Pain under right rib cage

[karwest]

I have been having a sharp pain under my right rib cage and my doctor put me on Reglan. I had my gallbladder taken out 2 years ago. I am about at my wits end with tests that say everything seems to be normal. Has anyone else experienced this? And what else can I do?

[georgie439]

I have had pain under right ribcage on and off for about five years, I have had my gallbladder out 8 weeks ago and that definately has helped. My pain is dull though, not sharp. The medication that they put you on, what is it for???

[karwest]

The medicine reglan is used to increase the rate at which the stomach empties into the intestines and the muscle between the stomach and the  esophagus. The last test I had done 2 months ago which was a ct scan showed nothing. I think I need to change doctors because he seems to be dragging his feet. It does not matter what I eat it still hurts.

[5fan]

I too have had chronic pain under my right rib cage.  My pain radiates up by rib cage to the center and then through to the back and up under the right shoulder blade.  

I had my gallbladder out 07/23/02.  I had pancreatitis at the time and was hospitalized for six days for them to get the pancreatitis under control before they could remove my gallbladder.

I have had the pain (to varying degrees) ever since I had the surgery.  At first I thought it was because they nicked an artery when they did the surgery so I have a 5cm scar from them having to open me up and oversew the artery.  The doctor had warned me that I would have more pain than the normal person.  

About four weeks after the surgery he started doing a number of tests to check and make sure my liver and pancreatic levels had stabilized and they had.  I had a repeat CT and Sonogram to make sure I didn't have any cysts or anything.

I lived with the pain until the end of September until I had another trip to the ER and ended up admitted for pain and to see if they could figure out what was wrong.  Another six days and no answer.  I have had so many tests done I can't remember them all.

My gastroenterologist decided to refer me to a specialist because he felt that I may have sphincter of oddi dysfunction.  On December 23 I say the specialist.  I have had blood drawn and tomorrow I will have a gastric emptying study done (this is the second one I've had done).  

I did find out today that I have pancreatic insufficiency.  Something that didn't show up in all the labs that were drawn before.

If your gastroenterologist can not or will not help you then I suggest you find one who will listen and be willing to refer you to someone else when he/she isn't able to give you a diagnosis.  I feel so lucky that both my surgeon and my gastroenteroligist took/take me seriously and I was never told it was "all in my head".

BEST OF LUCK.

5FAN

[SlugGB]

There seems to be a group of us with the same complaints that the doctors cannot pin down.

I have found a GREAT ARTICLE that addresses the question "I have had my gallbladder out so why am I still having gallbladder pain?"  The internet address is:

http://indiana.edu/~engs/hints.oddi.html

Let me know if there are problems accessing this article and I will e-mail it to you.  It addresses: "What is the medical treatment for this syndrome?"  "What are the types of this dysfunction?"  "What foods to eat/ to avoid?", etc.

The article is entitled "How to control your Sphincter of Oddi or bile duct spasms"  Basically it says the pain in that area, besides being caused by the gallbladder, can be caused by Biliary duct spasms or a tightening of the Sphincter of Oddi (the muscle opening that controls the flow of bile and pancreatic enzymes into the small intestine).  It also goes on to say that sometimes "gallstones" can form in the duct that may not be visible on Ultra sound that will produce this pain.  

I have had the same type pain that varies in intensity under my right rib cage since Oct 2000 and sometimes radiates to the back/under the rt shoulder blade.   Some I would call "attacks" and have been to emergency 3 times.  I have had 4 ultrasounds - the first in Oct 2000 showed a "mildly thickened g/b wall" could represent an inflamed g/b.  The doctor, at the time could not correlate w/ other symptoms, so it was not considered a definate g/b problem.  My three ultrasounds since have shown the g/b normal.  The only other thing is, I have had numerous blood tests, and my amylase and lipase levels are low (below the normal range).  The doctors have assured me it is only of concern if they are HIGH.  Why is there a lower range then??  I have had CT scans, endoscopy w/ biopsies, barium enema, HIDA scan w/ ejection fraction(68%) - still no answer.

The question for me is, do I have the gallbladder removed?  Not such an easy question when I keep hearing that it not always is the answer to the pain. (Although I have been feeling so miserable these last two yrs it may be worth giving it a try - that decision is coming soon after another HIDA scan at the end of January..)

I have also tried Reglan and another anti-spasmatic drug Hyoscyamine - neither worked.  It is so frustrating to hear them say everything checks "normal" when we know whats going on is far from normal.  Hang in there and lets keep sharing info.  I am convinced the answer is out there somewhere.  Do you share these same other symptoms as I do: excessive belching after meals, no tolerance for alcohol, fatty/fried foods, chocolate, garlic, and dairy - makes pain worse, general ill feeling, nausea at times.  Wish you well and Keep fightin.

