You have diabetes, and your sugar has been really high. You may have a condition known as diabetic ketoacidosis, or DKA, which occurs when the body has used up its last drop of insulin. Since insulin is required to absorb and process glucose (sugar) from the blood, your sugar levels skyrocket and your body turns to alternate sources of energy. Unfortunately, using those sources results in heavy breathing, fatigue, lightheadedness, and abdominal pain. The condition occurs in diabetics who forget to take insulin, don’t take enough insulin, need more insulin (because of an acute change in metabolism, which happens during infection), or didn’t previously need to inject insulin (but now clearly do). In rare cases, DKA can be the first sign of diabetes. The complications can be fatal, so it’s essential to get urgent treatment with intravenous insulin and rehydration.
You have sudden-onset pain and hives (splotchy red rash). Did you just chow down a peanut butter and shellfish sandwich? “Anaphylaxis” is the term for a rapid-onset, whole-body allergic reaction typically consisting of hives, lip/tongue swelling, nausea, abdominal pain, wheezing, shortness of breath, lightheadedness, and/or loss of consciousness. Most patients have at least two of these symptoms, though rarely all of them. If you think you have anaphylaxis, it may be just a few more minutes before your airways completely close down. Call an ambulance or start scribbling your will. If you’re feeling really short of breath, and you’re also in a public place, you can (as a last resort) see if any bystanders can offer an EpiPen to quickly reverse your symptoms. If the ambulance is approaching, however, just wait for professional help.
You have excruciating pain in the right, upper part of your abdomen. You may have a blockage in the tube connecting your gallbladder to your intestines. The gallbladder (also described here) is a little sac full of green fluid called bile, which gets released into the intestine after meals to help process fat. The gallbladder often contains stones, which sometimes become permanently lodged in the tube draining bile to the intestines. The net result is swelling and infection of the gallbladder, which can ultimately burst. This condition, known as cholecystitis (gallbladder infection), causes fever and severe pain in the right, upper portion of the abdomen. The pain is often so severe that any kind of movement is unbearable. Many (not all) patients have a history of biliary colic, as described earlier. An ultrasound usually clinches the diagnosis. In most cases, the treatment is emergency removal of the gallbladder.
You have excruciating pain in the right lower part of your abdomen. You may have a blockage in your appendix, a little wormlike tube that arises from part of the colon. The appendix is thought to be a vestigial organ, serving no apparent function in humans other than randomly trying to kill them. An infection in the appendix, also known as appendicitis, occurs when the appendix gets blocked up—often by poop (yuck), sometimes by swollen immune glands, and occasionally by a nearby tumor. Regardless of the cause, the appendix gets swollen and can actually burst apart. The main symptom is abdominal pain that starts around the belly button and then moves to the area right above the appendix, in the lower right-hand corner of the abdomen. The pain is usually so severe that the mere thought of eating is repulsive, and any movement is excruciating. Fever, nausea, and vomiting are also common. A CT scan confirms the diagnosis. The standard treatment is emergency removal of the appendix. If you’re female, you could also have a problem with your right ovary or Fallopian tube (see here).
You have excruciating pain in the left lower part of your abdomen. There are many potential explanations for pain in this area. If you’re female, you could have a problem with your left ovary or Fallopian tube (see here). If you’re over forty, you may have a condition known as diverticulitis. As you age, and especially if you have constipation, your colon develops little sac-like bulges known as diverticula. These not-so-hot pockets are especially common in the part of the colon located in the lower left-hand corner of your abdomen, where poop is stored just prior to release. Although diverticula usually cause no harm, they sometimes get plugged up and infected, like the appendix. Typical symptoms include fever, nausea, and severe pain in your left lower abdomen. Diverticulitis can often be managed with antibiotics alone, though severe or recurring cases may require surgery.
