Undiagnosed right upper quadrant pain

[gandalfgirl]

I am a 31 year old female, overweight, two c-sections, relatively healthy.  I have had right upper quadrant pain of varying severity for about 2 years.  I have had the following tests:  upper endoscopy, ct scan with iv and oral contrast, hida scan with cck, hida scan with fatty meal, numerous blood tests including LFTs.  Fatty foods tend to bring on the pain, but not always. My pain begins in the upper right quadrant and wraps around to my back.  It comes in waves, is sometimes achey (achy) and mild, but at its worst is very sharp and disconcerting.  I also have had severe epigastric pain. I sometimes feel nauseous but have never vomited. After the attacks, my upper abdomen is sore for a few days.  The attacks tend to come in groups; I will feel bad for seven or eight days then the pain/aches will go away completely. I have taken various proton pump inhibitors, antacids, and sucralfate with no relief.  My current nurse practitioner (I am a military dependent, so I'm pretty much restricted to the base hospital) referred me to a surgeon, who has told me that while it sounds like gallbladder, all my tests are completely normal.  He said that if I had one abnormal test, he would schedule me for gallbladder removal with the understanding that it may or may not help my symptoms. Of course, all my tests are normal. My last HIDA was in Oct. '05 and it was normal, with 46% ejection fraction and no evidence of blockage.  I am currently taking Bentyl only during these attacks, which helps decrease the sharp pains.  In the past five months, I have been losing weight and exercising, which seems to have helped decrease the severity and frequency of the attacks. My questions are:  1.  Is there any other test I can request to possibly diagnose my problem?  2.  If I do have an undiagnosed gallbladder problem, am I in danger of becoming seriously ill from infection/rupture? I am afraid of some of the horror stories I have heard.  Thank you in advance for your response.

[Kevin Pho, MD]

To answer your questions:
1) You have had a pretty comprehensive workup for your symptoms.  You can consider Sphincter of Oddi dysfuction as well as diseases of the biliary ducts.  An MRCP or an ERCP with Sphincter of Oddi manometry can be considered to evaluate these possibilities.

2) With the negative tests you have had thus far (CT scan, ultrasound (presumably), HIDA scan), it is unlikely there is an undiagnosed gallbladder problem that would lead to rupture.

You can consider another opinion at a major academic medical center for further evaluation.

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_b

[gandalfgirl]

I neglected to add:  I have had three ultrasounds, all are normal, no stones, no sludge, no other abnormalities.

[buschclub]

HELLO I JUST HAD MY GALLBLADDER REMOVED AND MY HIDA WAS NOEMAL EJECTION 56% I HAD 1 ULTRASOUND AT FIRST AND SHOWED FINE THE 2 CATSCANS SHOWED FINE BUT OH WAIT 3RD THEY FOUND I HAD A GULL BLADDER WITHOUT STONES THAT HAD A FILLING DEFECT WHEN THE REMOVED IT WAS INFECTED AND 3 TIMES NORMAL SIZE I HAD ALOT OF THE SAME FEELINGS HOPE THIS HELPS

[FlDebra]

I don't know if this will help, but when you are in pain -- go to the base ER and ask them to run a lipase and amylase.  It took forever for my attacks of pancreatitis to get dx's even though I was telling them I thought that was what it was.  I would go to the base family practice clinic the day after acute pain, still sore.  The PA would not have a clue but give me a referral to gastroenterologist.  That would take a month or so and by then no enzyme elevation was showing.  

Finally I just went to the ER during one "attack" and the doc immediately said lets look at pancreatic enzymes -- they were sky high.  I had an ERCP a few days later and had some work done while he was in there.  I am still having some problems and worry they took so long to dx, some long-term damage was done.

[alwayspokey]

I too am having the same kind of pain beginning in my upper right quandrant just under the bottom of my ribcage, extending around my ribcage and into my back just between the blade and the spine.  When it first starts in my back, it feels just exactly like the electricity from electric stem and then quickly elevates to where it feels like the electricity has been turned up much too high and it is a burning, electricity feeling.  This pain extends all along my middle back and now the whole right ribcage area hurts and feels sore.  I am even having some of the pain in my middle chest area and under my right breast too.  The pain has been there in my side for around 5-6 years right where your gallbladder is, and has only come in spurts before, but has progressively gotten worse to the point I too feel like there is something inside my ribcage poking me on the inside and also like there is a spear running through me from front to back.  I had an ultrasound when it first began to get bad years ago, with normal results.  I went to the Dr. today.  She ordered blood tests for biliruben, liver and pancreas and I had a full abdominal ultrasound.  Will post results when I receive them.  Anyone else had any tests results they haven't posted for the past few days? I am curious as to what this is.  A lot of us seem to have the same symptoms.

[showtruck]

I have very similar symptoms.  I first notice symptoms during a long distace car drive.  It started with back pain directly behind the gallbladder, which felt like muscle strain.  Within two weeks, I had a sunburn sensation below my right ribcage that has never ended.  The sensation is always there with varying intensity.  Two weeks after the sunburn sensation began (about 1 month after the original back pain), a physical, knotting pain in the gallbladder area of my abdomen.  It felt as if I had a bloated organ, so I went to an ER.  There, they did a complete blood count, urine test, multiple x-rays, and a CT scan only to say that nothing was wrong, other than a small amount of white blood cells in my urine (ie, kidney or bladder infection).  Since then, the pain has intensified (knotting internal pain, sunburn sensation, and back pain) and I have went to a second ER.  This time at the University of Tennessee Medical Center.  They too, took a blood and urine sample and confirmed that all counts were within normal limits.  This doctor did however palpate the abdomen and pressed on the exact spot that hurts internally, which caused elevated pain.  He identified this spot as the area where the gallbladder and liver is located and said that I may have a growth/tumor on the gallbladder or possibly, gallstones.  He suggested I go to a family practioner for ultrasound, since there was no emergency to be addressed at the ER.  

I have not noticed an increase or decrease of intensity before or after eating.  Also, when I sleep at night, it is more comfortable to sleep on the affected side.  

I am scheduled to go to the doctor on Thursday January 12, 2006.  Are there any specific questions I should ask the doctor or any specific test I can ask to be performed for diagnosis purposes?

[lolosalinas]

I too suffer from upper right quadrant pain. It feels like a ball burning in my right side. I sometimes can feel it with my fingers if I press down into my right side, just below my rib cage. It is a burning feeling. Could this be my gall bladder? If so, what tests can I get to get a diagnosis?

[rlap]

A related discussion, upper quadrant pain or burning sensation was started.