Reliable diagnosis or need to seek 2nd opinion?

[ckwt]

Since giving birth to twins 4 years ago, I've had intermittent RUQ pain which occurs at the exact same spot on my back. To date, doctors have suspected gallbladder problems, however none have been found. Liver enzymes taken in a Complete Metabolic Panel blood test last November were all normal. Complete abdominal ultrasound taken in March didn't show any abnormalities with any intenal organs.

Other symptoms I've begun experiencing lately ( in addition to the intermittent RUQ pain in front and back) include:
1. itching in my RUQ area only - front and back
2. little veins on the front and back of my RUQ area only. None on the left side or anywhere else on my body.
3. When I drink a really cold drink (ie: smoothie or slurpee) I can sometimes feel it in my RUQ area, front and back. It hurts for a second and then goes away - like brain freeze in my abdomen.
4. Increased heartburn symptoms, particularly at night when trying to sleep on my right side. This, too, is intermittent. I've also had some heartburn occur following a large meal. The only other time I've experienced heartburn was during pregnancy.
5. When doing extremely intensive exercise, like a long bike ride, I experience lingering pain in the very upper right quadrant of my abdomen, right where my sternum is, but slightly to the right. This lingers for a while after the exercise, and I've also experienced this after eating.
6. With certain types of movement in a sitting position, I feel sort of a "clicking" sensation in my RUQ, like something is rubbing or getting stuck on something when I move. It doesn't hurt, but feels like something's rubbing against something with movement.

I'm wondering if there could be something going on with my gallbladder or any other organs in the RUQ that just isn't apparent based on the tests run so far. If the gallbladder and liver look normal on ultrasound, is it safe to say there's nothing wrong with them? Would hiatal hernia show on ultrasound or not?

What about scar tissue? Before I got preggo, I had a laparoscopy performed to check for endometriosis. During that exam the Dr. found TONS of scar tissue covering my appendix. It was never removed, and no one has ever thought it necessary to find out why it was there. Could the scar tissue continue to spread and cause pain in the RUQ area?

Any other suggestions? Thank you.

[Crampster]

In regards to test not showing anything.  I was having similar issues RUQ pain in 2002 very severe... left then on and off again.  Thought it was my IBS or GERD.  Kept having tests done HIDA scan in 2002 or 2003 was normal.  Pain came and went.  This last year pain more than not... New GI doc said gallbladder.  I explained I had been through this before.  He smiled and said I know you had the test and they were negative.  We will do the test again... another HIDA scan normal... CT scan normal.  Referred to a surgeon he agreed gallbladder removed.  Pathology report on gallbladder came back... gallbladder very inflammed.  Caught it before had further problems.
Wish you luck.
crampster

[ckwt]

Saw a gastroenterologist yesterday who recommended various invasive tests, including upper endoscopy, HIDA scan and even colonoscopy.

Based on the tests he recommended, doesn't sound like he has anything particular in mind and is just checking it ALL out. So, I guess we just have to keep jumping through the "hoops" until something shows up!

Anybody have any personal expeiences to share re: upper GI endoscopy procedure? Preferably, positive stories! I'm trying to muster up the courage to have a tube shoved down my throat while I'm partially awake.

Thanks!

[cricket6868]

I had an upper endoscopy and don't remember a thing.  I was totally out during the proceedure.  Actually this is my second endoscope.  
I have been going through a lot of testing lately. I think that the Dr. is illiminating differant causes of my right upper quadrant pain.
Have had. colonoscopy, cat scan with contrast, ultrasound, endosope, hida scan and the usual blood tests.
I was nervous before every test but, now that they are done there is not one to be afraid of.
I have to mention that the hida scan is just plain boring.

Think we are heading towards gall bladder but, not sure yet.
Good luck hope you get answers soon.

[ckwt]

Yes I  have had a chest x-ray too and it was normal as well. It was taken last Fall when I was having a flare up of this pain in the RUQ area of my front and back.

I don't seem to have any shortness of breath, although there is another symptom I forgot to mention...When I take a really deep breath, like a sigh, I have a slight gurgling sensation in the center of my chest. However it only seems to occur with that first deep breath I take - in other words, I can't replicate it with a second deep breath. I've also noticed it's particularly pronounced and happens more frequently when I have an empty stomach.

Does anyone know if I do the HIDDA scan, that would pretty much rule out any gallbadder issues, correct? If that's done and there is still pain, how likely is it that it's a liver problem. I've had a clean liver panel and a clean ultrasound done, but is that a solid sign that there's nothing wrong with my liver? Or are there other imaging tests that would be better for ruling out liver disease?

[TamR]

I too have almost exactly the same symptoms, but I have also been expriencing heartburn. Sometimes very sever heartburn. What convinced to go the doctor was a sever pain in the URQ under my breast in the rib area radiating to my back and down my right arm. I though I was having a heartattack. For about 15 to 20 minutes I could not move or take a deep breath. When the attack finally went away that area was very sore and it hurt to lean back in a chair.

I went to the doctor and she smiled and said yeah, gall bladder. They did blood work and sent me for a ultrasound and chest x-ray. The all came back negative or noraml. Next they sent me for a Hidda Scan with CCK. I thought great now I will know for sure if it is my gallbladder. Well the nurse said over the phone that it came back normal, and the doctor told her I was having classic gall bladder symptoms and that she would refer me to a surgeon.

So now what, I don't want to have surgery if my gall bladder is normal. I am thinking maybe I need a second opinion. I guess I could get the surgeon's opinion. Just hate to be bounced back and forth between doctors.

Any ideas?

[ozark]

have they done a chest xray to rule out anything from your lower lung?

[Kevin Pho, MD]

Scar tissue is possible and can be evaluated with a repeat laparoscopy or CT scan.

Other causes would including non-calculous gallbladder disease or various types of upper GI disease (i.e. GERD, ulcers, or inflammation).

I would consider a HIDA scan with CCK stimulation which can evaluate the gallbladder ejection fraction.  If low, removing the gallbladder can be considered.  

Upper GI disease can be evaluated with an upper GI series or upper endoscopy.  Blood tests looking for H Pylori can be considered as well.

These options can be discussed with your GI 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.
kevinmd_