Question Title: Acute abdominal pain

Hello. My name is Chelsea. I am f/28/5'8"/130 lbs. I do not take any medications (none!). I have no other illnesses, other than a slight heart murmer that I do not even know that I have. I am suffering from almost daily acute abdominal attacks. I am looking for opinions. Here is my background:

It all started in August 1997, I was washing the dishes one day and felt a sudden intense hunger type of pain below my breastbone (where it is soft). I went to my doctor the next day and she ordered an upper GI series (barium) and the blood test that checks for ulcers. Both were negative! The pain continued through the fall...with many weeks between attacks...or sometimes just days or hours. I went for an ultrasound in October and found that I had multiple stones and sludge in my gallbladder. I quickly learned through the internet (not by my doctor) that fatty foods can cause an attack. I revamped my diet so that I only ate foods containing no more than 6 grams of fat per meal! This worked...because I had no attacks for 3 months! But..I did lose 15 lbs.

February 1998, I had my gallbladder removed laparoscopically. After the 3-4 weeks of incisional healing and pain and discomfort that went along with it....I began having the same attacks again! I went back to the surgeon and he ordered an ultrasound...it was negative. He said I was fine.

I have had 16 attacks since the surgery. I had 6 this past week. The pain starts out (always) in the center, below my breastbone it grows in intensity to a very severe intense (no highs or lows) pain. Then it moves to my back, between my shoulder blades...but down a bit. I do not have a fever...but I do experience chills and sometimes sweating. I do not have any jaundice or itchy skin. No diahrea (sp) either. The pain now lasts 2-4 hours.

I have noticed on occaision that my stools are pale yellow to almost white in colour. As well, I have very little of an appetite and get full very quickly. After eating such small amounts. I notice the pain to come on 2-3 hours after eating anything now.

I have noticed....a change in the pattern of the pain. It always starts out in the middle then goes to my back. But..I also now have at the same time a sharp intense pain on my left side under my ribs. And sometimes a sharp crampy pain on my right side under my ribs. What does this mean? The local ER at the hospital said if I develop a fever and the pain lasts for more than 3 hours then I should come in....otherwise just wait it out!

I have a referral to a gastroenterologist and I have an ERCP scheduled for May 27/98. He says that he thinks it is a stone in the bile duct.

What is your opinion?
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Dear Chelsea,
There are several possibilities to consider that might explain your symptoms. I am certain that your doctors have done blood tests to check your liver and pancreas. Do you know if these tests have always been normal? The description of pale stools, your type of pain and the chills definitely raise the possibility of a common bile duct stone. It is indicated to perform an ERCP to check for stones as well as to verify that the pancreas is normal, in my opinion. During the course of the ERCP, the physician should also check the stomach and duodenum looking for ulcers or signs of inflammation.

If the ERCP is normal, I would suggest that you have a small bowel x-ray to exclude inflammatory conditions of that organ.Separately, a gastric emptying study should be performed because disorders of motility can produce many of the stmptoms of which you complain.

This response is offered for your general information and should not replace the conclusions drawn from a careful and complete evaluation by your physician.

If you want, we would be happy to see you in the Division of Gastroenterology at Henry Ford Hospital, in order to review your records and initiate treatment to improve your symptoms. You can arrange an appointment with Dr. Fogel, one of our experts in the investigation of abdominal pain. He can be reached by calling the Henry Ford Physician Referral Line at (800)653-6568.
HFHSM.D.-rf
*keywords: gall bladder, gall stones. Cholecystitis, common bile duct stones, abdominal pain
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