Multiple Problems with no answers or urgency from general doctor.

I'm a 30 y/o white, female. Brief medical history: In 2005 I started having upper right quadrant pain. I saw a GI, who performed a HIDA scan, and it showed no disease and no gallstones, but the ejection fraction was low due to a severe kink. The gallbladder was removed. I got pregnant 1 month after the surgery. Normal pregnancy and delivery (vaginal with forcepts). Soon after delivery, I started having upper right quadrant pain, again. I went beck to the GI, he performed an endoscopy, which showed bile acid build-up and gastritis. He prescribed Cholestramine. It did not alleviate the pain. The pain landed me in the ER on several times and Morphine amplified the pain). Went back to my general dr., he mentioned Sphincter of Oddi Dysfunction, and getting an ERCP.  I didn’t have it because I became pregnant, again (at 6 months postpartum). Normal pregnancy and delivery (c-section). 4 days after I had my second baby, my blood pressure sky rocketed (173/115), and has continued to remain high (I am now five weeks postpartum). My blood pressure was normal throughout pregnancy and I've never had protein in my urine. My doctor also noticed that my thyroid felt enlarged, so he ordered an u/s and TSH, T4 blood work. TSH was 1.68 and T4 was .70.  U/S showed that my thyroid is enlarged and there are also 5 small nodules, with the largest measuring 33mm. Dr said no need for treatment. He also ran a B12 blood test, which was extremely low at 168. He put me on over-the-counter B12 supplements. I also had low B12 four years earlier and was put on over-the-counter B12 supplements (different dr), but I never had my B12 rechecked. I am concerned because this is a serious deficiency, and it seems that I may have an underlying issue here. I'm worried that I may have a problem absorbing B12. I am having symptoms of deficiency), my blood pressure will not come down (it hovers around 150/92. Do you have any idea what is going on, what I need to have evaluated, and what type of dr. to see?

[Kevin Pho, MD]

A GI physician would be the appropriate specialist.

Regarding the abdominal pain, I agree that Sphincter of Oddi dysfunction can be considered.  You have otherwise had a pretty comprehensive evaluation that would have ruled out many of the major medical disorders.  The ERCP with Sphincter of Oddi manometry can be considered.

Further evaluation of the B12 can be done with measurement of anti-intrinsic factor (IF) antibodies.  This can make the diagnosis of pernicious anemia - which can lead to chronic B12 deficiency.

These options can be discused with your eprsonal 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 patients education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
www.kevinmd.com