Where may pain appear from bile/pancreatic duct obstruction?

My wife has had an unidentified pain in her right abdomen for months.  It is slightly below, repeat below, the belly button.  The pain increases with pressure on the spot described.  She is on narcotics to control the pain.  Colonoscopy was normal.  There appears to be an enlargement of the ducts and a narrowing/obstruction of the opening on an MRCP.  The doctor is planning an ERCP.  Is it reasonable that the location of the pain mentioned above is consistent with pancreatic/bile duct problems?

[Kevin Pho, MD]

The right upper quadrant would be suspicious for liver or gallbladder disease.  Atypical causes would be dyspepsia (i.e. GERD, inflammation of the upper digestive tract, or an ulcer).  

If the ultrasound was normal, the MRCP/ERCP would be a reasonable next step.  This can comprehensively evaluate the biliary tract for any stones.

If the workup continues to be non-revealing, you can consider a HIDA scan with CCK stimulation - which can evaluate the gallbladder function.

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:
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