Last week, we began to deal with the various factors that could cause chest pain and indicated that we would be continuing the exercise this week because of space constraints and other factors. Today, we will be looking at some of the features within the abdomen that can lead to an individual manifesting such a condition as chest pain. One of the most common problems that cause such chest pain to manifest is known as gastroesophageal reflux disease (GERD), also known as acid reflux. This happens when the contents of the stomach move back into the throat after a meal has been taken. This often happens during sleep, and it will usually cause a sour taste in the mouth and a burning sensation in the chest or throat.
Many people know enough about this particular symptom to call it a heart burn. The factors that are often seen to trigger reactions like these are pregnancy, heavy cigarette smoking, obesity and the consumption of fatty and spicy foods. These two conditions of pain and heartburn resulting from acid reflux usually have a similar feeling because the heart and the oesophagus lie very close to each other and share a common nerve network. Furthermore, contraction disorders within the oesophagus and incidents of hypersensitivity when the pressure inside the gullet changes or it is exposed to acid can cause similar pain in the chest. The patients will have difficulty with swallowing, regurgitation and heart burn in addition to chest pain.
Besides, a sudden onset of chest pain following vomiting or a procedure carried out in the oesophagus indicates often that a perforation or rupture of the organ has occurred. Another common abdominal condition that often leads to having chest pain is pancreatitis. This is an inflammatory condition involving the pancreas, the organ that produces insulin and glucagon. We have discussed this organ in the past while talking on this page about diabetes. People who indulge in binge drinking and chronic intake of large volumes of alcohol are particularly prone to developing this condition and they will often manifest with a sharp, persistent pain in the lower aspect of the chest that worsens when they lie down flat but gets better when they lean forward.
At other times, the specific cause of this inflammation involving the pancreas may not be determined easily, but the pain is usually severe. However, the patients will often notice that they have a fever as well as a swollen and painful abdomen. The pain spreads to the back and it can range from mild to moderate to severe. Each attack like this can last for several days. Problems in the gallbladder can similarly cause chest pain. Such pain is usually felt in the right lower aspect of the chest or the right upper side of the abdomen. The pain is typically worse when someone has consumed a fat-rich food such as fried eggs or fried plantain and there may then be associated nausea or even vomiting.
For the sake of clarity, let us appreciate here and now that the gallbladder is an intra-abdominal structure that lies underneath the right side of the liver. It will cause chest pain when it has a problem. Lastly, another disease condition that we have discussed on this page, called shingles, can also cause chest pain. The pain is often like a band and starts before the rash appears. In most cases, chest pain seen in children and young adults is not as a result of a heart problem. Therefore, the most common cause of chest pain in this segment of the population is due to chest wall pain. The chest wall refers to the structures that enclose and protect the lungs and the heart, and these include the ribs and sternum. The sternum is also called the breastbone. In these groups, the only useful investigations that should be conducted are a chest X-ray and an ECG (electrocardiogram).
Generally speaking, when a certain type of chest pain comes and goes, it may be related to the heart, muscles, digestive system or some psychological problems. In many of these cases, the underlying causes of such pain may be mild. In women who are breastfeeding, an inflammation of the breast called mastitis can be responsible for severe chest pain. The same is true for a breast abscess. However, it is not only in breastfeeding women that these associations can be found. Breast cancer can also be responsible for chest pain.
And although it is not as common, these can occasionally become issues in younger women and girls. Generally, therefore, blunt blows delivered to the breast, especially during physical altercations, can become a focal point for such pain. There were certain conditions we discussed last week that often co-exist with chest pain and have their origin within the heart. That was not an exhaustive list. Some of these problems include myocarditis, a condition in which the muscles of the heart become inflamed resulting in symptoms that are similar to a heart attack. The patients affected will have a fast and often irregular heartbeat, shortness of breath and easy tiredness. It usually results from a viral infection, and it is a condition that is more commonly seen in children. Without energetic treatment, it is often fatal.
Another heart condition that often causes chest pain is pericarditis, which is an inflammation of the sac that is formed around the heart. Fluid can build up between the sac and the heart such that a significant pressure can build up to the extent that it presses on the heart. At this stage, there is severe chest pain often behind the breastbone and inability of the heart to fill up with blood that it can pump effectively around the body. This leads to a state of clinical shock of an obstructive variety and the condition is clinically diagnosed as cardiac tamponade. This is a dire emergency and only vigilant healthcare staff members in our underequipped emergency rooms can make the relevant diagnosis and come to the aid of the suffering patient.
