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Treating abdominal pain



By Dr. Jeff Daniels EBS Medical Columnist

Diverticulitis is one of the more common serious abdominal illnesses that we see at the Medical Clinic of Big Sky. It most often occurs in those of us over 50 years old, and it can range from mild abdominal pain to life-threatening situations requiring hospitalization and surgery.

Anywhere from 35-50 percent of people in western countries develop diverticulosis in the large intestine (colon), as we get older. This involves benign outpouchings of the colon, which appear as small openings in the inside wall, as seen through a colonoscope. There is no perforation through the muscular wall of the colon, and most people never develop a problem. This part of the colon is filled with a myriad of bacteria, and if infection develops in one of these outpouches, diverticulosis now becomes diverticulitis.

Fever and pain are the predominant symptoms and they often start suddenly. Some develop diarrhea while others experience constipation. Nausea and vomiting, as well as bleeding, may occur. The pain is almost always in the left lower side—“left lower quadrant” is the proper anatomical description of this area—of the abdomen, because that part of the colon, called the sigmoid colon, is most often involved.

There are many theories as to why a natural aging process of the colon can lead to infection. One theory that has been disproven is that certain hard-to-digest foods, like peanuts and pepper, can clog up the diverticula and lead to infection. So dietary changes to prevent diverticulitis don’t really make a difference. Obesity may be a factor, but I find this disease occurring in perfectly fit individuals as well.

There are several other conditions that can cause pain in the left lower quadrant of the abdomen, and must be considered when a patient complains of pain there. Even though the vast majority of cases of appendicitis cause pain in the right lower quadrant, once in a while a case of appendicitis will cause symptoms on the left side. Colon cancer, Crohn’s disease and ulcerative colitis, and irritable bowel disease must be ruled out if a presumptive case of diverticulitis does not respond to treatment.

In my experience, many cases that prove to be diverticulitis are not serious enough to warrant hospitalization, and will respond to a combination of two common and fairly well tolerated antibiotics, taken orally. So an office visit and inexpensive antibiotics are all that are necessary to achieve a cure.

In severe cases, blood tests, a CT scan of the abdomen, and even hospitalization with surgical intervention may be necessary. If proven to be a rare case of left-sided appendicitis, which can be diagnosed on a CT scan, surgery certainly is a consideration, although some cases of acute appendicitis are now being treated with good results by a course of antibiotics.

An adult older than 50 presenting with left lower quadrant pain and fever who doesn’t look severely ill or terribly dehydrated deserves a trial of oral antibiotics. Diverticulitis usually responds quickly, and if it doesn’t, other tests will be necessary. This plan can keep the medical costs in a reasonable range for a majority of people with the illness.

On another note, the influenza vaccine is available at the Medical Clinic of Big Sky. No appointment is necessary, just come on in.

Dr. Jeff Daniels was the recipient of the 2016 Big Sky Chamber of Commerce Chet Huntley Lifetime Achievement Award and has been practicing medicine in Big Sky since 1994, when he and his family moved here from New York City. A unique program he implements has attracted more than 700 medical students and young doctors to train with the Medical Clinic of Big Sky.

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