medical informaton

[hartann]

I need some medical help. For years I have been treated for chronic pancreasitis.I have have a dilated bile duct.

I have been going into these servere stomach attacks. In the last three months the pain has been un
bearable (the last 3) I have been aspirating into my lung.I wake up and be like making awful noises.and having just the worst pain in the back.(so sharp.) and stomach under rib gage
also with this going on whenever eat the pain in the abdomen(under right rib) is much worse. Iseem to be losing weight
and so nausea all the time. My chest -ray and blood work is normal. What can be going on with this stomach of my
that has changed so drastically and now the aspiration. The lung dr. heard all the noise in my lung,He put me
on antibotics and predasone. I am still in so much pain.What tests will show under the rib and into the back.
hartann


This discussion is related to Bile duct obstruction?.

[boron]

You have to solve this right away! Having constant aspirations of gut content can cause untreatable lung damage (aspiration pneumonia).

1. Do you have heartburn?
If yes, this is from gastric reflux, first investigation is breath test for Helycobacter pylori bacteria in stomach.

2. Do you have occasional pale (yellow) stools, or you feel pain in the right scapula or shoulder?
It is possible that a small stone, either from the gallbladder or from the pancreas has lodged within the bile duct. Or pancreas itself presses on the bile duct. This would cause colic pain under the right rib.

It is HIDA scan, which shows your bile ducts. They inject a contrast substance into your vein, and after a while they monitor (special scan) distribution of this substance in the liver, bile duct and pancreatic duct.

Before HIDA scan, doctor might want to make ultrasound of gallbladder, liver and pancreas. If nothing found - it means nothing; ultrasound is pretty unreliable. So, insist on HIDA scan (if you think it's gallbladder). And even before both tests, liver enzymes in blood may be checked (they are obviously elevated in blockage of bile duct).

3. Back pain may be from gallbladder/bile ducts, or it can be from pancreas. CT or endoscopic ultrasound are good to check pancreas, but if your blood work was normal, I doubt it's pancreas.

Aspiration is of what taste - burning, sour (acid), with foamy white saliva, or bitter (bile)?
Does it occur during the night? Rise the bed, so your head will be higher, or use additional pillow, reflux can really damage esophagus or lungs.

[hartann]

No heart burn. I take prevacid for heart burn.
For this HIDA scan,can they use a none indonine dye?
getting a lung and stormach scan this am.
aspiration ,sometimes bitter,after a bout of servere abdominal
pain ,such a raddle in lung for until antibotics start to work.
Bed stays propped up.head higher always.
pneumonia like symptoms.
gallbladder removed years ago,thats basically when all
this pain on r.side began.

[boron]

First, it has to be discovered, what your reflux contains: acid or bile.

Acidic reflux would go with heartburn (you say no), white and foamy saliva and acidic taste ion the mouth. Causes of acidic reflux are in the stomach

Bile reflux would taste bitter. Bile reflux is a known complication of gallblader removal, it happens because bile is constantly flowing into intestine. This bile then finds a way up through your stomach, which itself is already loose enogh to permit acid reflux.

So, the problem probably is that your stomach allows this upward flow of the bile. You will need tests regarding this bile reflux.

[boron]

More about bile redlux:
http://www.medhelp.org/forums/search/68?query=bile+reflux&camp=

Also searh for "bile reflux" on Mayoclinic site.

[hartann]

what type of test is done for bile reflux?
Is that different than HDIA?
Sometimes when I am unbearable pain in the abdominal pain, I vomit strong yellow,green (I guess) bile.But that is not to often.
Yes, my stools are creamy color at times.
See,many years ago, It showed the pancreas was enlarged either just the head or tail.
It shows the duct dilated in one area also. So far the size of the enlarged pancreas
hasn't changed,(dosen't show).The dilated duct,the Dr.states is normal after gall bladder surgery.
The biggest change is the chronic pain has worsened and the aspiration is new.I  feel nauseous all the time now.

hartann

[boron]

If you are saying that you vomit bile, this is then already a sign of bile reflux. Acid and bile reflux often go together, especially after gallbladder removal. I don't know what exact tests will they do (something like checking content of your reflux, not sure). It's not HIDA scan. The point is how to correct this.

Read this:
http://www.mayoclinic.com/health/bile-reflux/DS00651
get diagnosis, and then
get detailed informations about the best treatment option (drugs, operation, diet).

[hartann]

thanks for all the input.

I went to the read page.and said it wasn't listed

thanks

hartann

[boron]

What wasn't listed?

[hartann]

The page where you said read this www.mayoclinic.com.health/bile/reflux/DS00651..

hartann

[boron]

Exact page about bile reflux tests is here:
http://www.mayoclinic.com/health/bile-reflux/DS00651/DSECTION=4

[hartann]

I went to the Dr. today. On the way I picked up the results from the lung and abdomen
(ct's)
It said the following.examination of the mediastinum reveals a tiny low-density lesion
associated with the right lobe of the liver in the diaphragmatic region measuring 4.8mm in size. rest of liver normal. r. and l. adrenal glands,pancreas,l.and r. kidneys appear un-
remarkable.There is a mildly prominent node seen alsong right side of the celiac axis measuring 1.3 x 1.1cm in size.

OK ,the Dr. didn't explain any of this. I only know about it because I picked up a copy. what does this mean?Can any of the above make
me so sick(nausea) ,wt.loss.etc in so much pain under r.  rib and in back.  He has scheduled me for a test with a camera.
I don't think that will show much do you? I ask him if he would run a HDIA test, he said no. I am not only sick but don't understand,can you explain any of this to me?

thanks hartann

[boron]

The lesion "associated to right liver lobe" may be some sort of tumor. This can be only diagnosed with biopsy - they take a sample with a needle through abdominal wall. The node in celiac axis is probably enlarged lymph node, and may be connected with the tumor.

Camera would show nothing of this, but camera can show eventual inflammation of the stomach and small intestine. Now, I don't know what this camera means to you (cost). If you have no heart burn, it is not likely you have gastritis or ulcer, so you better ask a doc what is exact purpose of camera, what is he looking for.

Ask for biopsy of that liver lesion, it's possible that all originates from there.

[hartann]

On Friday the Doctor did  that camera test. It basically showed nothing other that very
mild inflammation.
Now he says he wants to to a MRA of the abdominal.  He said he is a little concerned
about the node,still hasn't mention the lesion. I just don't understand why he can't do
tests that would show what the lesion and node is.. I know ,at least feel certain that
all this pain is coming from either a duct or the liver. If appears if I mention something
like the HDIA test or other,he says he won't do that.  I am scheduled for a reversed
shoulder replacement on 6-3- 08. I am very concerned getting this done before I see
what all this other problem is caused from because when I get these spells of pain
I literally fold up. The arm has to be in a sling for 4 weeks. I told him this,I don't think
he gets the jest of it. He says if I get sick they can give me something!!!!! How can I
ask him or suggest to him.  Lets get to the bottom of this first...

Thanks  hartann

[boron]

With MRI, the doctor maybe want to check, if there are other smaller lesions in the liver, and if there are another enlarged nodes. This will give him an idea about the nature of the lesions. He will probably suggest lesion biopsy after that.

HIDA may still be an option, but, I guess, you can go with MRI first. Beside HIDA, an ERCP is also an option, but allow him to do MRI first.

ERCP:
http://www.medhelp.org/Medical-Dictionary/Terms/2/19213.htm