Sudden Onset Chronic Abdominal Distention

[csteffl]

I am a 48 yr old female who woke up last Nov. 1, 2004 with sudden abdominal distension, which has not gone away. There was a 10 lb weight gain in a 10 day time period, which within days went back to my normal, but the distension never left. My stomach always was very small, but I woke up this day somewhat in shock when I looked at the mirror.
My diagnosis list is: IDDM (40 years); a genetic seizure disorder which presented - controlled with Depakote & Felfatol (40 years); CAD (2 stents last year)advanced EBCT score of 2,546; hyperlipidemia; spinal stenosis - genetic; anemia; "mild gastroesophageal reflux with gastritis"; small hiatal hernia; focal nodular hyperplasia on dome of right lobe liver;
Last summer, I saw a gastroenterologist due to lower & upper right quadrant pains, where the above GI dx were made. Colonoscopy was clear, Gastroscopy showed an irregular GR junction. Biopsies were obtained. Squamous & glandular mucosa with minimal chronic inflammation. No evidence of goblet cell metaplasia or dysplasia. . Hyperplastic polyps biopsied in the stomach.  An esophagram and manometry was done also. "Essentially WNL" . Pulmonary tests were done due to continued SOB for past 2 years-negative findings. The stent placements did not resolve the SOB or angina I have had for 2 years. (circumflex was 90% closed and LAD 1st diagonal was 95%; I was a converter with a positive mantoux 12 years ago and went with INH tx last June. I was also put on 80mg Zocor last June when my 2nd stent was placed. My heart echo is normal. I have a heart murmur-mild mitral regurgitation.So back to the question..

What are the possible GI reasons my stomach would dtay distended. yet my overal weight can is the same as it has been for the past 20 years, if not less. I am physically active. It was a sudden overnight event, has not gone away. Ultrasounds and CT scan was done of my abdomin (abdomen) with negative findings of tumors or ascites or fluid of any kind. Bowels are fairly normal. Constipation is an issue on the iron. I stopped the iron 4 days ago to see and the stools are normal. The stomach will get very hard at times, irregardless of the stools and then soften but the overall measurement of my waist remains about 4-5" wider than "normal. The stomach has an appearance and feel of bread dough that has risen for a few hours-real soft and spongy. My doctor tried diuretics which did not change the stomach size much. I would still be 1-2" up or down and my weight would fluctuate up or down 10# over days. My kidney function has always been excellent until I went on the diuretic. Then my BUN started to elevate. 4 days ago, I stopped the diuretic and the the weight is now stable at 140#, up or down 1 lb. The swelling seems to be in my trunk and upper legs only. The stomach measurement has stayed the same off the diuretic. A CA-125 and Cortisol test were WNL. Any ideas what this could be? Any other tests that could define it?

[Kevin Pho, MD]

You have been through a comprehensive workup.  My first thought was ascities, leading to the possibility of ovarian cancer.  The normal ultrasound and CT scan would make this possibility less likely.  

A normal echo would make congestive heart failure unlikely as well.

With the rest of the workup being non-revealing, you can consider irritable bowel syndrome as a possibility.  Optimizing treatment by increasing the amount of fiber in the diet as well as the use of antispasmodic agents can be considered.  

Another, more specialized test, to consider would be a gastric emptying scan looking for gastroparesis.  This uncommon disease can certainly lead to abdominal distension.

You can discuss these options with your personal physician or in conjunction with a GI referral.

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

[lostforwords]

I am very curious to see the answer. I have a very similar problem, and assumed it was from a kidney donation. While I do have several medical conditions, none explain this. Good Luck, I will be coming back here often to see if there is an answer.
Deb

[yoshi]

what did the tests say about your hiatal hernia?

[csteffl]

July of last year I was referred to a G.I doctor to rule out GI cause of the residual chest pain and SOB I had since Jan. 04. Two stents later,(March and June 04), I still had the SOB and chest pain, but essentially, only when I walked up stairs or used my upper body (arms) like brushing my teeth?? or carrying something or bending over. Cardiac rehab would not see me after 3 visits being I still had the chest pain. The gastroscopy done only showed small polyps in my stomach (biopsied-benign-not precancerous) and " a small hiatal hernia". The Dr. said the hernia was not the source of my chest pain.  
I told the G.I doctor that after the endoscopy/manometry, it felt like there was something stuck in my throat at times, especially when I sat. She decided to do an esophagram to evaluate the cervical esophagus, WNL. She said I shouild go back to cardiology which I did this past Jan. 05. They said they felt they had opened the arteries that they could and had no idea why my stomach had suddenly distended "overnight". The GI doctor never saw me when my stomach was like this because that was last summer. Nov. 1, 04 is when everything changed. I had an MRI done Sept. 04 which showed "severe multilevel central canal spinal stenosis. Most severe at C6 interspacem severe at C3 thru C5 interspace & mild at C2. No definate T2 signal signal within the spinal cord parenchyma. There is a focal disk protrusion at T1 interspace."
The reason I say this is that this large world reknown medical center said surgery on the back should be put off until the pain was far more intense than I had due the extensive repair it needed and the problems it could start in fixing it. They said the area's affected on my back would not be causing the chest pain, SOB or weird feeling in my throat, like something was in it. Again, this was 1 month before my stomach got so large, so sudden. There are so many potential pieces to this puzzle but no one appears to be looking at the "big picture". There is sometghing wrong here and I would like it identified, hopefully treated. (This was a long answer to the hiatal hernia question-sorry! ) I am hoping the G.I doctor can give me some ideas...........

[Reba58]

Have you ever been checked for hypothyroidism?  Folks with thyroid problems commonly seem to complain of "the buddha belly."  I also have periodic arm and chest cramps but have been checked out thoroughly and it seems to be related to the hypothyroidism and the meds I take for it.

[yoshi]

are you on hormone replacement program??

[csteffl]

Mu thyroid tests are normal. They have been periodically checked for years, due to the fatigue. Once, my thyroid enlarged but then went back down in size. I am not on hormone replacements. I still am suspicious of ovariam issues and uteran, as my uterus keeps growing-it is at the upper limits of "normal". Apparently my endometrium is growing into the muscle of the uterus. My GYN says this is not a problem but the tech who did the ultrasound said it was very large. I also have small ovarian cysts and a couple uterine fibroids. The CA-125 should have picked up a tumor, which it didn't. I have a repeat ultrasound of my pelvis Friday. If it is clear, the GYN rules out "pelvic causes". Then I am left with heart, kidney or GI. The other question in my mind is, could the severe spinal stenosis I have cause nerve problems to my GI system that slow motility and cause distension.

[yoshi]

check ovarian cancer and its symptoms.

[csteffl]

CA-125 test was 14 (within normal limits

[michele36316]

A related discussion, severe abdominal distention was started.

[michelle317]

A related discussion, cronic abdominal distention was started.