Gut Feeling: How to Know if Stomach Pain is Serious

GI-Couch-FBAbdominal pain is the single leading reason for emergency room visits in the U.S., accounting for more than 10 million of the 130.4 million annual ER visits. Most people call it stomach pain, but it’s not always a stomach problem. Your abdomen holds many other organs, too, including your intestines (colon and bowels), pancreas, liver, gallbladder, kidneys, spleen and appendix.

So it’s not surprising that, just as with chest pain, it can be difficult to tell what’s really going on in there when your tummy’s not feeling well. Add in other vague symptoms such as nausea and vomiting and you could have the stomach flu, food poisoning, gallstones or any number of other conditions.

Listen to Tim Hartman, DO, Medical Director for Medical City ER at Stonebridge, discuss when to go the ER with severe stomach pain.

The Big D.

We’re not talking about Dallas. Nope … diarrhea. No one likes to have it or talk about it, but this dreaded symptom can clue you in on what your stomach pain may mean.

“Diarrhea with vomiting is a good indication that you have a viral or bacterial infection and not a surgical emergency,” said David Hanscom, DO, an emergency medicine physician at Medical City Fort Worth and Medical City ER Burleson. “Viral infections are more common, but you could have a bacterial infection, such as from food poisoning. You’ll know pretty quickly after eating contaminated food — within a half hour to an hour.”

Christopher Ramos, MD, a gastroenterologist at Medical City Alliance, agrees that the difficulty when dealing with abdominal pain — especially the upper abdomen — is knowing whether it’s heartburn or something more serious. More clues to help you (or your doctor) pinpoint the cause of symptoms include:

  • Type of pain: is it sharp or dull, constant or intermittent, mild or severe?
  • Location of pain: is it right or left, lower or upper, concentrated in one spot or radiating outward toward your chest or back?
  • Onset of pain: did it come on suddenly, start after eating (maybe spicy or restaurant food) or have you felt this pain for any length of time?

Recently, Dr. Ramos has seen a rash of norovirus cases in North Texans returning from cruises.

“Norovirus is the leading cause of gastroenteritis in the U.S., so it’s very common but sometimes hard to diagnose,” he said. “Members of the same family can have the same disease process but different symptoms and duration.”

Dr. Hanscom agreed, adding that there is no point-of-care test for norovirus.

“We don’t have a test for norovirus in the ER,” he said. “Diagnosis is done by looking at the patient’s symptoms and other clues, such as if there’s a local outbreak, if the patient has been on a cruise or if it’s during the colder parts of the year when people congregate indoors and spread germs.”

When to go to the ER with stomach pain.

You should seek medical care for these symptoms of abdominal pain:

  • Accompanied by a high fever
  • Accompanied by repeated vomiting
  • Accompanied by other serious or unusual symptoms, such as difficulty breathing or change in behavior
  • Severe or prolonged (lasting 24 or more hours)
  • Localized to one particular area
    • Right lower quadrant could indicate appendicitis
    • Right upper quadrant could indicate cholecystitis or a gallbladder infection
    • Left lower quadrant could indicate diverticulitis or a colon infection

“It’s important to not get dehydrated, especially for infants, children and older adults,” Dr. Hanscom said. “If you have any of the above symptoms, come on down to the ER and we’ll assess your need for IV fluids. We can also give you an antiemetic — a drug to prevent nausea and vomiting. It’s not really something that you can get without a prescription.”

Matt Bush, MD, Medical Director for the Emergency Department at Medical City, discusses when to go the ER with abdominal pain.

Poison prevention. 

Some GI issues are not caused by viral or bacterial invaders, but from an overdose of toxic substances.

“In children, the weekly pill reminders can be problematic because they are easy to access and can contain large amounts of medication,” said Dr. Hanscom. “It’s important to keep them where kids can’t get to them.”

Matt Bush, MD, Medical Director for the Emergency Department at Medical City, explains when to take a child with stomach pain to the ER.

Dr. Ramos sees a different problem in his adult patients.

“There are a lot of over-the-counter medications used for valid reasons,” he said, “but if they’re not used properly they can cause toxicity and poisoning. It’s a very common problem.”

One of the biggest culprits is one of the most commonly used drugs.

“Acetaminophen is used in almost everything,” Dr. Ramos said. “Overuse — 4 x 2 extra strength doses of Tylenol® a day — can easily lead to liver damage and possibly even become an indication for a liver transplant. Taking that dose alone can cause toxicity, but adding something like NyQuil™ for a virus can further increase the amount of acetaminophen. And depending on how long the virus lingers and you continue taking the meds — your liver tests can definitely be elevated.”