[SlugGB]

Hi 5fan, you mentioned above that they determined you have pancreatic insufficiency.  How did they determine this?  Blood test?  My amylase and lipase blood levels are BELOW the normal ranges and was curious if this is how they determined you have pancreatic insufficiency?

[karwest]

Well I had to go to  the ER last night because of the pain. They did a x-ray and said it was normal. and then took blood which it was normal. My doctor said that he thinks my stomach is producing to much acid. hmmmmmmm do what? They gave me a shot of demerol and sent me on my way.  Now I think it is time to find a different doctor. Some one who will take me seriously! I am glad that I am not the only one out there with the same pain. It helps to talk to people that are going through this to.

[MAVA]

I have had my gallbladder out 6 month ago. since then I haven't fill well, I have a pain in my right side and it radiates to my back ... I have all the symptoms of SOD. My GT is trying to not go for a ERCP so I had an endoscopy, ct scan and 2 ultrasound and all came back normal. now I'm going for other ultrasound the 14th of January. I have a  dull pain that some times come stronger specially after lunch or dinner.
I finally decide to exercise yesterday and I had a good experience, my pain was gone for couple of hours, does some body had this experience ... is ok to exercise??? my pain was back after 2 hours and it was the same, but I don't want to make a mistake....thank you!!

[5fan]

My "pancreatic insufficiency" was found throught blood work.  I live in Florida and was referred to a specialist at Shands Hospital which is part of/affiliated with the University of Florida system so they are a teaching hospital and do a lot of research also.  It just happens that pancreatic issues are one of their top specialities.

My specialist ordered liver enzymes, glucose (diabetes), pancreatic enzymes (amylase and lipase) and also TRYPSIN levels to be done.  

All of my results came back with in the normal level EXCEPT for the Trypsin level.  This was the result that indicated I have pancreatic insufficiency.  I haven't been able to find a lot of information on it yet, but the doctor is supposed to call me on Monday (hopefully - he is on vacation until then so I know it will be a buzy day for him) and the nurse practitioner was pretty sure he would go ahead and start me on an enzyme supplement that will help with the insufficiency and also with the pain.  I have been taking Darvocet for the pain because my local GI didn't want me taking Tylenol, Advil or Alieve because of the affects it can have on your liver, stomach and kidneys (I also have severe gastritis).

I told the nurse that I had had Trypsin levels done when I was in the hospital in September, they came back as 27.3, but that there was not range for "normal" listed on the lab report.  (I have had to get copies of all of my medical records for the specialist so I made a copy to keep for myself.  I have learned a lot from them).  She told me that part of the problem with doctors trying to diagnose from Trypsin is that when they are sent to "outside" labs the standards are different so what is "normal" in one lab can be "abnormal" in another.  I understand what she told me, I just don't understand why labs would have different standards, you would think "normal" would be normal and not be subjective.  I understand normal for everyone is a little different because we are all different, but you would think the range would be the same regardless of the lab.  (Sorry, just had to vent a little there!!!).

You may want to ask your doctor about having the test done.  They just run it from the blood they pull for the other work.  Unfortunately, I'm not sure how beneficial it will be - it sounds like it depends on where you have it done.

I haven't heard of having low pancreatic levels.  Mine have either been within the normal range or elevated (my lipase was 1919 and my amylase was 678) when I had my attack.  Since returning to normal after that attack they have been within the normal range.  

I did have one of my local gastroenterologist's partners see me when I was in the hospital in September and I had been doing some reseach because I knew there was something not right with my body.  I'm 31 years old and have bascially been healthy all my life.  I think we are the best judges of when something isn't right in our own bodies.  Anyway, I asked the doctor I saw if it was possible I might have chornic pancreatitis (from the research I did I felt like my pain pretty much fit).  He flat out told me that I didn't have chronic pancreatitis because I am not an alcoholic, my triglicerides (triglycerides) were not elevated nor were my amylase and lipase levels elevated.  He also said "you don't want chronic pancreatitis".  I was sooooooo mad I just let him leave the room.  I wanted to ask him if he had been on the Johns Hopkins websit to see where they state that you don't have to have elevated levels to have chronic pancreatitis!

Anyway, I know it probably sounds funny, but I think you'll understand - I'm so happy to finally have a diagnosis.  Even if it is only a partial diagnosis.  You know the pain isn't all in your head - that it is real, but after a while it becomes so depressing when they can't figure out what it is, but you know it's something.

BEST OF LUCK TO YOU.  Let me know if you have any more questions I might be able to answer.  I know this is a long post, but I wanted to give you the info I had so far.

5fan

[aj2]

My brother has been diagnosed with chronic cholecystitis (inflammation of gallbladder) and cholelithiasis (gallstones) and is concerned about removal of his gallbladder at an age of 35.He complains about the above pain every once a month and feels there is is something mild going on all the time the upper stomach.

