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Family Medicine (Expert Forum)
Any ideas? Your comments are appreciated!
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Any ideas? Your comments are appreciated!
by DodiAD, May 22, 2002 12:00AM
Dear Doctor: I would like to ask a question about my GI system. Late last week I suffered from severe pain in the RUQ. It was intense and had gone through to my back and around my ribcage. I felt like my insides were in a spasm. The only thing I could do was rest in bed to help take the edge off, but it didn't go away. I also made sure to drink lots of water. No trips to the bathroom would help, nothing. I considered going to the hospital because I never had pain like this before. (I have had other abdominal pains from a hiatal hernia and bad reflux, but this was different). I decided however to just sleep it off and see how I felt by morning. Well, I was feeling a bit better and within 2 days I felt like the pain never even happened. But by the next morning (the 3rd day) I was feeling yucky again. I went through the day feeling wiped out and achy but constant and not as severe. By this time I also begun to notice that my stools were continuously dark green (something new too)and I eventually had an attack of diarrhea that was the greenest I had ever seen. I have some medical background myself and frankly I was shocked at what I saw--it was so green that the typical brown color was unrecognizable. I have never seen this before. Nothing in my diet has changed except for my loss of appetite and nausea.
I'd also began to get chills and a low-grade fever (100-100.4). I went to a nearby acute care facility and they were pretty sure I had a gallbladder problem. Gallbladder problems run in the family; my mother specifically around my age now had problems and eventually had it removed.
I was sent for an liver & gallbladder ultrasound the next morning and that apparently came back normal--no gall stones. My labs thus far have been normal --CBC in particular. In the meantime, I am still in rather chronic pain, I feel wiped out and still have no answers. Because my appetite is down, I am not eating as much; I have begun to lose weight as a result. I am following up with a physician very soon about this, who also is a family practitioner, and I wonder what you would do with a patient with these kind of symptoms? I had hoped the ultrasound would have been more helpful here.
Thank you so much for your comments.
I'd also began to get chills and a low-grade fever (100-100.4). I went to a nearby acute care facility and they were pretty sure I had a gallbladder problem. Gallbladder problems run in the family; my mother specifically around my age now had problems and eventually had it removed.
I was sent for an liver & gallbladder ultrasound the next morning and that apparently came back normal--no gall stones. My labs thus far have been normal --CBC in particular. In the meantime, I am still in rather chronic pain, I feel wiped out and still have no answers. Because my appetite is down, I am not eating as much; I have begun to lose weight as a result. I am following up with a physician very soon about this, who also is a family practitioner, and I wonder what you would do with a patient with these kind of symptoms? I had hoped the ultrasound would have been more helpful here.
Thank you so much for your comments.
Doctor's Answer
by Forum-M.D.-DT, May 22, 2002 12:00AM
Thank you for visiting the Family Practice Forum.
Your symptoms really point to some type of problem with the gallbladder or bile ducts. I have seen this situation many times, where the gallbladder appears normal on an ultrasound, yet there are symptoms which make one think of gallbladder disease. A possibility is the presence of a "common bile duct stone"(s). This can be diagnosed with a test done by a Gastroenterologist called an ERCP.
The presence of "green" stools, fever, and pain in the area you describe makes me think that either a gall bladder problem was missed, or there may be a common bile duct stone. Your symptoms are clearly coming from a "gastrointestinal" source. Therefore, my next step would be to see a Gastroenterologist and recommend an ERCP.
Also, people can have problems with their gallbladder and not necessarily have "stones". Some times there is "sludge" (or very thick thick bile) in the gall bladder. This causes symptoms similiar to gallstones, but no "stones" will show up on the ultrasound.
I heop this helps, I really would consider another opinion, from a gastroenterologist.
Your symptoms really point to some type of problem with the gallbladder or bile ducts. I have seen this situation many times, where the gallbladder appears normal on an ultrasound, yet there are symptoms which make one think of gallbladder disease. A possibility is the presence of a "common bile duct stone"(s). This can be diagnosed with a test done by a Gastroenterologist called an ERCP.
The presence of "green" stools, fever, and pain in the area you describe makes me think that either a gall bladder problem was missed, or there may be a common bile duct stone. Your symptoms are clearly coming from a "gastrointestinal" source. Therefore, my next step would be to see a Gastroenterologist and recommend an ERCP.
Also, people can have problems with their gallbladder and not necessarily have "stones". Some times there is "sludge" (or very thick thick bile) in the gall bladder. This causes symptoms similiar to gallstones, but no "stones" will show up on the ultrasound.
I heop this helps, I really would consider another opinion, from a gastroenterologist.
Thank you very much for your response. I am glad to hear (as sad as it sounds) that you have seen this many times where an ultrasound was normal but things still point to a gallbladder problem. I am hoping that I will not be stranded to suffer. Be stranded to suffer unfortunately has happened many times in my case and I often don't see a doc anymore unless I am in incredible pain.
It's interesting you mention ERCP. My mother, whom I wrote about with the family history of gall bladder problems, also had this done. I have already had a gastroscopy before so I pretty much know what to expect. I anticipate going to a GI specialist; the family doc I am seeing is a new doc for me and I am told he is aggressive.
Again thank you for your feedback and personally, I must say that I am glad to have been able to get a caring response back.
Keep up the great work.