Undiagnosable RUQ pain -- cyst related?

[Joely]

Hello,
I am a fit, ns, 38-yr-old female with RUQ pain for the past 4 months. Pain radiates to upper right back/shoulder, seems worse with food or fatty food, sometimes worse around menses, can be disabling, and a low-level pain that has become fairly constant. There is  some nausea when the pain is most intense. The pain feels very deep (coming from deep inside the body cavity) and often has a "burning" or "on fire" sensation. I often cannot wear anything even remotely binding over the right lower ribcage because of the sensitivity to pressure.

I have lost appx 20 pounds since this started, mostly due, I think, to fear of eating and causing more pain. I have voluntarily cut out all alcohol, coffee, and fat in the hope of relief. At the outset of this problem, I was convinced it was my gallbladder, but now I am  wondering if it isn't my liver.

Tests done include 3 ultrasounds (1 vag, 2 abd), CT scan, HIDA scan, endoscopy, colonoscopy, upper GI with sm bowel -- all negative. Blood work including hep b&c tests all normal. The only finding is a 1.2 cm cyst on the dome of my liver, but I am told that is not uncommon and would not cause this pain. I am advised to  have laparoscopic surgery to explore.

What I am wondering is would/could the liver cyst cause the pain? Could the "cyst" in fact, be something else -- an abcess, a hepatoma? What is the next step, and -- finally -- are there any risks to laparoscopic exploratory surgery?

Thank you very much for any advice or guidance.

[URQSUFFERER]

I have had the same periodic URQ pain too, just behind the first rib. Quite painfull, when it is sytomatic seems to associate sometimes with greasy foods, sometimes just after a cold or after a period of physical stress, but not always. Hurts more with deep breaths or full stomach. I often will develop a mild pluresy from the shallow breathing if the pain goes on for more than a few days. On a couple of occasions, (once about 25 years ago, again about ten years ago, I had the sensation of somthing poping or bursting resulting in first a burning sensation then almost total and abrupt relief of the pain. This occurs, every few years sometimes a couple times in a row. Like the other I had lots of tests, my doc thought of Gall Bladder, Pacreatitus, stones, etc, all with no luck. Then in 2001 I had surgery for GERD and the surgon mentioned that I had scaring from a syst on my liver where it touches the diaphram? Since then I figured that was the trouble with my URQ pain.

[doc holiday]

I have been trying for years to understand this pain. I am going to put togeather a study and compare symptoms and causes. anyone wanting to please email me at ***@****. As I take in info of a larger group I will email you back. I am really frustrated with all people are going through and every body acts like they are crazy. there has to be a common link. scripts, infection, diet, exposure, something tell me your story tell be as much as possable about when, where, how this happened. life style, part of the country,meds you are on, habits, work history,operations you have had, anything will help. dont worry about telling be about allthe tests and dr. oppions spare me the medical jargin.I'm not intrested because they are't helping,that is why we need to do this. on the other hand if any one has had this and is cured please forward quickly.I am now house bound so I have time to do this.


                                         Thanks
                                         Doc Holiday

[Leslie2733]

Hi,

I have had a similar problem. I have lost weight and I am down to 103 lbs. But, I look smaller to most people.
I went to a local out patient clinic and the doctor told me, I was most likely suffering from a abcess in my gall bladder or gallstones. I went the next day to a gastro doctor and the physcian assistant suggested, I go this morning to have a sonogram. I had a low fever and very much discomfort.
I spoke with the sonographer about my pains (RUQ)at the end of the test.. he said my gall bladder appeared normal. He wouldnt tell me exactly my health issues. But he seemed focused on my liver, pancreas and bile duct.  I think, I must have pancreatis or something. Much of my issues, seem similar to this condition.
I read it is possible for the bile ducts to become blocked with gall stones and cause this pain.

I was also diagnosed the year before with have 5 cyst on my liver, I don't drink hardly at all. The nurse in the ER told me such cyst are normal.

But, I wonder if all these things are related.
The cyst, weigt loss, RUQ pain, cold chills and general feeling of being sick.

I am thinking of asking the gastro doctor about having the gall bladder removed any ways. I don't believe such test can tell all what is going in internally in your body.