Two sonograms over the last 18months dont reveal anything flagrant, traces of fatty acids have been located in liver in
addition to shadows (of gallstones) in gallbladder. No other fluids have been detected that may indicate some form of infection.

He tried ayurvedic, now is going through homeopathic treatment to dissolve the gallstones. Is non-surgical treatment without removal of gall-bladder an option? What has been your experiences? Many,many thanks

[nadia]

I had chronic cholecystitis and it can be quite a severe condition if left untreated.  It usually results after the acute cholecystitis stage has passed.
Chronic gallbladder disease should never be ignored.  Chronic inflamation (inflammation) can lead to herniation of the gallbladder wall and eventually rupture.  This can result in peritonitis and even death.
He should get a Hida scan with CCK ASAP. This will reveal the functionality of his gallbladder.
I'm all for homeopathic treatments, but in this case conventional medicine should be his first priority.

[SlugGB]

I concur w/ nadia 100%!  If not dealt with can lead to  alot worse things.  Get the HIDA scan w/ CCK!

[tired of pain in ga]

have any of you had a rear end collison. my pain started after one. i was upset to see that my pathology report indicated no inflammation and that i had my gallbadder removed. i was severly ill for over 18 months with lots of symtoms that the doctors ignored.  well after a physical therapist almost 18 months later decided to do something new to help with the shoulder pain, i finally stop having severe pain under my arm pit, ribs, and shoulder.  what helped? i had cervical traction done.  i felt relieve immediately. in one 15 minute session i felt over 75 percent better. i felt the muscles stop hurting and i felt the burning dissappear.  my problem was that i had lots of symtoms but most doctors won't take the time to figure you out.  they think that we are crazy, when most times it's a logical answer to everything. keep fighting don't give up.  i almost did. also try lidocane patches, they help.  i use a tens unit nearbut not on my c5-t2 spinal area and i got lots of relief. i also had a muscle stimulator used on the area to the right of my right scapular and that got rid of that nagging, deep painful sensation.

[SlugGB]

Thanks for the indepth response!!  I checked my lab work records and did not find that the TRYPSIN levels had been checked.  I will ask my doctor about checking these.  I understand and feel your frustration w/ the "different" lab standards.

I am curious about your severe gastritis.  How did they diagnose that?  Endoscopy?  Barium swallow?  Other test?

I have approached my doctors w/ the possibility of chronic pancreatitis - especially w/ my severe reaction to any amt of alcohol  - they gave me the same response!  During my research I have read in at least 3 different places that you do not have to have elevated amy/lip levels to have chronic pancreatitis.  What I know is I have attacks - pancreatic, gallbladder, what other kinds of attacks are there??  Also, I have read of people having chronic pancreatitis who don't drink.  I continually ask doctors about my severe reaction to alcohol - not one can give me an explanation.  I realize not all the answers are out there but how about a little educated guesswork as to what areas would be so affected by alcohol (as well as fatty/fried foods).

I have used digestive enzymes and have had some success w/ a reduction in pain.  My new doctor suggested them.  He recommended a brand that you can buy over the counter at whole foods (or most health stores) or at their website Solgar.com.
The product is called "Vegetarian Digestive Modulators" made by Solgar.  They just provide some extra help in digestion.  My doctor (who I really respect) has told me you can get digestive enzymes at the store that are just as effective as prescribed ones (and less expensive as he likes to say!!).  He pointed out (and I have read this as well) to make sure you use a VEGETARIAN based enzymes as opposed to ANIMAL based enzymes as the vegetarian work in a wider pH range in your stomach then the animal based enzymes and are more effective.  With pancreatic insufficiency it seems like they would help - GOOD LUCK!

You are right on the money.  After my endoscopy w/ biopsies I made a copy of the GI's report to my doctor for my records.  In it the comment was made "everything is normal.  I don't know how much of this is generated in his head". ARE YOU OUTTA YOUR MIND!!  IF I HAD A BASEBALL BAT.........!  I have researched, read, asked questions; not because I am obsessed, but because I WANT TO GET BACK TO THE OUTSTANDING LIFE I WAS LEADING BEFORE THIS "ILLNESS" STARTED!  I was "diagnosed" as having IBS for the first year of this ordeal.  But the more I read, the more people I talked to w/ IBS (including my new doctor who has IBS!!), the more I knew this is not IBS (and my doctor agrees).  I have met some wonderful doctors out there and can accept the fact that what is going on is not so easy to diagnose - but to say it is in my head is a lame copout!!   It does become depressing at times but we need to keep searching, asking, talking; if it is something that can't be helped, so be it - I'll deal w/ it.  I cannot rest w/ "its in your head" or a diagnosis that doesn't make sense.

I probably went overboard - but your point is well taken - the search must continue!  Thanks again for your detailed response-all the info was great.  Take care and keep me posted!

