Abdominal Problems

A little history on me to give you an idea whats going on. I am normally a very healthy 33/m. Work out 5 days a week. Not overweight and try to eat healthy.

8 months ago went into the ER. Thought I though I was having a heart attack. I had back pain and a very tight chest. Did all the blood work, CT on my heart, Stress test. Everything checked out well. He chalked it up to acid reflux because I was still having some burning in my stomach. Tried Nexium for a month or so. It didn't phase it. Most of my burning was at night and caused me not to sleep. During the day the burning would pretty much go away. I never really had any per say heartburn, it was mostly right below my sternum. Had an endoscopy - discovered small hiatal hernia, a little esophagitus. The symptoms went to a mild status for about 3 weeks and flared back up again with back pain, mostly in the middle to the right shoulder blade.

My GI wasn't much help so I swithced to an IM Dr. I had two tests on my gall ballder, both normal (HIDA and ultrasound).  Had another blood test. Everything normal except my lipase was slightly elevated and Discovered I had Gilberts syndrome.

We then did a CT scan of the whole abdominal area. Everything came out normal.  Again the symptoms would come and go. Did another blood test. Lipase still slightly elevated. We then did a MRI/MRCP on the abdominal area. Everything came back normal except that my gall bladdder was markedbly contracted(med term). This was in comparison to my CT exam.  I didn't eat before the test. I did take a pill for relaxation for the MRI.

Again, the symptoms come and go. If I eat anything with a lot of grease or chocolate it tears me up in the upper abdominal area for about 3 days. Sometimes I have mild back pain with it. Here recently I have been waking up with a tender area in my upper abdominal area right where my esophogus meets my stomach and down to the right a little, but it goes away after I have a little to eat. My IM Dr. suspects that it still could be my GB.  I sure hate to take the thing out and still be stuck with the problems I am having now. Could this still be due to a small hiatal hernia?  My Dr. says a small hiatal hernia should cause any problems.

[Kevin Pho, MD]

You have had a pretty comprehensive evaluation.  If the HIDA scan was done with CCK stimulation, a gallbladder ejection fraction should have been measured.  If this number was low, then removing the gallbladder possibly can help.  

You can also consider more specialized testing for further evaluation.  This can include a 24-hr pH study to give a more definitive diagnosis of GERD.  This test can also be done with esophageal motility studies to evaluate for any dysmotility.  

Another possibility can be gastroparesis - which can be evaluated with a gastric emptying scan.  

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

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

[frankj417]

Would a small hiatal hernia cause these symptoms at all?  I did have a HIDA scan with CCK. I'm not sure what the final number was though. They just told me it was normal. My IM Dr. said that they have removed Gall bladders before that were bad, but the tests (ultrasound & Hida) were normal.  I'm curious if anyone else has had these symptoms and turn out to be their gall bladder?

[frankj417]

Forgot one other thing. What does a contracted gall bladder from an MRI signify?

[versute]

Hi Frank, do you suspect anything from the working out causing a problem?  I ask because I'm having pain in my throat, esophagus that makes it difficult for me to eat like I want.  I work out as well, 31/m, 175 normally, but now I'm 135(I'm not ill, moved in February and haven't gotten back to working out).  I would do heavy deadlifts 400+ lbs, and I would get a backed up feeling in my throat.  I would eat afterwards and go to bed on a full stomach.  I think it's caught up to me and that's why I am having problems.  Just thought to ask you if you think the straining from working out contributes?

[frankj417]

I'm sure in contributes if you have a sliding hiatal hernia. I believe a hiatal hernia can cause all kinds of pain and strange symptoms.