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What Causes Stomach Tightness, Pain Near CABG Surgery Scar, Gas And Bloating?
Question: Hello,
My dad is 66 and he has undergone a heart bypass surgery 6 yrs back. He also has smoking history for past 45 yrs. He is not smoking for past few yrs.
Recently he has been complaining about the stomach tightness and lot of pain near the surgery scar. His physician diagnosed that he has lot of gas and bloating. His blood pressure keeps fluctuating between 145-80 to 170-100. The physician also did ultrasound the reports of which show normal stomach functioning.
Today he is experiencing a lot of pain in belly and waist area. His blood pressure is 175-110. You think this is because of gas? What might be causing the pain? What are the next steps?
Thanks,
XXXXXXX
My dad is 66 and he has undergone a heart bypass surgery 6 yrs back. He also has smoking history for past 45 yrs. He is not smoking for past few yrs.
Recently he has been complaining about the stomach tightness and lot of pain near the surgery scar. His physician diagnosed that he has lot of gas and bloating. His blood pressure keeps fluctuating between 145-80 to 170-100. The physician also did ultrasound the reports of which show normal stomach functioning.
Today he is experiencing a lot of pain in belly and waist area. His blood pressure is 175-110. You think this is because of gas? What might be causing the pain? What are the next steps?
Thanks,
XXXXXXX
Brief Answer:
Please give some more details to evaluate the possibilities.
Detailed Answer:
Hello XXXXXXX
It could be many things.
I would need to know many details before I can arrive at possibilities.
1. What time does the pain occur?
2. Is it related to food?
3. Does he have nausea/ vomiting?
4. He must be on Aspirin & Clopidogrel. What other medicines is he on?
5. Any medicines changed recently?
6. Does he pass stools daily, normally? Any constipation?
7. Any dark colored stools?
8. Does he have diabetes?
9. Any burning in urine or reddish urine?
10. How does the pain get relieved or how does it decrease if it does.
11. Has he lost any weight in the past few months?
He could be having Gastritis.
He will require an Ultrasound abdomen and KUB to begin with.
Do let me know the details to help me proceed.
Take care,
Dr Rishi, New XXXXXXX XXXXXXX
Please give some more details to evaluate the possibilities.
Detailed Answer:
Hello XXXXXXX
It could be many things.
I would need to know many details before I can arrive at possibilities.
1. What time does the pain occur?
2. Is it related to food?
3. Does he have nausea/ vomiting?
4. He must be on Aspirin & Clopidogrel. What other medicines is he on?
5. Any medicines changed recently?
6. Does he pass stools daily, normally? Any constipation?
7. Any dark colored stools?
8. Does he have diabetes?
9. Any burning in urine or reddish urine?
10. How does the pain get relieved or how does it decrease if it does.
11. Has he lost any weight in the past few months?
He could be having Gastritis.
He will require an Ultrasound abdomen and KUB to begin with.
Do let me know the details to help me proceed.
Take care,
Dr Rishi, New XXXXXXX XXXXXXX
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi Dr. XXXXXXX
Thanks for the response, please find the answers to your questions below:
1. What time does the pain occur?
It occurs pretty much all day. After passing stool he gets some relief. There are 2-3 days that go without pain but it comes back. Mostly after having food he experiences it. Today he's having it entire day.
2. Is it related to food?
He says any kind of food intake give him stomachache.
3. Does he have nausea/ vomiting?
He had some nausea/ vomiting feeling today but it is gone now.
4. He must be on Aspirin & Clopidogrel. What other medicines is he on?
Revelol
Ecosprin
Enzyplex
Rabonik
Zolpidem tartrate (takes occasionally but for last 1 week he's taking it every night)
5. Any medicines changed recently?
For few days he is out of Rabonik so he took the replacement drug Mosa SR which he stopped around a week back and since then he's been taking Omeprazole.
6. Does he pass stools daily, normally? Any constipation?
He passes stool alternate day. He has severe constipation tendency.
7. Any dark colored stools?
No
8. Does he have diabetes?
No
9. Any burning in urine or reddish urine?
No
10. How does the pain get relieved or how does it decrease if it does.
It decreases with time but he claims he always has some discomfort. It is less in the morning but as day progresses it gets worse.
11. Has he lost any weight in the past few months?
No he is at constant weight 133 lbs.
Yesterday he went for Ultrasound abdomen. the report is attached here. He was diagnosed with Duodenitis through an endoscopy performed in 2008.
Hope this helps in your further diagnosis.
Thanks again,
XXXXXXX
Thanks for the response, please find the answers to your questions below:
1. What time does the pain occur?
It occurs pretty much all day. After passing stool he gets some relief. There are 2-3 days that go without pain but it comes back. Mostly after having food he experiences it. Today he's having it entire day.
2. Is it related to food?
He says any kind of food intake give him stomachache.
3. Does he have nausea/ vomiting?
He had some nausea/ vomiting feeling today but it is gone now.
4. He must be on Aspirin & Clopidogrel. What other medicines is he on?
Revelol
Ecosprin
Enzyplex
Rabonik
Zolpidem tartrate (takes occasionally but for last 1 week he's taking it every night)
5. Any medicines changed recently?
For few days he is out of Rabonik so he took the replacement drug Mosa SR which he stopped around a week back and since then he's been taking Omeprazole.
6. Does he pass stools daily, normally? Any constipation?
He passes stool alternate day. He has severe constipation tendency.
7. Any dark colored stools?
No
8. Does he have diabetes?
No
9. Any burning in urine or reddish urine?
No
10. How does the pain get relieved or how does it decrease if it does.
It decreases with time but he claims he always has some discomfort. It is less in the morning but as day progresses it gets worse.