[snowflake1432]

I'm in the Air Force and had my gallbladder removed May 2002. I only stayed in the hospital for a few hours then I was sent home. I felt good for a few months, but the pain slowly began again. In Oct 2002 I ended up going to sick call and was refered to a Gastroenterologist who scheduled me for an ultrasound. I finally had the ultrasound in Nov, which showed nothing. When I went for the ultrasound I got to look at my medical records and found that no stones were found when my g/b was removed. I ended up in the ER on Dec 3rd from pain very similar to but more local & intense (right side under rib cage and radiating to back and right shoulder), just like the first time that lead the doctor to do an xray & ultrasound to find gallstones. The ER doctor gave me darvocet and I've been on it ever since then. I have another appointment this thursday with the GI clinic. I saw a "doctor" today and he told me that the appointment on thursday will decide what's to happen next (CT Scan or MRI). He also told me that this pain might all be in my head!! I really want to thank all you people, I know I'm not going crazy!!! I'm going to print out all the comments and do more research, any more comments or info would be a great help!!!

[Lillibet]

This is very scary! I have an appointment with the surgeon tomorrow and a tentative date for surgery (24th). My symptoms are similar to yours, and I have had all the tests done (came back normal) and negative for stones! They want to remove the gallbladder.

I also have ulcerative colitis and don't know if there is a correlation or not.

Please let us know what you find out about your situation.

[5fan]

My gastritis was diagnosed with and EGD (endoscopy).  I take 40 mgs Nexium 2X a day and Librax (antispasmotic) 4X a day (used for IBS).  My local Gastro wanted me to take the Librax because he felt that no matter what other condition I ended up diagnosed with that I didn't have IBS on some level.

I found out today that I have gasstroparesis (slow stomach emptying) so on top of the Nexium 2X a day; Librax 4X a day; FiberCon 4X a day (2 pills each time for a total of 8); and pain meds - I now will be taking erythromycin four times a day!!!!!!!!!!

At 31 I feel like nothing but a pill popper!!!


5Fan

[beebug]

Hey guys, if you have had your gallbladder removed and you have any pain under the right ribcage, get it checked out.  That happened to me and my bile duct was blocked.  The gastro doc went in and did an ERCP and found it.   That can really lead to serious stuff!

[SlugGB]

Was curious as to how they determined your bile duct was blocked?  Was it only discovered during ERCP (and if so, what other tests had they done on you that missed it?)?  Thanks for your answer in advance.  I have pain on the right side that they cannot seem to figure out.

[snowflake1432]

I was just scheduled for an ERPC and the procedure was decsribed to me like this. They insert a camera down your throat and stop it at you Sphincter of Oddi, which is where the duct from your liver and the duct from your pancreas meet in your small intestines. They then insert it in your sphincter to see inside the ducts and sometimes to measure the prssure in each duct. In some cases this sphincter is contracted, so they cut it to release the pressure that has built up. At least this is how I understood it from my GI that I saw yesterday. I hope that helps!!

[Dahling]

I am doing some research for a friend about her pain under her ribcage on the right side. I noticed your symptoms about belching
and nausea. I ran upon an article about Cholecystitis while doing
some research on the internet. The article is on www.umm.edu and
states the symptoms of Cholecystitis as:Chronic Indigestion, Vague Abdominal Pain,Nausea, & Belching. You might want to look into Cholecystitis further on that website. Just wanted to inform
you. I hope you find out what is wrong and can treat it. I found out I had IBS by going on the internet and checking out my symptoms.

[Aging]

I've been having pain on my right side - just under the breastbone for about 6 weeks.  It's constant pain - not episodic or related to food intake.  I only get relief by laying completely horizontal (even the recliner does not provide relief).  I had an US - which showed some stones - and then did the research - like the rest of you - before accepting the referral to a surgeon and a recommendation for gallbladder removal.  

However, I also have symptoms that do not appear to be consistent with gallstones.  My research indicates that constant pain is not usually a symptom of gallstones or gall bladder disease.  I have persistent diarreah - sometimes bloody stools.  Sometimes mucous in the stools - not always.  One dose of Immodium helps for a few days - then back to the usual. Until recently - I had constant heartburn.  I gave up my diet sodas and for the most part - the heartburn has calmed down - with fewer episodes and less intensity - but not completely gone.

My PCP recommended a colonoscopy - but the referral agent at the clinic has not gotten around to making the arrangements for that - despite several phone calls from me.  My next step may be to go camp on the clinic doorstep until I get my referral!  Not that I want to take that barbaric test - but would rather do that and eliminate the possibility of colorectal cancer than undergo unnecessary surgery.

Has anyone else had these same symptoms?  I cannot find ANY literature that says the pain from gallstones is constant rather than episodic and related to food intake.  I'd certainly like to hear other suggestions or ideas.