a problem in the small intestine cause blood in the urine?

[Kevin Pho, MD]

Hello - thanks for asking your question.

You note consistent, intermittent abdominal pain.  There is blood in the urine.  There is a questionable mass in the ascending colon.  

A "bad prep" suggests that there is residual fecal matter that is interfering with the study.  The most definitive way to differentiate fecal matter from a true mass would be via endoscopy.  

The colonoscopy would be the best test to evaluate this mass.  The GI doc can visualize it and, if suspicious, take a biopsy of it to see if it is cancerous or not.  

I am unaware or systemic scleroderma manifesting as a colon mass.  All masses should be tested to exclude cancer first.

As for the blood in the urine, that is a seperate problem.  Causes include infection, bladder cancer/mass, or intrinsic kidney disease.  An IVP or cystoscopy, urine cytology, and a kidney ultrasound should all be considered to evaluate the source of the blood.  These tests should be discussed with your personal physician.

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.

Thanks,
Kevin, M.D.

[johntc]

An update for you.  On Monday I had the colonoscopy.  The Dr. biopsied two "red spots".  On Wednesday the intermittent pains returned.  I checked my BP shortly after one of the attacks and it measured 90/50.  On thursday my company nurse measured 95/55.  The pains continue even today.  On Monday my BP was 120/80.  I did get a call from the doctor and the results from the biopsy was negative.  He wanted to see me again because there was significant inflamation (inflammation).  Could there be a relationship between BP and these pains?  I don't see my doctor again for four weeks.