Gall Bladder? Liver? Muscle? Rib? Please help!!!!!

[jlmorgan]

I am a 31 year old male.  I am 6’ tall, 225 pounds.  I am probably about 25 pounds overweight, but I have a lot of muscle, as I workout a lot.  I do not have any medical problems, and in general have always been in good health.

I started have stomach aches about four weeks ago.  The very first one came right after I ate the two biggest peanut butter sandwich’s I have ever had.    That was the very worst.  Since then I have had stomach aches everyday.  They come and go, but I get them everyday.  I can’t narrow it down to any foods, and I haven’t had peanut butter since that day.

Two weeks ago, in the middle of the night, I got a severe pain on the right side of my chest, under my ribs, the area consistent with gall bladder pain.  The pain hurts when I touch the area.  It hurts when I take deep breathes.  I cannot jog or run because the pain hurts too bad.  When I lay down it hurts really bad for about five minutes, and then kind of settles down and doesn’t hurt.  Basically it hurts when I move or touch it, but not so much if I am very still.  I normally am very active (golf, running, lifting), but I had not done any activity for three days prior to this sudden pain.    I went to the ER that day.  My ultrasound came back fine.  My blood work to test for liver for pancreas came back fine.  They thought maybe I had something going on with my stomach, and that the pain under my rib was just a muscle pull.

I say my family doctor (Internal Medicine).  She ordered several X-Ray’s to check for a broken rib and to check for possible fluid in my lungs.  The test came back negative.  She told me to continue taking Aciphex, and come back in two weeks.  She mentioned possibly getting a hide a scan at that time.

In four weeks (two weeks on Aciphex), there hasn’t been any change in my stomach aches.  In two weeks there hasn’t been any change in the pain on my right side under my chest.  I have no other symptoms.  I eat fine, I have regular bathroom visits, no fever, no vomiting, etc.

Here are my questions.

1.  Can gall bladder or liver problems cause consistent and constant pain like I have?  The level of pain never changes.  It doesn’t hurt when I am very still.  Only when I press the area, take deep breathes, or do any activity.

2.  Does this sound like it could be muscle related?  I haven’t done ANY activity for two weeks, and it isn’t even 1% better.

3.  Could the pain be a stress fractures?  Wouldn’t it be a little better after a few weeks?

4.  Any ideas on what could be causing the stomach aches?

5.  Do you feel these two things are related or separate?

6.  Do these flushes with olive oil help?

I am very confused on what this could be.  I can’t find consistent symptoms that would make me believe this is gall bladder, but with the way the pain on my right side came on, and given I hadn’t done any activities for three days, I can’t believe this is muscle or bone related.

Please help!

Thanks,

Jason

[Kevin Pho, MD]

To answer your questions:
1) Liver or gallbladder disease can lead to the symptoms you are describing.  A negative ultrasound would make this possibility less likely however.  You can consider a HIDA scan with CCK stimulation if gallbladder disease continues to be suspected.

2) A muscle-related condition continues to be possible if the tests continue to be negative.

3) Again, musculoskeletal causes can be considered if the GI tests continue to be negative.

4) GERD, an ulcer, or inflammation of the upper digestive tract are all possibilities.  A blood test for a bacteria known as H Pylori, as well as an upper GI series/upper endoscopy can be considered.

5) Difficult to say without physical examination.  

6) I am not aware of data supporting flushes with olive oil.  

These questions should 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 patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
kevinmd_

[jlmorgan]

If the pain on my right side is gall bladder related, is it possible for the pain to become worse from physical activity (i.e. golfing or running)?  What I am getting at, is if I do some physical activity, and if the pain becomes worse, would that rule out gall bladder or can gall bladder pain become worse with activity as well?

Thanks,

Jason

[Kalio1]

Your symptoms sound liver related to me. Do you drink alcohol? If so, I'd stop all alcohol and have a liver panel done. Be careful of what mediations you take, be careful of OTC drugs too and avoid taking any if possible until you find out what is going on. Liver issues are very quiet and usually do not cause symptoms at all until the damage has progressed to some degree and they can be very hard to diagnose in some patients.

[jlmorgan]

My blood work for liver and pancreas came back fine.  Is there something else I should have done?

[jlmorgan]

Also, I rarely drink.

[Kalio1]

Liver issues can be hard to diagnose sometimes and unfortunately they can fly under the radar and sometimes have to get worse before they are discovered,  did you get a copy of the blood work results? what were the numbers and which tests were done? If it was me, I'd ask for a referral to a Heptologist if possible, or a gastro might be good.
Have you had an ultrasound? You don't drink, which is good, how about supplements or other meds? Did you have a test for hepatitis b and c? I'd do that test to rule that out, many dont test for it because the patient has no kown risk factors but you can pick it up and not know it.
Good luck, I know how frustrating it is. Keep at the doctor for further testing and try a second opinion with someone who's focus is on these type of issues. PCP's are great for some things but sometimes a specialist is in order.
Of course it could be something else entirely, I am certainly not a doctor but I went through not getting answers and I know how it is.

[Linda J]

In the absence of a GI diagnosis, I would also consider costochondritis. I've had it and it hurts like heck when you move. Mine was so so bad that at one point I couldn't stand to even wear a bra.

I would try icing it for 20 minutes 3-4 times daily and taking ibuprofen. It can take weeks to improve and it can return if you reinjure it.

http://www.emedicinehealth.com/costochondritis/article_em.htm


Linda J

[CurlyFriez]

i would also check about a hernia

[erholmes]

Consider. I have just researched having a CCK HIDA Scan. So many people commented on having these same symptoms, and the failure of any of the prescribe test revealing the problem. More importantly, I haven't discovered where anyone found the answer. The overall symptoms are exactly the same as described by so many...like a knife in my back, through to the gall bladder; swollen, very sore, with attacks of pulsating pain. I spend 2 days in ER and 2 days in the office of specialist. I have demponstrated all the physical symptoms of a gall bladder episode, but NONE of the test support a gall bladder problem.

I wonder what is a doctor suppose to think and do when each and every test comes up negative, but the physical symptoms are obvious and real.

[Lori16]

A related discussion, gall bladder was started.