Unfortunately, someone with liver inflammation from substance toxicity will likely not have any symptoms other than fatigue until they’re at the point of liver failure and they need emergency medical intervention. Liver function tests are not a random screening and are typically ordered to rule out other conditions such as hepatitis C, fatty liver and gallbladder disease.

The only way to know for sure if you’re overdosing yourself or your children is to read all medicine labels and know the ingredients.

If you suspect poisoning.

Both Dr. Hanscom and Dr. Ramos agree that your first call should be to Poison Control at (800) 222-1222.

“Toxicology is a very broad area with many different agents that can cause harm,” said Dr. Hanscom. “Depending on the severity — whether your child ate one baby aspirin or a whole bottle — Poison Control will do a phone consult and let you know whether to treat at home or come in to the ER for emergency treatment or testing and bloodwork.”

Dr. Ramos encourages everyone to keep the number handy, even physicians.

“This is what Poison Control does,” he said. “They have the expertise and are the best resource for both patients and doctors. We (physicians) view Poison Control as a valuable resource.”

If someone in your family gets a gut feeling from a virus, bad food or even from their medications, one of our many Medical City Healthcare emergency locations has you covered. With average wait times posted online, if you do have an emergency, you can spend less time waiting and more time on the moments that matter most.

Find a fast Medical City Healthcare ER near you.

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Flu Season Expected To Be Harsh This Year. What’s Your Flu IQ?

flu1-fbGot chills? Are they multiplying? Then it’s probably the flu calling for you. Dallas County Health and Human Services is predicting a busy flu season this year. If you want to pop out and get a flu shot before reading on, we don’t blame you. While it takes about two weeks for the flu vaccine to fully kick in, you will have some protection immediately and it could help lessen symptoms and duration if you do get sick.

As if to underscore the DCHHS’ projection, Medical City Plano reported 420% more flu patients in their emergency room in December than in November — and most of those were seen over the course of just one week.

“Typically, flu levels decline during school breaks.” said Russell McDonald, MD, a Medical City Plano pediatrician. “But this year, we saw a big increase over the holidays, which means it will probably spike again with kids back in school.”

i-got-chillsAnother virus, RSV, continues to spike as well. RSV is responsible for many common respiratory conditions, including colds, bronchitis, bronchiolitis, pneumonia and croup.

“RSV is even more contagious than the flu,” Dr. McDonald said. “So when you have kids in preschools and day cares, if one child comes down with RSV, pretty soon everyone’s got it.”

Curtis Johnson, MD, an emergency medicine physician at Medical City North Hills, agrees that the number of flu patients is unusually high following winter break.

“This is pretty early to start seeing a spike in flu cases so soon after the holidays, but that just means the 18 or so patients we’ve already seen this week are going to escalate even more,” he said.

The surge in local flu cases has also been noted at Medical City Denton and aligns with the national spike, according to chief hospitalist Jaya Kumar, MD. Each year, more than 200,000 adults and children are hospitalized from the flu. Dr. Kumar says the best way to prevent the flu — a contagious respiratory illness with symptoms such as fever, cough, runny or stuffy nose, body aches and fatigue — is for everyone to get the flu vaccine.

Flu can be serious and lead to hospitalization and even death.
“We admitted three people to the hospital recently with flu complications, including dehydration, pneumonia and chronic obstructive pulmonary disease. In addition to the flu vaccine, I also recommend that people cover their mouths when they cough or sneeze, stay away from people who are sick and practice good handwashing hygiene.”

Flu IQ.
Think you’re an influenza expert? See how many of these can you answer correctly.

Q: Should I go to the ER with flu symptoms?

A: Maybe. Seek emergency care within the first 48 hours if you:

  • Are having trouble breathing
  • Are vomiting excessively and can’t keep anything down
  • Have a lung disease like asthma or COPD
  • Are under one year of age or over 65
  • Have a compromised immune system, such as from chemo or steroid therapy
  • Are pregnant

Eric Pearlman, MD, an emergency medicine physician at Medical City McKinney, explains more about flu symptoms and the ER.

Q: Can you get the flu from a flu shot?

