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ER or Not: Severe Stomach Pain

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ER or Not: Severe Stomach Pain

Jun 28, 2018

You wake up in the morning with stomach pain so severe that you can’t stand up straight. Emergency physician Dr. Scott Youngquist tells you if that’s a reason to go to the ER.

Episode Transcript

Announcer: Is it bad enough to go to the emergency room or isn't it? Find out now. This is ER or Not on The Scope.

Interviewer: Dr. Scott Youngquist with the University of Utah Hospital, are you ready for ER or Not?

Dr. Youngquist: I'm ready.

Abdominal Pain

Interviewer: All right. Here we go. Here's the situation. You wake up and you can't stand up straight because your stomach hurts so much. ER or not?

Dr. Youngquist: In most cases ER.

Interviewer: Really?

Dr. Youngquist: Yes. The reason is there could be some very bad things causing that abdominal pain. So in some way it depends. If this is a chronic issue obviously it may not require any treatment in the emergency department at all, and some people unfortunately suffer from abdominal pain on a daily basis. But I'm going to assume this is new, you've never had this before and you woke up with abdominal pain so severe that you couldn't stand up. So what could it be?

Appendicitis Symptoms

If you're a young and otherwise healthy person, the most likely cause is appendicitis. And usually if you've got appendicitis you've started with some mild abdominal pain; it's often located around the belly button and then tends to migrate to the right lower quadrant of your abdomen and gets severe over time. It can perforate if it's not treated surgically and cause a large intra-abdominal infection or sepsis or even death from infection.

Interviewer: It's nasty because it releases all that nasty stuff into your body that it would normally contain in the appendix.

Dr. Youngquist: Absolutely. People don't feel well when they've got it. They feel sick all over and it's all coming from their appendix.

Gallbladder Symptoms

Now the other things that can cause this particularly in middle aged older people are gallbladder disease. So you could have a gallstone that is obstructing the common bile duct or even causing perforation or infection of the gallbladder. And that also requires emergency treatment sometimes and removal of the gallbladder or at least antibiotics.

Interviewer: Got you. I'd be afraid that I was just a little bloated or gassy or had some sort of a weird cramp.

Dr. Youngquist: It could be, but that should resolve in a matter of minutes, seconds to minutes.

Interviewer: Okay.

Dr. Youngquist: It shouldn't last hours.

Interviewer: Okay.

How Long Is the Stomach Pain Lasting?

Dr. Youngquist: So if you want to wait a little bit and see if it goes away that's probably fine. But if it's lasting for minutes/hours, then you need to come in and see somebody about it.

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updated: June 28, 2018
originally published: June 29, 2014