May - Jun 2012

An Upset Stomach - Is It Serious?

By Carey Brown, MD

 

When patients describe food intolerance, they may use phrases such as nausea, vomiting, or a sour queasy stomach feeling. Nausea is a symptom that is nonspecific for several different conditions. An acute viral gastroenteritis may be occurring especially if one has had exposure to others with the same symptoms. For some, nausea may be the only symptom for a gallbladder attack (biliary colic). To diagnose this problem, a physician will need to order an ultrasound of the gallbladder to look for gallstones or a HIDA scan to evaluate the function of the gallbladder.
   

And keep in mind, for each of the various bariatric operations there may a different cause. With the adjustable bands, there may be a couple of causes. One, the band may be too tight which may occlude and the internal opening of the stomach. An unfill adjustment of the band should relieve this problem. More concerning, this may be a sign the band has slipped. The occurrence rate is approximately 3% and typically occurs 18 to 24 months after placement. To diagnose this problem, a standard abdominal x-ray or an upper gastrointestinal series (upper GI series) may be ordered by your surgeon. An operation may be required to correct this problem.

When a gastric bypass patient complains of nausea or food intolerance, the surgeon may be concerned about the connection of the small stomach pouch and the small bowel being too small resulting in a stricture. An upper endoscopy will be required to diagnose this and also treat it with a balloon dilation of the connection. If a stricture has been ruled out, then a bowel obstruction due to adhesions or an internal hernia will be considered. This may require x-rays or a CT scan of the abdomen. If the work up is not conclusive, a laparoscopic evaluation may be offered to explore the abdomen to identify the problem.

Anytime a patient has a “GI” complaint such as nausea or abdominal pain, it is recommended to notify the bariatric surgeon first to prevent delays in diagnose. Treatment for many of these conditions might require an operation and the sooner the surgeon is involved, the sooner the problem will be treated.