You have upper abdominal pain, and perhaps also shortness of breath, that gets worse when you exert yourself. Life would be so much easier if all dangerous medical conditions had obvious and specific symptoms. Unfortunately, some present in very unexpected or atypical ways. A classic example is heart disease producing abdominal pain rather than chest pain. If your bellyache gets worse whenever you climb stairs or shovel snow, the culprit is probably a blocked artery to your heart, which needs extra blood during exertion. (Even as the heart constantly pumps blood to the rest of the body, its muscular walls require their own blood supply and become extra thirsty as the pulse rate goes up.) For this reason, all (good) emergency rooms check for heart disease whenever patients have severe, unexplained abdominal pain.
You’re a woman with severe, new-onset pain in your lower pelvis. Trouble down under? There’s a whole tangle of organs in the pelvis that can cause acute pain. First, a quick review. You have two ovaries, located on opposite sides of your pelvis, responsible for creating and releasing eggs. The eggs travel down the Fallopian tubes toward the uterus, located in the middle of your pelvis. The uterus connects to the vagina at the ring-shaped cervix.
Problems can arise at any level and produce severe pelvic pain, often with nausea and vomiting. For example, the ovaries may get twisted around their blood vessels, producing a condition called ovarian torsion. Likewise, an ovarian tumor or cyst (fluid-filled structure) may bleed or spontaneously burst open. A fertilized egg may accidentally get stuck in the ovary or Fallopian tube, rather than the uterus, producing an embryo where it doesn’t belong (called an ectopic pregnancy). An infection can spread from the vagina to the cervix, uterus, and Fallopian tube. And, of course, a urinary tract infection, or UTI, can always cause pelvic pain, though it’s usually not as severe, and it’s also associated with frequent and painful urination.
The bottom line is that many different problems are possible, and some can rapidly progress to serious complications, like infertility. If you have severe pain, get an urgent assessment, usually consisting of a pelvic exam, some basic blood and urine tests, and a pelvic ultrasound.
Your skin or eyes look yellow. The combination of abdominal pain and yellow eyes and/or skin is a sure sign of liver problems. The yellow skin occurs when the liver, which normally produces bile to help process fatty foods, can’t transfer bile to the gallbladder and intestines. Instead, the bile gets into the blood and turns your skin yellow. The two main causes are acute hepatitis (irritation of the liver by a viral infection, alcohol, or acetaminophen/Tylenol overdose) and blockage of the tubes that drain bile from the liver. Both require immediate attention. Blood tests and an ultrasound of the liver usually make the diagnosis.
You have severe belly and/or back pain after a night of heavy drinking. All new surgeons are indoctrinated with three basic rules: “Eat when you can, sleep when you can, and don’t mess with the pancreas.” If you pour yourself that seventh or eighth drink, you are definitely messing with your pancreas, and there may be hell to pay.
The pancreas is an organ in the abdomen that produces many essential hormones, like insulin and chemicals that digest foods. For unclear reasons, an alcohol binge can leave the pancreas very inflamed and sick. This condition, known as acute pancreatitis, can make even the worst hangover feel like a walk in the park. Milder forms cause severe abdominal pain that often spreads to the upper back. More severe forms can progress to multi-organ failure and death. Obviously, you want to nip this disease in the bud, usually with intravenous fluids and at least a day or two of fasting.
There are some other causes of acute pancreatitis, such as gallstones and autoimmune disease. But the only risk factor you can control is the amount of alcohol that you drink. So take it easy, tiger, and limit yourself to one o
r two servings per day whenever possible.
You have spasms of severe pain in your lower belly and back. It’s often said that passing a kidney stone is the closest men can ever come to experiencing childbirth. The unfortunate women who have experienced both will have to tell us whether they agree.
Little stones can form in the kidneys, where urine is produced, and then get stuck in the narrow tubes (called the ureters) that drain urine into the bladder. The blocked ureters intermittently produce waves of excruciating pain in the lower back, lower abdomen, and/or pelvis. In many cases, the stones also shred some of the blood vessels in the ureters, resulting in bloody urine. The suffering continues until the stone finally works its way down into the bladder, where there is plenty of room to float around.