[Joely]

Wow, thank you very much for sharing your story. I am actually in a "good" phase right now, feeling pretty well and eating what I want for the first time in months. Perhaps some "sludge" has passed... or not, we'll see. I've have good periods before that have reverted back to pain. I find it interesting that you (like me) felt strongly that it was your GB even without confirmation by so many tests. And then, there is was, a diseased GB that could not be detected. If I have the pain again as severely as it has been in the past, I believe I will opt for exploratory, with "permission" to remove diseased or bad-looking GB.

May I ask how long it's been since your procedure and how you are currently feeling, regarding eating and elimination? Thanks so much for posting.

Joely

[daron]

Your post sounds exactly like what I have just been thru the last 4 months and I acutally placed a post under "gallbladder" to this dr. You can read my post under "gallbladder" specific on 6/05/05 from daron.
I am a 38-year old female that had all of the same symptoms you described. I had all the same tests you had run including an Abdominal MRI and the HIDA scan with CCK the dr. mentioned. The only thing they found was a 2.7 cm cyst on my right kidney. Once again Internist,Gastro and Surgeon all told me that would not cause my horrendous RUQ pain.
Finally 2 weeks ago we did an Exploratory Lap with consent to take my Gallbladder out because even though none of the tests showed it even the HIDA scan, everyone still felt like it was that.  The pain got so bad and it was constant whether I ate or not, no matter what I ate; I was so desperate for an answer and to stop the pain I told them to take it out.  
When the surgeon got in there, there was a kink in my cystic duct which is connected to the gallbladder that she said could have caused the problem, therefore she removed the cystic duct with the gallbladder.  Then they sent the gallbladder to pathology to biopsy and it turned out to be very infected and diseased.  None of these things showed up on all those tests,ie. Abdominal sono, Adb CT Scan, Abd MRI, Abd X-ray, HIDA scan, Upper endoscopy.
I am feeling much better, but I still have some of the same deep knawing pain I had under my rib cage and a little in my back.  With every day it seems to become less and less. I am praying my body is just adjusting to not having a gallbladder .
I will tell you I spent many years "dieting" the wrong way, not eating anything "fasting" and eating absolutely no fat and this is very hard on your gallbladder.  You do not necessarily have to have any stones to have a bad gallbladder.  My biopsy showed no stones, but Chronic Cholecystitis.  Good Luck with everything.The surgery itself is not bad at all.  But I will tell you some people do have what is called "post gallbladder syndrome" afterwards.  This can cause loose stool, diarehhea, and cramping.  But for the most part you just have to let your body adjust and watch what you eat.

[doc holiday]

I have been suffering from this kind of pain for 4 years now I have had all the tests and procedures these gastro guys are lost. I have found mine is heat realated some tests have showed a histamine reaction with mild heat. I mean 70 deg. I have to live inside at about 68 deg. I do pretty well and after a week or so at this temp. pains gets better. I have been to hospitals including mayo clinic. I with I could tell you what it is but I cant. I well tell you it is real.If I find the answere Ill post on this site.

[Kevin Pho, MD]

Liver cysts of that size typically would not be causing the symptoms.  Further evaluation of the cyst would include an MRI - however with a non-revealing CT scan, that would be less likely.  The same is true for an abscess.  

I would ensure that the HIDA scans were with CCK stimulation to evaluate the ejection fraction of the gallbladder.  If low, it can replicate the symptoms you are experiencing, and gallbladder removal may be beneficial.  

If these tests continue to be negative, then you can consider looking outside of the GI symptoms for a cause - i.e. can start looking a musculoskeletal or neurological diseases that may lead to the symptoms.

The risks for laparoscopy surgery can include infection and bleeding as well as the risks of general anesthesia.

You can discuss these options with your personal physician.

Followup with your personal physician is essential.

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, M.D.
Medical Weblog:
kevinmd_b

[surgeon]

liver cysts, especially of that size, don't cause any symptoms. It's usually very easy to tell the difference between a simple cyst, and a tumor such as hepatoma, or abscess. The risks of laparoscopy are low, but not zero. There's general anesthesia, which is highly safe, but can have rare consequences. Laparoscopy can, in very rare instances, cause bleeding, infection, or damage to internal organs. The chance of a significant complication from the anesthetic or the procedure itself is very low.