Cramping RUQ pain for 2 months

[sue200]

I am a 39-year-old female in good health. I take Levoxyl and Cytomel for thyroid, but that's it. I had a bout of bronchitis followed by the stomach flu in January. Since that time (it is now mid-March) I have had a burning, cramping pain in my RUQ. On a scale of 1 to 10, it's about a 4 to 5. The pain pulsates, cramps briefly every 5 to 10 seconds and then releases. It seems to be located right where the gallbladder is. It doesn't seem to lessen or worsen depending on what or when I eat. Every few days, it goes away for a few hours, but then comes right back. It is severely annoying. I had an ultrasound because my doctor thought it might be gallstones. However, all my organs (gallbladder, liver, pancreas, spleen, kidneys) look good. I then saw a GI specialist who performed an endoscopy. Everything looked great-- no duodenal ulcer or gastritis. I've had blood tests, but everything looks okay there as well (WBC, H. Pylori, liver panel). Any ideas what this might be? Other tests I should ask for?

[Kevin Pho, MD]

The most reasonable initial evaluations have already been performed.  I would suggest considering tests to evaluate the gallbladder function - which can be done via a HIDA scan with CCK stimulation.  Some studies have shown that patients with a low gallbladder ejection fraction may benefit from a cholecystectomy.  

Other tests to consider would be a 24-hr pH study, looking for GERD (although this would be an atypical presentation) or tests for the pancreas (via imaging studies like a CT scan and pancreatic function tests like amylase and lipise - this too would be an atypical presentation).  

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.

Thanks,
Kevin, M.D.