Another serious heart condition that is often chronic in nature because of the length of time it takes to develop is known as the hypertrophic cardiomyopathy, a terrible condition that sees the heart growing too thick as a result of certain genetic abnormalities. Such resulting thickening of the heart’s muscles ultimately makes the organ unable to receive an adequate amount of blood to pump out and also becomes less able to pump out blood in a coordinated fashion. The muscles are then forced to work overtime to pump out blood. The symptoms of this condition include changes in heart rhythm, shortness of breath, dizziness, feeling faint and chest pain. The feet, legs, ankles and abdomen may also swell with excess fluids as the heart gradually fails and is unable to efficiently pump out blood.
Equally very serious is a frequently tragic phenomenon that affects people of all ages. This is known as aortic aneurysm, an enlargement of the aorta, the vessel that takes oxygen-rich blood from the heart to the rest of the body. This is an emergency condition just like aortic dissection is. The latter condition results when a tear develops in the inner walls of the aorta and separates them such that the various layers become distinct. Both aortic aneurism and aortic dissection can cause the vessel to rupture or burst leading to death within a few minutes.
Lastly, it is important to discuss a lung condition that also causes chest pain. It is not a commonly seen condition, but it exists, and it is known as pulmonary hypertension, which means high blood pressure in the arteries that take blood to the lungs. These people are often breathless and suffer body swelling due to the accumulation of fluids. They also get tired easily.
Dear Dr. Sylvester, thank you for your invaluable services to humanity in the field of health care and medicine in the Punch Newspaper. May our dear Lord bless you immensely. I am a 68-year-old man. For about seven years now, I have been suffering from dissected tongue (swollen tongue formed into different shapes). It hurts whenever I take any form of spices, like pepper, ginger, hot food, tea and the like. I have visited the University Teaching Hospital in my area (Uyo) and was attended to by specialist doctors there in the Ear, Nose and Throat section. However, the doctors confessed that they were not familiar with the ailment. They, however, recommended that I gargle my mouth with hydrogen peroxide (hydrogen water). This, I did, without any positive effect. Several pharmaceutical stores that I visited told me that it was caused by internal heat and recommended folic acid. After several years of taking folic acid it has seemed not to afford any improvement.
However, recently a private doctor, who attended to me, said I was suffering from dehydration and advised that I should drink not less than four big bottles of water each day. He recommended it after several laboratory tests. I have been drinking a lot of water since then, although not up to the recommended quantity. It has shown sign of positive effect but does not heal the wounds. Dear doctor, in my opinion, it seems that some heat is generated from inside my stomach, which now heats up my throat passage and which effects is what is responsible for the swollen tongue (parched tongue). Kindly, advice on what treatment will solve this seemingly uncommon challenge. Thank you and God bless you.
Anonymous
Answer: Thank you very much for this important question sir and thank you also for your kind words. It is a bit confusing what you mean by dissected tongue. That, in itself, is a very serious problem as it is sometimes used to describe certain types of cancer of the tongue. However, if what you are referring to instead is a form of discoloration of the tongue, that is associated with desiccation rather than dissection, it will become much clearer. In that case, the advice you will get is that this is a change in colour that will clear on its own without any form of treatment. On the other hand, this problem may be a combination of niacin deficiency and general inflammation of the tongue leading to fissures, pain and swelling in different parts of the tongue in addition to changes in colour. You should see a physician at the University of Uyo Teaching Hospital for advice and treatment. The ear, nose and throat surgeons that you saw previously can easily make such a referral possible.
