Right Upper Quadrant Pain / High Levels of Bilirubin

Hello,
Approx. 1 year ago I began having severe pain in my right upper quadrant (at that time I was 5 months pregnant).  I was referred to Gastro doctor.  A series of tests were conducted to rule out gall stones as well as CMP blood testing was conducted.  The test results came back pretty much normal, other than the ultra sound technician stated she felt by ducts were a little enlarged, but clarified this with the radiologist stating this is common in pregnant women.  The Gastro doctor basically, informed me to follow up after my delivery if I continued to have pain.  Well, the pain continued and I did follow up 2 monts post-pregnancy.  Additional ultrasound and CMP were conducted and came back completely normal.  I am now 8 months post-pregnancy (37 years old) and continue to have a dull constant pain in my upper right quadrant 24/7.  It almost feels like someone has their fingers under my rib cage and is tugging on my ribs, the pain does radiant into my back, I would call it mid back area. The On a side note; ultrasound technician did verbally inform me I have scarring on both my kidneys (I do not think this was written in the report).  I informed my doctor and he indicated this is not the cause of my pain.  Recently, I had an extensive blood work conducted due to I applied for life insurance.  The test came back stating my bilirubin was a little more than 25% higher than the top expected range.  I brought this to my doctor's attention and he is having me do another CBP test.  Not sure why he is having me do this when I finally received confirmation that my bilirubin is high.  At any rate, I am concerned that the test will come back normal, yet this other lab indicated my bilirubin is not normal.  I have a HMO and the lab that conducts the test is UNILAB, I am not sure if I completely trust this outfit.  I have been researching the internet to find out as much information as to what my problem is.  The only other symptom I can think of is I have read that stools will be paler in color.  I have noticed that this is occuring in me.  I do not see that I have any yellowing of my eyes/skin.  

I am wondering what you would recommend for treatment/further testing and am I at any risk of whatever is going on being untreated for over a year?  Lastly, I also noticed that you should fast prior to CBP testing.  My doctor has not informed me of this, and I believe on prior testing I never did this, except for my life insurance testing.  Would not fasting cause any alteration in the outcome of my results of my bilirubin?  I wouldn't think so.  Thanks for your time, I appreciate your assistance.

[DeeA]

This has been known to happen a person had all normal gallbladder test, hyda scan, Ultrasound etc., but continued to have discomfort, serious pains. The GI doctor decided to do an exploratory lap and found a badly infected gallbladder that was almost gangrenous. I am no doctor and I am by no mean diagnosing. If I were you I would talk to my GI doc about having my gallbladder removed or at least investigating the reasons for your continous pain.  A lot of women start to have gallbladder s/s right after pregnancy do not ask me why, but this happens a lot. I see this in my field to often. My personal opinion of course, and as  I said I am no doctor, but it sounds like a gallbladder problem, or something in that area near the Liver.

RN, C CLTC

[DeeA]

Bilirubin is a breakdown product of hemoglobin. Total and direct bilirubin are usually measured to screen for or monitor liver or gall bladder dysfunction.


How to prepare for the test

Fast for at least 4 hours before the test.
The health care provider may instruct you to discontinue drugs that affect the test.

Drugs that can increase bilirubin measurements include allopurinol, anabolic steroids, some antibiotics, antimalarials, azathioprine, chlorpropamide, cholinergics, codeine, diuretics, epinephrine, meperidine, methotrexate, methyldopa, MAO inhibitors, morphine, nicotinic acid, oral contraceptives, phenothiazines, quinidine, rifampin, salicylates, steroids, sulfonamides, and theophylline.

Drugs that can decrease bilirubin measurements include barbiturates, caffeine, penicillin, and high-dose salicylates.


Normal values

This test is useful in determining if a patient has liver disease or a blocked bile duct. Bilirubin metabolism begins with the breakdown of red blood cells by phagocytic cells. Hemoglobin is broken down to heme and globin. Heme is converted to bilirubin, which is then carried by albumin in the blood to the liver. In the liver, most of the bilirubin is conjugated (chemically attached to) with a glucuronide before it is excreted in the bile. Conjugated bilirubin is called direct bilirubin; unconjugated bilirubin is called indirect bilirubin. Total serum bilirubin equals direct bilirubin plus indirect bilirubin. Conjugated bilirubin is excreted into the bile by the liver and stored in the gall bladder or transferred directly to the small intestines.

Bilirubin is further metabolized by bacteria in the intestines to urobilins, which contribute to the color of the feces. A small percentage of these compounds are reabsorbed and eventually appear in the urine, where they are referred to as urobilinogen.

-----------------------------------------------------------------What abnormal results mean

direct bilirubin: 0 to 0.3 mg/dl
total bilirubin: 0.3 to 1.9 mg/dl
Note: mg/dl = milligrams per deciliter

Symptoms Of Gallbladder

abdominal pain
in the right upper quadrant or middle of the upper abdomen
may be recurrent
sharp or cramping or dull
may radiate to the back or below the right shoulder blade
chills
fever
stools, clay colored (may occur)
recurrent jaundice

[raquel H]

I had the same exact symptoms that you had. They decided to take my gallbladder out. It was terribly infected. I even had scar tissue that had grown all over my liver also from my gallbladder. I had a ultra sound and it was normal. I had another test done..and it got screwed up somehow. But after a couple of weeks of awfull pain on my right side and in my back they decided to take it out. I feel great. The surgery was easy. They did lazor surgery. I have three teenie tiny little slit scars on my abdomen. I stayed in the hospital one night. I felt good the day of the surgery though.

[kenshinlyn]

A related discussion, High Bilirubin? was started.