Atkins Diet, RUQ pain despite cholecystectomy

Hi. I have been on the Atkins diet (high protein, high fat, low carb) and now am starting to have a nagging RUQ pain, just like I used to before I had my gallbladder removed four years ago. I also notice a bit of discomfort under my right scapula. This reminds me of the mild, nagging, constant RUQ pain I had between bouts of biliary colic before my cholecystectomy. Is it possible to have mild RUQ pain, similar to gallbladder irritation when you have no gallbladder? Is this indicative of stones or would simply changing my diet back to a lower fat diet resolve this issue? Do I need to be concerned about gallstones re-forming without a gallbladder?
I just happened to have blood tests last week as part of a routine check. Cholesterol was elevated (229), but triglycerides and all liver enzymes were normal. I feel fine otherwise. I generally don't have problems with diarrhea or other post-cholecystectomy syndrome symptoms. Thank you. Teresa

[Kevin Pho, MD]

One consideration for RUQ pain in those who had their gallbladder removed would be Sphincter of Oddi dysfunction.  This can present with gallbladder-like pain in those without one.  Typically this disorder is unmasked after removal of the gallbladder.  

The gold-standard test for this would be an ERCP with Sphincter of Oddi manometry.  Another test to consider before this one would be a fatty-meal ultrasound.

If there is evidence of dysfunction, treatment can involved surgery, or endoscopic treatment (i.e. there are some trials with injection of botulinum toxin).  

Another consideration would be the presence of stones in the bile ducts.  Again the ERCP, or an MRCP, would be an appropriate test to investigate this possibiity.

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

[ABitConcerned]

I need to clarify that the RUQ pain only began a couple of days ago. When I had my labs drawn last week, I had not yet experienced any pain in my RUQ area. Thank you.

[frncokaf]

A related discussion, Adkins Diet was started.