Kidney stones can result from dehydration and are also more common in people with a history of gastric bypass surgery (since the rearranged plumbing increases the absorption of chemicals that cause stones), diabetes, high blood pressure, or obesity. The diagnosis is confirmed with either an ultrasound or CT scan. From there, the goals are pain management, intravenous fluids (to increase urine production and push the stones along), and medications that help the stones pass. In some cases, the stones are actually too big to pass on their own and need to be broken up or removed using special procedures.
You have a fever and/or shaking chills. You probably have an infection in your abdomen. Common sites include the intestines, liver, kidneys, and reproductive organs (particularly in women). It’s important to have a complete assessment right away; if you wait too long, the infection can spread to your bloodstream and rapidly lead to disaster.
You have had profuse vomiting and/or diarrhea, and you feel lightheaded and weak. Lightheadedness and weakness are signs of excessive fluid loss and low blood pressure. Take frequent sips of sports drinks, broths, or solutions like Pedialyte, which contain both the water and sodium needed to restore your blood pressure. (Water alone doesn’t help nearly as much.) If you’re just puking everything back up, you may need to hit the emergency room for intravenous rehydration.
You have severe, constant abdominal pain that doesn’t match any of the preceding descriptions. Just the pain alone is enough reason to get checked out. Some life-threatening problems, such as intestinal obstruction or intestinal ischemia (in which the intestines aren’t getting enough blood), don’t cause specific symptoms beyond severe pain. If you have the worst abdominal pain of your life for more than thirty minutes, get checked out.
Unintended Weight Loss
Unless you’re a contestant on the The Biggest Loser, a significant and rapid drop in weight may not be cause for celebration. In fact, rapid unintended weight loss is one of the surest signs of a serious underlying disease.
Did you lose more than 5 percent of your initial weight in less than twelve months? Did you pull off this feat even though pizza is your main source of nutrition, and you regularly take the elevator to the second floor? If so, you have significant unintended weight loss.
So, what to do now? Shop for new clothes that don’t require safety pins, and take a few selfies in your bathing suit from high school? Head over to the local tuberculosis ward? Get an updated cancer screening?
Take a Chill Pill
You have entered your golden years. Many people start losing weight around the time the AARP membership card arrives in the mail. The list of age-related indignities includes changes in taste and smell, which make food less enjoyable; dental problems, which make food harder to eat; and medication-related side effects, like dry mouth, bloating, and decreased appetite. All of these factors can make your calorie intake plummet, resulting in significant and sustained weight loss. It’s important to get weighed whenever you see your doctor and to watch for any downward trends, so that you can work together to fix reversible problems.
You just said no. For the first time. People who regularly use marijuana and then stop will often experience decreased appetite and weight loss. Think of it as the reverse munchies.
Actually, you just said yes. Many drugs increase metabolism and promote weight loss. So if you’ve been popping amphetamines (like Adderall) to stay focused at school or work, you’re probably going to lose weight. (Also: please don’t do this with someone else’s pills.) Cocaine, crystal methamphetamine, and nicotine also promote weight loss (and death).
You have been improving your habits. It’s possible that you’re exercising more or eating better than you think. Sometimes just one small but consistent change can slash off quite a few pounds. Did you stop drinking regular soda? Cut back on the happy hours? Start a new job that requires significantly more walking?
Make an Appointment
You’re always thirsty and wake up throughout the night to pee. You likely have diabetes, which occurs when your body either runs out of insulin (type 1 diabetes) or no longer responds normally to insulin (type 2 diabetes). Either way, the lack of normal insulin signaling means your body can’t process and store the sugar absorbed from food. Instead, the sugar sticks around in your blood, and your kidneys constantly make urine in a frantic attempt to unload all that sugar somewhere. Because that sugar would normally be stored as fat and muscle, you also lose weight.
If you can’t see your doctor in the next few days, or if you feel really lightheaded and nauseous (a sign of a life-threatening complication of diabetes), please hustle to an E.R.
