RUQ pain & fatty stools

Having symptoms for a couple years now & getting a little worse over time.

Symptoms:
1 Mucus/fat in stools, soft stools, sometimes float a while before sinking, sometimes diarreha & undigested food particles.
2 RUQ pain under rib & radiates to back.
3 LUQ pain under rib mild & only occasionally.
4 Excessive gas especially after dinner & before bed time.

Tests have taken:
2/07 Ultrasound - normal
3/07 Colonoscopy -normal
3/07 Blood work - PH 8.0, Glucose 101, AST 23, ALT 24, Amlayse 67, Lipase 55
3/07 Abdomen xray - scattered gas within small & large bowel
4/07 CT scan w/ contrast - normal
5/07 Hapatobiliary Scan (HYDA?) - Gallbladder ejection fraction was 10.4%
5/07 Esophagogastroduodenscopy (Endoscope?) - normal

8/08 Complete blood work & CT scan w/ contrast - didn't obtain results but told all was normal
9/08 Colonoscopy - normal
9/08 Ultrasound - Gallbladder is well distended, no cholelithiasis.  Mild fatty replacement of liver, echogenic pancreas
                          suggest fatty infiltration, no free fluid..... these are compared to Ultrasound taken in 2/07

Does this point towards pancreatitis?  Any other suggestions?

Thank You

[Kevin Pho, MD]

Pancreatitis would be unlikely given the pancreatic enzymes and the results of the imaging studies.

I would evaluate for malabsorption or celiac disease, done via stool and blood tests respectively.  Imaging of the biliary tree for stones can be done as well, with an MRCP or ERCP.

Furthermore, breath tests can be done to evaluate for bacterial overgrowth or lactose intolerance.

If all the tests are negative, it is less likely that a major GI disease is causing your symptoms.  You can look towards irritable bowel syndrome, which is normally a diagnosis of exclusion.

These options can be discussed with your personal physician.

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 Pho, M.D.

KevinMD.com
Twitter.com/kevinmd

[pippigirl]

Your symptoms are almost identical to mine- My problems began during my seventh month of pregnancy with pain in RUQ and it was quickly dismissed as gas or an overextended ligament.  After my daughter was born (Jul 08) the problems got so bad that I was unable to leave my bed on some days.  I have had the same tests as you and more- everything reads "normal".  I have been told I "just" have ppd (like that's anything to dismiss either!) After speaking with some different "natural" healers I am guessing that there may be some blockage of bile ducts even though it is not showing on US or other scans.  I have not had contrast imaging bc I am still breastfeeding and cant have the chemical- I guess this test would show more?  I drastically altered my diet and have had a lot of relief.  I have eliminated dairy, red meat, as much sugar as possible (it's in everything!!!) and have incorporated tons of whole grains, legumes, veggies and fruits.  When I do have some dairy or fatty foods I seem to relapse. Just remember- science and medicine are not perfect- they do miss things as I am convinced is the case with me.  Try really altering your diet and see if it helps- it took about a month of eating this way to really start feeling better.  Good luck- I feel your pain.