A: No. The virus in flu shots is inactivated and can’t make you sick. It’s possible to come down with the flu soon after getting a flu shot, but that can be for one of two reasons:

  1. You were exposed to the flu before your flu shot took effect (it takes about two weeks to provide full protection)
  2. You caught a strain of the flu that wasn’t included in your vaccine

Q: Do I need to get a flu shot if I got one last year?

A: Yes. For two reasons:

  1. Immunity decreases over time (especially in older people)
  2. The current strains of the virus may be different from last year’s

Q: Can I get a flu shot if I already have a cold AND I’m allergic to eggs?

A: Yes. Unless you have a fever over 101°F or another significant illness, you can get a flu shot before your cold symptoms are gone. Likewise, new CDC guidelines state that flu shots are safe for people with egg allergies.

Q: Can’t I just skip the flu shot and get antibiotics if I get the flu?

A: No. Antibiotics fight bacterial infections, not viruses. If your flu gets serious, it can cause bacterial infections such as pneumonia, in which case you may be prescribed an antibiotic.

Q: Should I feed a cold and starve a fever?

A: Yes and no. Feed your cold AND your fever with plenty of liquids to prevent dehydration, healthy foods to keep your body well-nourished and lots of rest. And yes, a big bowl of chicken soup is just what the doctor ordered.

Q: If I get a flu shot, is that all I need to do to avoid getting sick?

A: Definitely not! Stay at least 6 feet away from sick people and wash your hands frequently and correctly. If you do get sick, protect others by covering your mouth when you cough or sneeze.

It’s not too late to get your flu shot. There are 28 convenient CareNow locations throughout DFW where you can get one fast. But if the flu comes calling for you, one of our many Medical City Healthcare ER locations has you covered. With average wait times posted online, if you do have an emergency, you can spend less time waiting and more time on the moments that matter most.

Visit to find a fast Medical City Healthcare ER near you.

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Tips to Prepare Kids for the Flu Shot and Helpful Hints to Avoid Getting Sick


What you need to know about FluMist® effectiveness this year. 

The CDC says it’s impossible to predict the potential severity of this year’s flu season. But unofficially, it’s been noted that an increase in summer colds, especially among those who don’t normally get them, might possibly mean an epic flu season. And in our corner of North Texas, we saw and heard reports of people coming down with viruses who never get sick, so perhaps it’s not too early to start planning for prevention.

If your first thought was — great, we’ll take the whole family out for FluMist — you’ll have to think again. The CDC has officially recommended the flu shot over the nasal spray version after data showed that the effectiveness of last year’s flu mist vaccination on children ages 2 through 17 was only 3%.

Or, as the CDC put it, “no protective benefit could be measured.” Sad face emoji.

But that’s no excuse to skip the flu vaccine. Annually, 200,000 adults and children are hospitalized from the flu. Matt Bush, MD, an Emergency Medicine Physician at Medical City Dallas, says everybody needs to get a flu shot this year.

Helping children overcome a fear of needles.

So how do you break the news to the kids? CareNow, which has flu vaccination locations all over North Texas, offers tips for taking the sting out of shots.

  • Be honest. If your child asks, tell them that they are going to get a shot and that it may hurt, but only for a short time.
  • Don’t make a big deal out of it. Only bring it up if they ask, and even then, keep your dialogue short and sweet. The more you talk about it — even reassuringly — the more anxious your child will be.
  • Provide a distraction. While the shot is being administered, talk to your child, squeeze her hand, tell a story or sing a favorite song. (If your child is screaming and has to be held down by three people, this will be ineffective, but it may distract you long enough to get though the ordeal.)
  • Know when to step back. As noted above, screaming tantrums are a signal to step away and let the professionals do their job.
  • Comfort your child afterward. Sitting quietly or rocking for a few minutes, placing an ice pack on the injection site or administering children’s pain relief medication may help your child feel better.
  • Offer a reward. A small incentive, such as a lollipop or sticker, can help children destress after a shot.

What else you can do to avoid the flu.

Make sure everyone knows how to correctly wash their hands.

Teach kids the right way to cough and sneeze.

Know when your child should is too sick and should stay home from school or day care.

Check out more tips for spotting sick kids and options for sick-child care at our pregnancy blog on WeDeliverDreams.

We hope all your flu shots are painless and effective, but if the flu goes askew, one of our many Medical City Healthcare emergency locations has you covered. With average wait times posted online, if you do have an emergency, you can spend less time waiting and more time on the moments that matter most.

Visit to find a fast Medical City Healthcare ER near you.