You have tremor, palpitations, diarrhea, and/or you always feel hot. You may have an overactive thyroid gland. The thyroid regulates your body’s metabolism. If it’s overactive, the body will constantly burn fat and muscle to generate energy that it doesn’t really need. Some simple blood tests at your doctor’s office can diagnose thyroid disease. (If you already take thyroid hormone, your dose may be too high and should be checked.)
You have had several weeks of nausea, abdominal pain, gas, and diarrhea. Are you going through a lot of toilet paper? Is your roommate lighting a lot of scented candles lately? You may have celiac disease or an inflammatory bowel disease, like ulcerative colitis or Crohn’s disease. In these conditions, your immune system gets confused and starts waging war on your intestines. As a result, the intestinal lining is no longer able to process and absorb calories from food, which instead just passes through and ends up as diarrhea. Your doctor may need to perform an endoscopy, in which a camera is inserted down your throat and into your stomach and intestines, as well as a colonoscopy, in which the camera is inserted through your anus and into your colon.
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Quick Consult
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Unintended Weight Gain
You’ve picked up a few extra pounds, and you’re not happy about it. Your clothes don’t fit. Your profile bulges. Your chin has a chin. Of course, most of us secretly pray that we actually have a medical condition to explain our predicament—something like a slow metabolism—which is totally not our fault. After all, if this were the case, the solution would be medicine, which is an easy fix, rather than a healthy diet and exercise, which are not.
Unfortunately, only a very, very small fraction of overweight people can blame their figure on anything other than eating too much and exercising too little. If, however, you also find that you are tired, constipated, and always cold, you may have hypothyroidism (low thyroid function). Because your thyroid gland is underactive, your entire metabolism slows down, causing some weight gain. Likewise, if you’re a woman of reproductive age who has acne, extra facial hair, and irregular periods, you may have a condition known as polycystic ovarian syndrome, or PCOS, which also causes weight gain. See your doctor if you think you have these conditions, or if you’ve gained a significant amount of weight (more than ten to fifteen pounds) in less than a year.
Several medications can also cause weight gain. The major culprits include tricyclic antidepressants (amitriptyline/Elavil, mirtazapine/Remeron), antiseizure drugs (valproic acid/Depakote, carbamazepine/Tegretol), and antipsychotics (olanzapine/Zyprexa, clozapine/Clozaril). Speak to
your doctor before changing any medications.
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You recently started a new medication. Many medications may have side effects that lead to weight loss, like loss of appetite, dry mouth, pain on swallowing, nausea, or bloating. The most common culprits include some medications for asthma, heart conditions, diabetes, seizures, and dementia; thyroid hormone; antidepressants; and antibiotics. Ask your doctor if one of your medicines could be causing these problems. Please do not stop a medication without speaking to your doctor!
You just started a diuretic for heart, liver, or kidney disease. If you have a weak heart, liver, or kidneys, your doctor may have prescribed a diuretic to help increase the production of urine and ensure you don’t retain extra salt and fluid. All that fluid being removed in your urine can add up to a lot of weight loss. (Indeed, the expression “pee like a racehorse” comes from trainers giving horses diuretics right before races, to make them shed a few pounds and become even lighter on their feet.) Common diuretics include furosemide/Lasix, torsemide/Demadex, and spironolactone/Aldactone. Keep track of your weight, since sudden increases may signal the need for a higher diuretic dose and/or change in your diet.
You have had a rough few months. People who suffer from depression may experience weight loss owing to loss of appetite. See your doctor to discuss starting one of the many available treatments, which can significantly improve your quality of life.
You have been coughing and sweating through your sheets. If you have recently traveled outside of the United States, have been in prison, or have HIV/AIDS, you are at risk of contracting tuberculosis. This lung infection was once called consumption, because it tends to melt away the pounds. Unfortunately, it also melts away your lungs and eventually your life. A chest X-ray and analysis of your phlegm can help uncover the diagnosis.
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