Upper right Quadrant Pain

[janafaust]

Good morning,
Thank you for offering your opinion.
I am a 44 year old caucasian female 5'9" at 159lbs.  Recently lost 15 lbs. I have had three episodes of URQ severe pain triggered by a high fat meal/ alcohol w cream (like Baileys or an ice cream drink)/ and/ or chocolate  when I have forgotten about this possibility and overindulged at a holiday or company meal.  My prior episode was about 5 years ago and I was checked for gall stones but did not reveal any.  Two hours after going to bed last Thursday, I had another episode of severe pain with nausea and chills while I was out of town (so I did not go to the hospital.)  I saw a new doctor yesterday in acute care and he sent me for an ultrasound which was again negative for gall stones. It has been four days and I continue to have pain under my ribcage and exactly in the spot where the ultrasound tech was viewing my gallbladder.  Both my parents and my siblings all have had their gall bladders removed and all of them did not have gallstones, but eventually developed gangrenous gallbladders.
We are awaiting bloodwork results. My results occasionally show elevated levels of liver enzymes.
I feel strongly that I should have this gallbladder removed.  I move frequently with my company, so it is hard to develop a trend with any one doctor.  Do you have any advice on next steps?
With business travel, especially overseas, it makes me very nervous about having an untreated issue and this time around I continue to feel very poorly.

Further background, I do not have any chronic GERD issues.  I do occasionally take a round of Prilosec if I notice frequent heartburn.  I am otherwise very healthy.
Thanks,

[janafaust]

Hi - just an update for you.
I was referred to see a surgeon last Friday due to elevated liver enzymes, elevated WBC, low grade fever, nausea and pain continuing on URQ.  The surgeon recommended gallbladder removal and an hour later I was in surgery.  I had a laparoscopic removal and was back home six hours later.  Amazing that it was so quick!  Even though I had post op pain, I could tell right away that the source of my pain was gone.  It has been five days since surgery and I am much better.  The gallbladder had "gravel and sludge" as described by the doctor which may have been the source of pain although not detectable by ultrasound.  
Thank you for your advice, Dr. Pho and good luck bibby737 -- I would consult a surgeon for an opinion as well.  He was quick and decisive and ended my misery.

[bibby737]

Keep me posted as to your check-ups. I have been having pain in the right side below the right rib cage for a while now, sometimes a burning sensation. I have had an abdominal scan and an ulltrasound ab done; also a pelvic ultrasound. Everything comes out normal. The liver has small cysts, but they told me not to worry. I am going for an endoscopy on Feb 6th. It is very frustrating. If someone shares similar symptoms, could you please let me know what, if anything, you have found out? Thanks a lot.
bibby 737

[Kevin Pho, MD]

I agree with the testing thus far, and there are further tests that you may want to do to exclude gallbladder disease.  

Evaluating the gallbladder function can be done with a HIDA scan and CCK stimulation.  This can look at the ejection fraction, and if low, may cause the symptoms.  

There are some small studies that suggest removing the gallbladder can be helpful in these situations.

Further tests can include an MRCP to evaluate the biliary tree, as well as an upper endoscopy to exclude diseases of the upper digestive tract.

These options can be discussed with your personal physician or in conjunction with a GI consult.

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 patients education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
www.kevinmd.com