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Avatar universal

five years of upper right abdomen pain

i was wondering if anybody could help me unravel this medical mystery...

my symptoms started 5 years ago - a couple of months after i moved to japan to teach english... it happened overnight - one day i was fine and the next i woke up with severe yellow-ish diarrhea which was immediately joined by a throbbing pain in the upper right abdomen - directly beneath my rib bone. The pain was fairly constant throughout the day and felt a bit like a cigarette burn inside. It decreased slightly for an hour or so after meals but came throbbing back again after. It was accompanied by a whole body feeling of malaise... i was nauseous, my head was hot and cloudy - i found it hard to concentrate and i flushed hot and cold thorougout the day. My eyes also became sensitive to bright light, and i was drained and exhausted. Around five or six o'clock the symptoms abated slightly.
This pattern then repeated day after day after day. The doctors there told me IBS and i resigned myself to it for the first couple of quite miserable years.
The best i could do at that time was food elimination trying to control symptoms - and this helped a bit here and there - but the condition would often still mysteriously trigger and then last again for days.
Now, this has been going on for more than five years. It controls my life. I am always exhausted by it, especially from trying to find a solution. Doctors have found and eradicated Pylori to no avail. I have had a gastrosopy which revealed no ulcer nor abnormality. I have had ultrasound which found nothing wrong with my gallbladder or liver, but did find a slight (perhaps irrelevant) enlargement of the spleen.

my latest belief is that it has something to do with my gallbladder or maybe liver as this is precisely where the pain comes from and the yellowish darrhea... but....
it seems that doctors have about reachhed the end of their ideas...

and so i wondered if anybody might be able to help me?' or have some ideas - needless to say i would be really grateful
thanks - ross
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Avatar universal
ok - i haven't had the HIDA scan yet - but i would like to explain one more symptom and see if it was suggestive of anything to anybody - that is that from the very onset of the condition i have woken every day with darrhea and this pain blah blah - except on those days when i have a hangover -
i mean that if i drink quite a lot the night before (and this happened sometimes in the first year which was by far the worse) - then i seem to wake up and pass the first half of the day miraculously symptom free -
the symptoms then slowly reappear as the day progresses -
in that first year these were the only days i woke up and felt anything approaching well...
alcohol is a muscle relaxant - could this support the sphincter of Oddi dysfunction theory?
-thanks for any replies :)
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Avatar universal
Definitely have a hidascan - mine just came back today with a gallbladder only functioning 12% - all of my ultrasounds proved negative so that doesn't really mean a thing - get the test done ASAP.  Anything less than 35% functioning isn't good and I'm sure you will feel better if they take it out - just make sure they leave the bile duct and cycstic duct in.
Debra
Helpful - 0
Avatar universal
hiya - thanks so much for all of that info - actually the low fat diet is currently by far my best method of stopping the pain from occurring-
i haven't had the HIDA yet - it's the next thing I want to get done -
The sphincter of oddi sounds kind of plausible for me...ii guess this spasming could somehow be similar to IBS with possible emotional/stress related causes...?
anyway i will have a trial with the anti-spasm meds....
thanks again
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Avatar universal
Ross, what you're describing sounds a lot like gallbladder issues. A lot of people describe exactly what you're going through. They have the indistinct pain in the URQ and diarrhea - which can be due to changes in bile output - and if they have an ultrasound there are no stones. Docs may or may not do a HIDA scan with CCK injection - you don't say you've had one done. In many cases if that test is done, the ejection fraction may come back only slightly lowered.

In the past that used to be enough to have the GB pulled, but these days it's not good enough. The problem is that without the presence of stones/sludge, there is a high probability that if someone has the GB removed, the pain will persist. For some that pain could be coming from an underlying condition called SOD - sphincter of Oddi dysfunction. It essentially means that for whatever reason the common bile duct or the muscular opening to the duodenum (sphincter) is/are spasming. In some, when the GB is gone, the symptoms become more acute, and it's hell to try to handle.

If you haven't had a HIDA scan done you might want to consider it. If the ejection fraction comes back severely lowered, the doc may then consider it sufficient cause to remove the GB.

In the meantime, you may want to try following a low fat diet. It may not help overnight, but it could over time. You could also try some anti-spasm meds like bentyl to see if that's of help.

Blood work does not rule out all problems of the biliary system.
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Avatar universal
also one year after the initial pains started i got very severe acid reflux but this was not present at all in the beginning
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Avatar universal
i also could add that i have had full blood work with no evidence of liver/gallbladder inflammation - also have no visible yellowing of eyes or skin -
does this completely rule out HepB or some kind of biliary duct problem?
anybody now?
thanks...ross
Helpful - 0
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