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Gastroenterology (Expert Forum)
Pain in Abdomin(abdomen) (middle/upper right quadrant)
Answered by
Kevin Pho, MD - Internal Medicine
KevinMD.com
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
Pain in Abdomin(abdomen) (middle/upper right quadrant)
by arsegja, Dec 19, 2003 12:00AM
I am a 39 year old male. (5'10", 175 pounds) who has experienced dull low level pain in mid/upper right quadrant of abdomin (abdomen). Occasionally I have stomach problems such as indegestion.
First I'll describe my symptoms and history, and then I'll list my question.
History: Pain in the abdomin (abdomen) originated 3 months ago and was quickly followed by a night of swelling in the abdomin (abdomen), followed by dizzy spells the next morning. Symptoms that followed included weakness, and occasional light headedness. It took me a week to feel strong again.
My blood tests came back normal. I also have normal blood pressure and cholestoral. My upper GI showed reflux, and my ultrasound came out OK (no gall stones). I do not feel the typical symptomes of reflux. I do not experience problems in my esophogas, but the upper GI did show reflux.
I had a Hida-Scan to check my gall bladder, and I had a reaction to one of the injections. The innitial injection was a radiological pharmicutical, that showed that the gallbladder was functioning normally. That part went OK. However when they injected me with the CCK, I felt nausiated and passed out. They told me that they only injected about 25% of the CCK, and had never seen this kind of reaction before. Unfortunately they were unable to acertain the ejection fraction because they couldn't administer the full dosage of CCK. I was concerned that I passed out from the CCK. The radiologist wasn't as concerned, and said the possible cause was a vagal reaction.
Endoscopy showed no masses but did show a small hiatal hernia. My doctor has since prescribed 10mg Metoclopromide to be taken before every meal and once at bedtime. He thinks that I may have a lazy gall bladder. It seemed to help over the past few months. The pain in my upper right quadrant had dissipated. However recently the dull pain in my right quadrant has returned. It has been recurring for about 5 days now.
Questions: What should my Gastroenterologist be looking at next? Is there anything that I could do with my diet that could help alleviate some of these symptoms? Could something other than the gallbladder be the problem?
Thank you for your help. I'd be interested in any advice that a medical professional can offer.
First I'll describe my symptoms and history, and then I'll list my question.
History: Pain in the abdomin (abdomen) originated 3 months ago and was quickly followed by a night of swelling in the abdomin (abdomen), followed by dizzy spells the next morning. Symptoms that followed included weakness, and occasional light headedness. It took me a week to feel strong again.
My blood tests came back normal. I also have normal blood pressure and cholestoral. My upper GI showed reflux, and my ultrasound came out OK (no gall stones). I do not feel the typical symptomes of reflux. I do not experience problems in my esophogas, but the upper GI did show reflux.
I had a Hida-Scan to check my gall bladder, and I had a reaction to one of the injections. The innitial injection was a radiological pharmicutical, that showed that the gallbladder was functioning normally. That part went OK. However when they injected me with the CCK, I felt nausiated and passed out. They told me that they only injected about 25% of the CCK, and had never seen this kind of reaction before. Unfortunately they were unable to acertain the ejection fraction because they couldn't administer the full dosage of CCK. I was concerned that I passed out from the CCK. The radiologist wasn't as concerned, and said the possible cause was a vagal reaction.
Endoscopy showed no masses but did show a small hiatal hernia. My doctor has since prescribed 10mg Metoclopromide to be taken before every meal and once at bedtime. He thinks that I may have a lazy gall bladder. It seemed to help over the past few months. The pain in my upper right quadrant had dissipated. However recently the dull pain in my right quadrant has returned. It has been recurring for about 5 days now.
Questions: What should my Gastroenterologist be looking at next? Is there anything that I could do with my diet that could help alleviate some of these symptoms? Could something other than the gallbladder be the problem?
Thank you for your help. I'd be interested in any advice that a medical professional can offer.
Doctor's Answer
by Kevin Pho, MD, Dec 20, 2003 12:00AM
, Dec 20, 2003 12:00AM
To answer your questions:
1) Without a gall bladder ejection fraction, it is difficult to say that you have a "lazy" gall bladder. Typically if the ejection fraction is less than 45%, some studies show that removal of the gall bladder may improve symptoms. You may want to discuss if there is a way to complete the HIDA scan with CCK stimulation. I would also consider a 24-hr pH study to evaluation for GERD and H Pylori tests.
2) Maintenance of a diet that is high in fiber and calcium and low in saturated fats is normally suggested for those with suspected gall bladder symptoms.
3) GERD or gastroparesis may a possible. Of course, with an incomplete HIDA scan, a low gall bladder ejection fraction can also cause these symtpoms.
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.
1) Without a gall bladder ejection fraction, it is difficult to say that you have a "lazy" gall bladder. Typically if the ejection fraction is less than 45%, some studies show that removal of the gall bladder may improve symptoms. You may want to discuss if there is a way to complete the HIDA scan with CCK stimulation. I would also consider a 24-hr pH study to evaluation for GERD and H Pylori tests.
2) Maintenance of a diet that is high in fiber and calcium and low in saturated fats is normally suggested for those with suspected gall bladder symptoms.
3) GERD or gastroparesis may a possible. Of course, with an incomplete HIDA scan, a low gall bladder ejection fraction can also cause these symtpoms.
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.
