Gallbladder Expert Forum
URQ Pain - Many tests, no answers?
About This Forum:

Welcome to the Gallbladder Forum! This is a place to ask your personal questions about gallbladder issues and receive personal answers from medical experts. You will also find other members who share your interest in the subject of gallbladders.

Font Size:
A
A
A
Background:
Blank
Blank
Blank
This expert forum is not accepting new questions. Please post your question in one of our medical support communities.
Blank Blank

URQ Pain - Many tests, no answers?

I posted in Oct 2012 - below is updated case w/questions:

I started having URQ pain 5 months ago-a cramp/dull ache under right ribs. The pain comes and goes-here for a day, gone for several, here for a day. On a scale of 1-10, pain's been between 1-4. Pain sometimes feels like it's wrapping around my right back a little, but I also have a back injury. Occasional pain to the right of my belly button and rarely a pinching in ULQ under ribs. Pain seems unrelated to eating. I'm having a lot of gurgling after eating in URQ and above belly button. No blood in stool, no vomiting, no shoulder pain, no nausea, rare mild heartburn. I was diagnosed with IBS 15 yrs ago, but my IBS presents as LRQ pain.

Tests within the last 5mo:
1) Two rounds of bloodwk - CMP, amylase, lipase, CBC - all normal
2) Abdominal ultrasound - normal
3) HIDA scan with EF - normal (50%). Some pressure/pinching in URQ after the CCK injection but didn’t really reproduce my symptoms. Infused over 30mins.
4) Upper endoscopy: Biopsies showed mild irritation in stomach.

Since endoscopy in Nov, GI put me on Prilosec 1xday. GI believes stomach acid is cause of pain. Prilosec seemed to help a little-I'd have more days without pain but the pain would still occur.

Over the last week pain has jumped to a 6 on 1-10 scale. Pain is constant aching - might wane for an hour then return. GI still thinks it's acid, increased Prilosec to 2xday and 40mg Pepcid/day. I think I feel a little relief after taking Pepcid but not a lot.

1)Do you agree with diagnosis of stomach acid given location/nature of my pain? Can stomach acid result in fairly localized URQ pain? I'd expect acid to result in more diffuse pain.
2)What additional/repeat tests if any should I get? If a CT-scan, I have already had 2 CT-scans in my life. Would you recommend a 3rd CTscan to your wife/daughter given radiation risks?
2827584_tn?1340583296
It sounds as though you have had a thorough evaluation to rule out structural or inflammatory causes. I do agree that a CT scan should be dne if you haven't had one since the pain started to be complete. If this were negative, you are most likely hving symptoms as a result of a "functional" problem. This could be IBS or biliary dyskinesia. I am assuming that, at some point, you have been given medicine to minimize the IBS symptoms. These would typically be in the form of smooth muscle relaxants. I am also assuming that celiac disease has been ruled out. If the answer to both of these is no it might be time for a second opinion from another gastroenterologist.
3 Comments
Blank
Avatar_n_tn
Thank you for your response. I have not had a CT scan yet for this problem. Do you believe a CT-scan would be better than getting an abdominal MRI and MRI enterography? I am very worried about having the radiation from the CT scan since this would be my 3rd CT scan. What are the risks of having 3 CT scans? I do not want to replace one problem with another by potentially causing myself cancer down the line due to the CT radiation. Celiac disease has been ruled out.
Blank
2827584_tn?1340583296
As a general screen in the situation of upper abdominal pain CT is the way to go. MRI is better at giving information about mass lesions sch as a liver or pancreatic mass. My general philosophy is that the radiation risk is justified when the test is truly indicated - the risk is minimal.
Blank
Continue discussion Blank
This Forum's Experts
351246_tn?1379685732
Dr. Kokil MathurBlank
Consultant
,
MedHelp Health Answers
Blank
Weight Tracker
Weight Tracker
Start Tracking Now
RSS Expert Activity
242532_tn?1269553979
Blank
Emotional Eating Control: How to St...
Aug 28 by Roger Gould, M.D.Blank
233488_tn?1310696703
Blank
New Cannabis Article from NORTH Mag...
Jul 20 by John C Hagan III, MD, FACS, FAAOBlank
242532_tn?1269553979
Blank
3 Reasons Why You are Still Binge E...
Jul 14 by Roger Gould, M.D.Blank