My first thought was that the patient might have irritable bowel syndrome, a condition that is associated with intermittent abdominal pain in the absence of any visible abnormality. But it would be unusual for it to turn up for the first time in a woman this age.
I noticed that the patient was quite thin, 5 feet 4 inches tall and only 100 pounds. When I asked her if she had lost any weight, she simply shrugged and told me she didn't even own a scale. I asked to look at the photo on her driver's license for comparison, and she did appear to have shed some pounds. Still, when I performed a physical examination, she seemed healthy.
Her chart showed that she was taking an oral medication to lower the level of glucose in the blood. I asked her if she was diabetic.
"Yes, I am," she replied. "It was just diagnosed a few months ago, much to my surprise."
"Why were you surprised by the diagnosis?" I asked.
"I never had problems with my blood sugar until now," she said. "Plus, nobody in my family has diabetes, so I guess I was just the lucky one. Now they tell me I have to take these medicines forever, and I hate checking my blood sugar all day long!"
The fact that she had new-onset diabetes raised a red flag for me, especially because she was so thin. Diabetes that develops after childhood is often a disease of overweight individuals who have become resistant to insulin, the hormone the pancreas secretes to lower the level of glucose in the bloodstream. This type of diabetes is uncommon in thin people.
"Does the pain in your stomach ever radiate through to your back?" I asked.
"Yes, yes, it does," she said after thinking for a moment. "Sometimes when I lie down at night."
"We need to take a look in your belly and make sure your pancreas is OK," I told her. "I'll order a CT scan of your abdomen right away."
The pancreas, which sits behind the stomach and in front of the spine, is a woefully misunderstood organ. Most of us think that the stomach is the main digestive organ, but in fact it does only a small part of the job. The pancreas secretes enzymes that break down foods into their basic building blocks. These simple sugars, fats, and peptides are then absorbed by the small intestine, whereas the colon primarily absorbs water. Most people are blissfully unaware of the pancreas until it gets them into trouble, usually by becoming inflamed, a condition known as pancreatitis, or by turning cancerous.
Vague abdominal pains are a dime a dozen, but vague abdominal pains in the presence of new-onset diabetes raise the possibility of pancreatic cancer. In addition, abdominal pain that radiates to the back often suggests a problem in the pancreas itself.