16 THE STRAITS TIMES OCTOBER 25 2012

Q I am a 21-year-old man. In recentmonths, my stomach has been bloatedwith air. Off and on, the “wind” in mystomach causes tummy pains and I

would relieve it with Eno effervescent fruitsalts.

Why does my stomach constantly have somuch “wind”? Should I see a doctor?

A Discomfort in the upper abdominal region,otherwise known as dyspepsia, is a verycommon condition. Some of the commondyspeptic symptoms include bloating,

fullness after meals and pain. Bloating is asubjective symptom and should be distinguishedfrom abdominal distension, which is ameasurable increase in abdominal girth.

Patients who feel bloated may or may nothave corresponding abdominal distension.

A visit to the doctor would be useful toexclude a more significant disease; otherwise, itis highly likely that you have a functionalgastrointestinal disorder, in this case functionaldyspepsia or functional bloating.

The term “functional” means that there is nounderlying organic disease such as an infectionor cancer, but the patient has very realsymptoms. Multiple factors contribute towardsdyspepsia, such as diet, hypersensitivity of thenerves in the gut, variations in gut motility(intestinal contractions) and how much thestomach can accommodate.

Simple measures would include avoiding“trigger” foods that could be the cause of yoursymptoms and eating a balanced diet withmoderate quantity meals.

Medication could range from simple antacidsand “digestive aids” to a trial of acidsuppressants and prokinetics (drugs that work tospeed up the emptying of the stomach and themovement of the intestines).

If these do not work, your doctor may thendecide to embark on tests such as an endoscopy(which uses a scope to see the inside of the

body) and radiologic imaging.

DR REUBEN WONG,consultant at the department ofgastroenterology & hepatology atNational University Hospital

Bloated stomach andtummy pains

Q I am a 62-year-old woman who had amammogram and ultrasound scanrecently.

The report said my breast tissues areheterogenously dense.

This may lower the sensitivity ofmammography. No dominant masses orsuspicious clustered microcalcifications arevisible.

The report also said there is no evidence ofskin thickening or nipple retraction seen.

No solid nodules are present in the rightbreast.

In the left breast, there is a left axillary lymphnode measuring 1.1 x 1.0 x 0.8cm in size. Thecause is uncertain.

This was not present in the prior study. Thedoctor’s impression is that there is no suspiciousmammographic lesion.

The doctor then said I should consider either ashort interval follow-up or further evaluation.

A private doctor I consulted suggested that Ido a scan two months later.

But the doctor at the polyclinic has arrangedfor me to do it in six months’ time.

What should I do?

A It is important for doctors to interpretfindings on scans with consideration to thecomplete clinical scenario of the patient.

I would consider the patient’s clinicalhistory and physical examination findings. I wouldreview the scans to look for other features notdescribed in this report and compare with pastscans if they are available, before advising on afollow-up plan.

Risk factors and medical history are importantas there are many reasons why axillary (armpit)lymph nodes may be seen on scans.

Conditions not related to the breasts, but ratherto the arms, chest and neck, may cause lymphnode enlargement. However, many of these are

not due to cancer.For example, a skin infection or eczema on the

arm can cause an enlargement of axillary lymphnodes.

It is important to assess the nature of thelymph node, to look for possible causes of lymphnode enlargement as well as examine if there areenlarged lymph nodes elsewhere.

It is also important to know why themammogram and ultrasound were done, forexample whether it was for breast cancerscreening or whether there was an abnormalityfound upon clinical examination.

Your mammogram did not find anyabnormalities, but the ultrasound scan detected aleft axillary lymph node.

Axillary lymph nodes are present in all of us andthere are several criteria for an abnormal lymphnode.

A 1.1cm lymph node is not abnormal.It would be useful to look for other features,

such as the lymph node having a thickened cortexor an abnormal shape.

The lymph node was not present in the priorscan. I assume this refers to the ultrasound scandone the year before. However, if available, weshould review scans even before that.

If there are no abnormalities in the breast andno suspicious features in the lymph node, it couldbe reactive in nature and generally no interventionis required.

A reactive lymph node is one that showsfeatures of responding to external exposure suchas infections.

It is structurally normal and may just be largerbecause it is actively functioning and doing its jobin removing viruses and bacteria.

However, if the assessment is that it is likely tobe benign, a short interval review may berecommended and this could range from a clinicalexamination in three months to a repeatultrasound in six to 12 months.

However, if the clinical findings areindeterminate or suspicious in a 62-year-old, Iwould recommend further intervention.

In your case, the ultrasound was done and nofurther intervention was advised at that time. Thiscould mean that there were no suspicious findings.

I would proceed with the repeat ultrasound insix months’ time as planned.

However, I emphasise the importance of goingfor a physical examination for a completeassessment to avoid missing a significantcondition.

Assessment should not be based on looking atscans alone, especially if there are symptoms.

For healthy women with no risk factors and nosymptoms, routine mammograms arerecommended for breast cancer screening.

Ultrasound scans are generally not used forscreening, but as an adjunct if further evaluation isneeded for findings on the mammograms or uponclinical examination.

I recommend women to undergo breastscreening; the benefits and disadvantages can bediscussed with their doctors.

Singapore residents can benefit from thenational breast screening programme,BreastScreen Singapore, where mammograms areavailable to residents aged 40 years and above ata subsidised rate.

It is run under the auspices of the HealthPromotion Board and involves dedicated andexperienced specialists.

For more information, go to Hpb.gov.sg/HOPPortal/programmes-article/3324.

DR BENITA TAN,consultant surgeon at thedepartment of general surgery atthe Singapore General Hospital

Got a problem? E-mail your questionto sthealth@sph.com.sg. Specify Ask TheExperts as the subject and include yourname, age, gender, identity card numberand contact details.

Confused by mammogram results

ST FILE POSED PHOTO

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