Postcholecystectomy URQ Tenderness & Diarrhea

I'm a 41-year-old white female, and last week I went to my family physician with the following complaints:

 recurrent diarrhea for 3-4 weeks, sometimes foul-smelling, sometimes as often as 6x/daily
 liver (or at least upper right quadrant) pain, recurrent, for 4 weeks
 some nausea
 some fatigue, chills, body aches
 history of cholecystectomy (June 2008)
 some low-grade fever (100 or less)
 history of hepatitis A (1979)


I mentioned two particular concerns to my doctor.  I remember my general surgeon telling me before the cholecystectomy that the most common major complication resulting from the laparoscopic surgery was injury to the common bile duct.  I've since read that sometimes such an injury doesn't manifest itself for quite some time.  My doctor assured me that, if my CBD had been injured, I'd be "sicker than snot."  (I thought I was pretty sick!)  The other thing that's scary, perhaps because it's made headlines so much lately and is so deadly, is pancreatic cancer.

I was surprised during my physical that, to the touch, my URQ was NOT tender.  My doctor gave me a prescription for Cholestryramine and ran several labs.  The prescription, she said, may be useful in helping my body to do what it could when I still had a gallbladder.  (I see that Cholestyramine is for lowering cholesterol, so that's a pleasant added benefit.)  The labs were as follows:

 (all normal):  CMP, TSH, blood sugar, kidney & liver function, lipase, sed rate, sodium
 (negative):  O&P, C-Diff, hepatitis
 (slightly elevated):  ANA
 (slightly low):  potassium

Every 2-3 days I have diarrhea and/or loose stool.  Just a note:  before my cholecystectomy, I had NONE of these issues.  For about a week now I haven't had the URQ tenderness/pain unless very slight.

I'm just wondering what the next logical step for me would be.  

[Kevin Pho, MD]

Imaging the abdomen with an ultrasound or CT scan can point to possible damage to the common bile duct.  

If there is concern about pancreatic cancer, you can consider an MRI, or if there is more suspicion that there is a biliary duct blockage, an MRCP can be considered.

One of these tests would be the likely next step - I would consider being evaluated by a gastroenterologist to discuss which of these options is most feasible in your case.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin Pho, M.D.
www.kevinmd.com
www.twitter.com/kevinmd

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