What is her age?
Did her blood work show anything abnormal?
Has she gas (more passing of flatus) and constipation?
Was a CT scan, barium meal with follow through done?
No she did not have a CT scan or Barium meal. Never heard of barium meal.
The reasons for excessive bloating can be;
1) excessive air swallowing.
Anxious people swallow air when they are stressed or anxiety supervenes.
2) increased intraluminal (inside the intestine) production from mal absorbed (improperly absorbed) nutrients,
3) decreased gas absorption due to some pathological condition of intestines like diverticulitis
4) expansion of intestinal gas due to changes in atmospheric pressure
A solitary reason or combination can be responsible for the excessive gas.
Following may help;
2) This may help;
a) Bismuth subsalicylate
b) Activated charcoal
c) Simethicone; (Maalox, Mylanta); Simethicone causes gas bubbles to break up.
d) Beano; contains an enzyme (alpha-galactosidase), which helps to breakdown certain complex carbohydrates.
All are available without prescription.
Avoid foods that appear to aggravate symptoms. These may include milk and dairy products, certain fruits or vegetables, whole grains, artificial sweeteners etc. But this is based on the personal observation for the aggravating food.
3) Investigations by the physician specifically for it;
a) Healthy people pass gas up to 20 times per day. If the frequency of passage of flatus is more than 20 times per day, gas chromatographic analysis of flatus collected via a rectal tube can differentiate air swallowing (which is nitrogen predominantly) from intestinal production of gas (which is hydrogen and carbon dioxide).
b) Colonic transit time.
Discontinue the following if she does them;
1) gum chewing,
3) drinking carbonated beverages, and
4) gulping food and liquids.
The gas formation and mild discomfort in her age would need to look for the following causes also;
1) Gallbladder disease (gallstones); HIDA scan and CT scan are needed for the diagnosis.
2) Irritable bowel syndrome
3) Diverticulitis; a barium meal with follow through is needed.
Please feel free for your follow up questions.
When there is a persistent problem which is not clear by the physical examination; further investigative work up is needed. As we discussed, colonic transit time and other investigation may be the key. A slow colon can be responsible for the bloating and big stomach. Intestines are the most bulky content of the abdomen and they are only structures which can change the size due to gas, fluid and other intestinal contents. So the direction of the investigative work up has to be for the whole of the gastrointestinal tract.
It is privilege assisting you.