RUQ Pain, Gallbladder Slude

[zmurray]

Hi,

For the past 8 weeks, I have been having a RUQ pain with the following symptoms:
* pretty constant pain just below the last right rib, straight down from my right nipple.  
* The pain ranges from a scale of 3 to 7. Sometimes its a dull ache,  sometimes it is a searing pain, with pressure from inside.
*  It feels like a bubble or balloon is stuck behind the ribs, slowly being inflated and deflated, causing pain and ache on a constant basis.  
* I do not have any colicky attacks.  No Vomiting or Nausea
* Pain does not go to the back or between shoulder blades
* Fullness and gas after small meal

I have had the following test:

2 complete bloodwork:  All appears normal, no elevated amylase or liver enzymes levels. No H. Plyori bacteria.
2 Ultrasound:  Negative, showing no stones or sludge in Gallbladder
1 Barium Swallow: Negative, appears normal
1 Upper GI Endoscopy: Negative, appears normal with no ulcers or irritations
1 Colonoscopy: Negative, everything appears normal
1 CT scan on Chest & Abdomen w + w/o contrast: Gallbladder sludge or small stones appear to be present, + "Tiny ndeterminiate  hepatic dome hypodense lesion" is seen,  which the radiologist thinks is a cyst area base on statistics.  GI doctor also thinks its an incidental finding.
1 HIDA Scan with CCK: Normal Uptake, and Ejection Fraction 50%

The GI specialist does not want to do anything.    He did not recommend surgery as my symptoms are atypical and are different than common gallbladder attacks.   No treatment has been given.  However, I am still in pain on a daily basis.  A "golfball" still seem to be stuck near the right rib area with pain and discomfort 24/7.  Also feelings of "bubbles" and weird "fluid" movement in gallbladder region.   Nexium or pain medication doesn't help whatsoever.

* Is this a Gallbladder problem ?     It feels like a GB problem to me
* Should I consider surgery ? and  I am willing to risk surgery if the problem will go away !  

Please help, & Thank you.

Simon

[Kevin Pho, MD]

You have had a comprehensive evaluation for your symptoms, which would have excluded many of the common causes.

More specialized tests can be considered at this time, including, an MRCP or ERCP to look for biliary duct stones, or, a Sphincter of Oddi (SO) manometry test to look for SO dysfunction.

Both of these conditions likely would have been already thought of by your GI doctor, but if not, can be considered as the next step.

If the tests remain negative, looking outside the GI system can be considered.

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.

KevinMD.com
Twitter.com/kevinmd

[zmurray]

I like to add, the HIDA scan with CCK did not produce any pain for me.   The CCK was injected over a 30 min. period.