11. Has he lost any weight in the past few months?
No he is at constant weight 133 lbs.
Yesterday he went for Ultrasound abdomen. the report is attached here. He was diagnosed with Duodenitis through an endoscopy performed in 2008.
Hope this helps in your further diagnosis.
Thanks again,
XXXXXXX
Brief Answer:
Thanks for answer. It is probably due to Duodenitis and constipation.
Detailed Answer:
Hello XXXXXXX
Thank you for the detailed and comprehensive reply.
I have reviewed the medications and history.
It seems the pain is related to the Duodenitis and constipation.
Rabonik is for the Duodenitis and he should continue that or exchange that with Omeprazole 20mg(which he is now taking) or Pantoprazole 40mg twice a day half an hour before meals(Empty stomach).
Rabonik cannot be exchanged for Mosapride which happens to be a gastric hurrying agent. It increases the speed at which food is cleared from the stomach and can help to decrease the bloating feeling. I would suggest stop MosaSR and start Tab Domperidone 10mg twice a day.
Why is he having Zolpidem? Does he have sleeping problems? Its usually given for that. This drug can increase constipation. Therefore, I suggest he sees his Physician and if this could be stopped it would be a better option.
It would be prudent to start him on Tab Dulcolax for constipation. You have mentioned he has tried that. I suggest he continues that or some other laxative(Senna, Isabgol, etc) that suits him and can help him to pass stools daily.
Since the Endoscopy was done 7 years back it would be a good idea to get it done again. Also, blood sugar testing to confirm that he has not become diabetic.
If by all these measures, it does not improve over the next one or two weeks then a CT Angiography should be done to rule out any narrowing of his Mesenteric arteries.
Take care and do let me know if there are other queries.
Dr Rishi, New XXXXXXX XXXXXXX
Thanks for answer. It is probably due to Duodenitis and constipation.
Detailed Answer:
Hello XXXXXXX
Thank you for the detailed and comprehensive reply.
I have reviewed the medications and history.
It seems the pain is related to the Duodenitis and constipation.
Rabonik is for the Duodenitis and he should continue that or exchange that with Omeprazole 20mg(which he is now taking) or Pantoprazole 40mg twice a day half an hour before meals(Empty stomach).
Rabonik cannot be exchanged for Mosapride which happens to be a gastric hurrying agent. It increases the speed at which food is cleared from the stomach and can help to decrease the bloating feeling. I would suggest stop MosaSR and start Tab Domperidone 10mg twice a day.
Why is he having Zolpidem? Does he have sleeping problems? Its usually given for that. This drug can increase constipation. Therefore, I suggest he sees his Physician and if this could be stopped it would be a better option.
It would be prudent to start him on Tab Dulcolax for constipation. You have mentioned he has tried that. I suggest he continues that or some other laxative(Senna, Isabgol, etc) that suits him and can help him to pass stools daily.
Since the Endoscopy was done 7 years back it would be a good idea to get it done again. Also, blood sugar testing to confirm that he has not become diabetic.
If by all these measures, it does not improve over the next one or two weeks then a CT Angiography should be done to rule out any narrowing of his Mesenteric arteries.
Take care and do let me know if there are other queries.
Dr Rishi, New XXXXXXX XXXXXXX
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you doctor. This is helpful, I will tell him to follow on the medication you have suggested. He takes sleep medication since he has problem falling asleep.
Today he got worried since his blood pressure was in higher range and kept fluctuating. Can this happen due to Duodenitis and constipation?
What do you suggest for the surgery scar pain? At what point we should consider taking him to urgent care or emergency room?
Many thanks for your advice !
XXXXXXX
Today he got worried since his blood pressure was in higher range and kept fluctuating. Can this happen due to Duodenitis and constipation?
What do you suggest for the surgery scar pain? At what point we should consider taking him to urgent care or emergency room?
Many thanks for your advice !
XXXXXXX
Brief Answer:
My apologies for ignoring BP. He should see a Physician for such high BP.
Detailed Answer:
Hello XXXXXXX
Any kind of pain and anxiety can raise blood pressure.
My apologies for ignoring blood pressure in both my answers. If his BP continues to be above 170 systolic or above 110 diastolic then please take him to urgent care to get his BP down. He might require addition of a drug for blood pressure +/- injectable pain killers.
At this high BP, he should be seen by a Physician and if possible examined by a Gastroenterologist or a Surgeon.
I doubt that the scar pain would be the cause so many years after surgery.
When you see the Physician please ask him if they could possibly give another alternative of Zolpidem.
All the very best and I hope he recovers well and fast.
Please do keep me posted about his condition and if I can be of any help at any time.
Regards,
Dr Rishi, New XXXXXXX XXXXXXX
My apologies for ignoring BP. He should see a Physician for such high BP.
Detailed Answer:
Hello XXXXXXX
Any kind of pain and anxiety can raise blood pressure.
My apologies for ignoring blood pressure in both my answers. If his BP continues to be above 170 systolic or above 110 diastolic then please take him to urgent care to get his BP down. He might require addition of a drug for blood pressure +/- injectable pain killers.
At this high BP, he should be seen by a Physician and if possible examined by a Gastroenterologist or a Surgeon.
I doubt that the scar pain would be the cause so many years after surgery.
When you see the Physician please ask him if they could possibly give another alternative of Zolpidem.
All the very best and I hope he recovers well and fast.
Please do keep me posted about his condition and if I can be of any help at any time.
Regards,
Dr Rishi, New XXXXXXX XXXXXXX
Note: Revert back with your health reports to get further guidance on your gastric problems. Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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