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Abdominal Pain

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    Severe or unexplained abdominal pain is often a symptom of more serious health conditions that can be screened for with tests such as colonoscopy. Contact your gastroenterologist (GI) doctor to discuss any persisting stomach pains you may be experiencing, especially if the pain is accompanied by diarrhea, blood in the stool or other symptoms, to find out if you are affected with a bowel-related disease. Your doctor may order any number of the following tests to examine you:

    CT Scan—during a CT scan, also called a CAT scan or a computed tomography, your doctor will use a medical imaging machine to take hundreds of cross-sectional pictures of your abdomen and put them together for a final, 3D image of your body’s insides. GI doctors and other specialists, including surgeons, will examine the results of the CT scan and determine the proper treatment necessary for any other problems that are detected. A CT scan can be ordered relatively quickly and does not require much preparation from the patient, as opposed to a colonoscopy or other procedures that requires sedation. The process takes a few minutes, exposing the patient to a minimal amount of radiation.  CT scans can detect structural defects within the abdomen, but are not sensitive or specific enough to detect small tumors, and are not reliable for detecting sources of blood loss without more advanced techniques such as angiography.

    Barium Enema X-Ray—during a barium enema x-ray, also called a double contrast barium enema, x-ray images of the large intestine are taken and examined by a specialist. The procedure is more involved than a CT scan because the patient will need to prepare his or her bowel with bowel prep, emptying the colon with laxatives and an all-liquid diet during the day leading up to the procedure.  The patient will also have an enema tube filled with a barium solution inserted into his or her body via the rectum to make abnormalities in the colon show up more clearly on the final x-ray image.

    Virtual Colonoscopy—during a virtual colonoscopy, abnormalities in the large intestine such as polyps or other growths can be detectednon invasively in a CT scan machine.  . The virtual colonoscopy procedure takes place in a radiology office and the procedure itself only takes 10 minutes. It involves inserting a flexible tube through the rectum and pumping gas or air to inflate the patient’s colon while a CT scan is taken. Patients also have to prepare for this procedure with bowel prep practices, similar to that done for colonoscopy.

    Flexible Sigmoidoscopy—during a flexible sigmoidoscopy, the insides of a patient’s sigmoid colon and rectum are examined for inflammation and abnormal growths. A device called a sigmoidoscope, shaped much like the long, flexible tube with a light and camera on the end of it that is used in a traditional colonoscopy, is inserted via the anus and guided slowly through the sigmoid colon. Images captured by the camera at the end of the sigmoidoscope are displayed on a computer monitor and examined by experts. Although a sigmoidoscopy also requires bowel prep and sedation, it is less comprehensive than a traditional colonoscopy, as the sigmoidoscopy procedure is limited to a lower third of the colon only, and can miss growths throughout the remainder of the colon.  Flexible sigmoidoscopy can be useful for determining the presence of proctitis, or certain types of colitits including Ulcerative colitis (a form of inflammatory bowel disease.)

    Colonoscopy—during a colonoscopy, a doctor is able to see inside the entire length of a sedate patient’s large intestine and examine it for possible sources of abdominal pain and other symptoms. A device called a colonoscope is inserted via the anus and moved through to the beginning of the patient’s colon—sometimes even into the lower part of the small intestine—while doctors examine the camera’s images on a computer or television monitor. Oftentimes, air or gas in pumped through the colon for better viewing. Images are captured both as the colonoscope goes into the body and as it is guided out. During a colonoscopy, minor surgical procedures such as polyp removal or other biopsies can also be performed.  A colonoscopy normally requires sedation to perform, which is usually administered by the gastroenterologist or an anesthesiologist.  Colonoscopy is considered the ‘gold standard’ for polyp and cancer detection, and is recommended for all adults over 50 years of age (earlier if there is personal/family history of colon cancer, or prior history of colon polyps.)   

    Contact a colonoscopy specialist if you have not figured out the source of your abdominal pain. With all GI conditions, early detection is the key to proper diagnosis and treatment. Regular screenings can prevent more serious complications like colon cancer.

    Reviewed 12/29/2011 by David M. Nolan, M.D.
    Diplomate of the American Board of Internal Medicine, 2011
    Currently a Fellow of Gastroenterology, at UCI 2011-2014

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