Good day Sunday doctor. I am sorry to disturb you, but I have been confused a lot by what my doctor and my friends have told me is wrong with my right shoulder, the joint, in fact the socket. The pain is not terrible and even when I was in labour, I don’t think I suffered this much. It aches most of the day and night, and sometimes I am not able to sleep at all. I find it difficult to wash my back with a sponge when I am bathing, and I am surprised that there is no swelling. This problem has been with me for over a year and my friends have told me it is arthritis, while my doctor has said it is tendonitis. I don’t know who to believe but it is getting worse as I can no longer drive and that is why I am now so worried. Please I need your advice. Thank you. 0805*******
Thank you very much for your question. Rest assured that you are not disturbing me. Unfortunately, you did not share your age, sex or what you do for a living with us, because all these are relevant to the genesis of this complaint and its progression. However, what seems likely is a wear-and-tear disease affecting the right shoulder joint. The shoulder joint is described as a ball and socket joint with a high level of mobility, which makes it prone to peculiar types of joint diseases all of which could behave alike with minor but key differences. In this regard, osteoarthritis is a possibility but so also are at least two other types of tendon lesions. One of these is supraspinatus tendonitis and the other is restrictive capsulitis. You will have to see an orthopaedic surgeon for a proper examination and treatment plan. Your doctor can issue you with the appropriate referral and you should now be prepared to spend some money on quality investigations that will show what the problem is.
Questions and answers
Dear doctor Sylvester, I have been feeling rather funny over the last few days. I developed a cold and my nose has been running. Two days ago, I started to have headache for which I have been taking paracetamol, but there has been no improvement. This morning, I started to feel dizzy, and I don’t understand why. I am a 62-year-old woman and I have neither hypertension nor diabetes. What could the problem be? I need your advice please. Thank you. 0809*********
It is interesting and even though there is no fever at this point, you should do the minimum of having your blood film examined for malaria parasites. Your blood count should also be done in a simple test called the packed cell volume. These should show where your current problem lies. (This patient was advised as above during the previous week and the results came back within two hours confirming that she had malaria. She has had treatment and now feels well)
Please sir, a gynaecologist told me to do the tests I will forward to you just now concerning my monthly heavy flow, which has been on for more than two years due to fibroids that were diagnosed about seven years ago. I am 48 years old now. Please, I will like to know if these tests are actually necessary because at first, after the gynaecologist saw the results of the earlier test I did, he said I should just pray for early menopause and that there was nothing really to be done about it, but he gave me a list of tests that I should do. I don’t want to waste money unnecessarily sir. The tests are HPV, urine culture, HVS swab for culture, pap smear, FBC and urinalysis. – – 08026******
Thank you very much for the question. The gynaecologist treating you has examined you and determined that you need to do these tests so that he can give you quality advice and treatment. Those investigations are not expensive and you should please do them.
Dear doctor, good day to you. My husband is 67 years old and recently did some annual medical examinations that he does every year and his PSA was found to be 7.5ng/ml. The doctor he is seeing is saying that he should come for a prostate biopsy, which he will arrange for a urologist to do, but my husband is very much afraid. What do you advice sir? 080*******
This is an important question and my advice to you is that you should persuade your husband to do the biopsy. If the result is negative, he is free from worry; and if it positive for cancer, then early steps can be taken to treat it. This kind of biopsy can be done quickly with minimum discomfort, and it is safe, especially if the biopsy needle is guided with an ultrasound scan. Secondly, a biopsy is important because with this sort of reading, the result can be classified as suspicious.
Good morning doctor. No one knows what goes on inside the body and no one knows when the appendix ruptures. Working in the health sector is hard and when a patient dies, the doctor is blamed. Is the operation for appendix simple or difficult? Thank you. 0806*******
Thank you for this comment and question. When something goes wrong inside the body, the doctor can usually tell you what is wrong. All you have to do is report early enough to a hospital so that the proper examinations can be carried out. There are tests designed to determine what might be wrong. Secondly, it is not correct to assume that when an appendix ruptures, no one knows. That diagnosis is usually made far more easily than some types of appendicitis. That diagnosis can often be confirmed by conducting x-rays and ultrasound scans. The operation may be straightforward or difficult depending on various factors that are not required on this page. There is no simple operation. Every type of surgery has its own risks, including even the type of scar that forms after the operation has been deemed a success.
Good evening, Sunday doctor. I am a 48-year-old woman and I have a daughter that is 15 years old. I was recently diagnosed with an ovarian dermoid cyst. I have been asked to have an operation to remove it because it is quite large and has been causing me pain off and on. My real question here is whether my daughter is at risk for developing the condition later in her life. Thank you. 0803*******
It can certainly happen that a condition like this runs in a family, but it is very rare. It is not common at all. You should not lose sleep over it but if there is any concern with regards to that, your daughter can be screened even at her age because dermoid cysts are often present from early in life and grow very slowly over many years before they become evident. That is usually so when they cause pain due to torsion or a swelling becomes evident on the tummy.
Credit: Sylvester Ikhisemojie