Right Upper Quadrant Pain

Approximately three weeks ago I passed out at work and was taken to ER. After several tests, it was confirmed that I was dehydrated and that I had the flu and was sent home.    When I felt up to it, I tried solids and was doubled over in pain in the right upper quadrant.  Since then the pain/pressure has gotten worse. (Until after the flu, I had no GI symptoms.)
I have tried twice to eat solids and again the pain was even worse.  The pain in my right side is now chronic, but is around a 4-5 on the pain scale.  It bores to the right back and is also in my right shoulder.  After eating solids or some "offensive" liquid, the severe pain starts approximately 45min to 1 hour postprandial and lasts several hours. The only other time I have felt this type of pain was when I had gallstones 10 years ago and ended up with a cholecystectomy.

CT scan is normal.  Labs/enzymes are normal except for showing a macrocytic anemia.  Endoscopy only showed "gastritis" which doc says should not be causing this type of pain. They took culture for h.pylori.  The urinalysis was positive for bile.

That is where we stand.  My doc (gastro) seems perplexed as to what to do with me.  We will talk after she gets results regarding the h.pylori.  I continue to have the pain and have lost 10lbs due to the fact that all I can eat are basically liquids and fat free yogurt. I am able to work, but it is difficult.

The only other health issue I have is lupus.  I am on methotrexate.  Also on trental and plavix for raynauds and anti-phospholipid antibody syndrome. Lupus is fairly well controlled, although the joint pain can get bad. Also have disseminate granuloma annulare pretty much all over body, but have had this for over a year.   I am able to work full time.  Other meds include tramadol for pain prn and armour thyroid.

Your assistance is greatly appreciated. I am a practicing PharmD and would appreciate some detailed information as to what could be the problem.  

[Kevin Pho, MD]

I agree with the workup thus far, and it would rule out many of the major GI disorders.

Sphincter of Oddi dysfunction can be excluded with an ERCP with Sphincter of Oddi manometry.  There are studies that suggest that this condition is present more frequently in those without their gallbladders.

The biliary tree can also be evaluated with the ERCP, or imaged with an MRCP.  

Rare upper GI disorders can be evaluated with a 24-hr pH study (to rule out GERD), a motility test (to exclude esophageal dysmotility) or gastric emptying scan (to evaluate for gastroparesis).

These options can be discussed with your personal physician.

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 patients education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
www.kevinmd.com