upper right abdominal pain

[ohsmonarch]

I am a 41 year old woman, healthy, non-smoker, 5'4", 140lbs.

I had my gallbladder removed last year, all was well up until a few weeks ago, I am again getting upper right abdominal pain that radiates into my back, under my right shoulder blade and across the middle of my back and front. As well I am having lower right abdominal pain that migrates from my navel area to my hip bone. The pain will also sometimes extend up into my right shoulder and my right ear.

I have had 2 rounds of blood work done for gallstones, pancreas, liver, kidney and appendix.... all have come back normal. As well I have had an abdominal x-ray done at the ER, they said I was constipated and sent me home with an enema and a large jug of stuff to flush out my system, even though I told them my bowel function is normal, every day or every 2nd day... floating, normal size.

I have an abdominal ultrasound booked, but the appointment is not until Aug.15th.

I don't have any fever and feel fine otherwise... what could this be???

Thank you.

[Kevin Pho, MD]

Continued upper right abdominal pain can be due to biliary duct stones, dyspepsia, or Sphincter of Oddi dysfunction - amongst other causes.  

I agree with the abdominal X-ray.  I would further consider an MRCP to evaluate the biliary tree.  If Sphincter of Oddi dysfunction is suspected, an ERCP with Sphincter of Oddi manometry can be considered.

Lower right abdominal pain should be evaluated with a CT scan to rule out the appendix.

These options can be discussed with your personal physician.

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_

[Madral]

I too have pain in the upper rt. part of my abd. (Right Upper Quadrant - RUQ) that radiates through to my back, starting in the front almost right under the last rib (a little more toward mid-line) and across mid-line a little bit.  This pain is the worst pain one can ever imagine.  When my first bout of acute pancreatitis happened, eleven years ago, the pain never went away (nor did the nausea and vomiting either), even though my amylase and lipase levels were normal again in my blood.  For six months we did every test in the land, and, finally, they decided that I had Pancreas Divisium - a condition where your primary and secondary pancreatic ducts do not intersect to carry the enzymes to your common bile duct.  I had two stents placed and each stent would last about one month and then, when I would go in to have the stent checked, it would be completely occluded and would have to be removed and replaced.  Finally, in 1997, my Drs. decided enough torture is enough torture and they did a procedure on me, I think called the Galliot procedure, where they opened my abdomen up during surgery, took a small piece of my small intestine, made a ductal connection, and attempted to place some permanent stitches in the ducts, which they found were very small.  Although I did have complete pain relief from the surgery, it only lasted about two months and then "the ***** is back" (don't know how to make a musical note, but not intentended as an insult, intended as the line in the song).  Mine cam back with a vengeance and I still suffer greatly today.  My pancreas swells and will distend only the right side of my abs., it will cause bruising that comes from the pancreas (sometimes, but very rarely blood blisters), and hardening and distention of the organ itself, so that you can almost see the organ's imprint when I lay down or stand straight up.  
Unfortunately for me, after my surgery in 1997, we had to move from VA to CA and, once I got here, the Drs. were much less receptive to my problem because they either 1) didn't know what heck I was talking about; 2) didn't believe I knew what I was talking about; 3) thought I was "drug seeking"; 4) thought I was "Dr. Shopping"; or 5) were insulted when I tried to educate them a bit.  So, because I kept getting this "it's all in your head" "you just want the meds" "threre is nothing wrong with you psychiatry can't fix", etc. it caused me to doubt myself and I sought a second opinion from the University of Kansas Medical Center, Dr. Norton Greenberger, GI Specializing in pancreatic disorders and malfunctions (he was recommended by a Dr. friend at Mayo Clinic).  When I arrived, he asked me what my goal was for this visit and I said "I just want to know, is it all in my head?"  He laughed and said he doubted it.  He performed the ERCP and the MRCP and told me, "No, it's all in your pancreas".  He also said thet I have small ductal disease and biliary insufficiency in addition to the divisium.  He explained how, when we eat, the stomach puts out an enzyme to kick start the pancreas to produce enzymes to break down food, this causes the pancreas to try to get enough out so the food can be digested and the nutrients taken out, but the damaged pancreas can't get enough out at a time, so it tries and tries and, when it can't the stomach will send another message, which causes the pancreas to try harder, and this cycle continues.  Unfortunately, there are not a lot of options for those of who have this problem.  The least invasive is diet modification, exercise and synthethic pancreatic enzymes taken with food.  The next is to have done what I had done with the connecting the ducts, etc.  Then you have partial or complete pancreatectomy (making you a brittle diabetic the rest of your very shortened life), and then there's transplant.  One thing I still have problems with is getting Drs. to believe I have this, because I can't afford the $50 basic search fee and the $.86/page copying fee, I cannot request my request my records from either my diagnosing Hospital and MD nor my secondary opinion Dr. and Hospital.  So, now we are back to square one with the same "it's all in your head" comments, only now that I HAVE my law degree and License in CA to practice, they ARE a little more subtle about it.  Find yoursefl an Ombudsman, preferably a patient ombudsman who will lobby for your best interests as a patient.  Because,  believe me, one you hit the status as a chronic pain patient, your lobbying days for yourself are over, you will be stripped of all persuasive power and looked at as a hysterical whiny little thing, no matter how rational, no matter how true what you are saying is, there is no power when you are a patient.  Beyond that, try the enzymes, don't eat very much fat, don't eat a lot in one sitting (I usually space it out through the day - like five very small meals (snack size)), don't drink cranberry or orange juice and don't eat them either, cut back on the meat in your diet and make sure you ABSOLUTELY DO NOT DRINK A DROP OF ALCOHOL.  You also shoul ask you primary care physician to do a pancreatic test to determine if it is functioning o.k.  This is not that bad a test, you do have to drink some stuff that doesn't taste great, but ut's only about a cup or so and then have a series of blood draws.  I hope that this may help in a small way.  I'm not a Dr., but after living with this for 11 years and researching it for almost as long, I can speak for my experience.

Peace and Love Be With You

[SusieMo]

I was interested to read about your experience.  I have fairly recently had my gall bladder removed by key hole surgery and whilst I am a whole world better than I was before and the majority of the pain has gone, I have been left with a dull ache in my back - right hand side, below my shoulder blade.  I also feel nauseaous a lot of the time but am never actually sick.  I have been back to the specialist who has confirmed that two enzymes produced by the lining of the bile duct are indeed higher than they should be.  However, despite having an MRCP scan on the bile duct, he can find no reason for these elevated levels of chemicals.  Admittedly I was very poorly before the gall bladder was removed so perhaps it is just taking me longer to recover than I had anticipated.  Up until now (44 years old) I have enjoyed, with rare exception, extremely good health so it has all been a bit unexpected to be this unwell.  I am hoping that this web site can give me a bit of guidance or assistance in convincing my GP that I am not imagining my symptoms - you actually start to doubt yourself after a while.  Was good to read about your experiences.  Good luck for the future.  Susie.

[chzdudl]

Read your notes with interest.  I had my gallbladder out about 3-4 years ago.  My surgeon did warn of possible complications, and I ended up with a sphincter of oddi that just does NOT want to be open and a couple of retained stones to boot.

I've had the stones removed and 3 sphincterotomies by ERCP since, and was pain-free for about a year. Then, the pain returned and I'm told the pancreatic end of the spincter is now the issue, and they don't want to go in again as the risk of pancreatitis is too high.

low fat diet, no alcohol and I also now take low doses of elavil and an antispasmodic daily, which seems to make it more manageable.  You may want to check with your doctor about the medical options for management before looking at more surgery...