upper right quadrant pain

[RDGMOM3BOYZ]

I have been experiencing upper right quadrant pain for well over a year.  I have had an MRI, CAT scan, upper GI series, upper GI scope, nuclear scan of my gallbladder and an ultrasound.  In the testing they found that I have a 7cm hemangioma in my liver but believe it should not be causing any problems.  Everything else has come up normal.  My liver function bloodwork was normal last year and in September when last tested.  I've also had an endoscopy to rule out celiac disease.  That came back normal but I have tested positive for gluten sensitivity through a stool test and dairy intolerance so I have avoided dairy and gluten since September.  My PCP has had me try several low doses of anti-depressants in hopes of finding one that works for the chronic pain.  I haven't found one that works well enough to endure side effects.  

Currently:  I stopped taking Effexor about a week ago--had tapered down from 150mg to 75mg for three weeks and then stopped.  I have had some strange withdrawal like symptoms and my abdominal pain has gotten much worse.  I have also been experiencing intense lower right pain, though not constant, and have upper right shoulder pain (in my back--between my shoulder blades).  The pain seems to be getting worse daily. At times if feels like something inside is swollen and even is sensitive when I walk.  My PCP wants me back on the Effexor but I declined because it didn't help enough and I don't want to go through these withdrawal symptoms again.  I also feel like it just masks the pain and maybe I'm stubborn, but I want to know what is causing the pain and treat that, not just cover it up.  I'm trying alternative therapies for the pain--I had my first acupuncture treatment today and it helped the pain for about two hours.  I will be seeing a chiropractic friend of mine this week and plan on visiting my old PCP from a city I used to live in as I trust him a lot and my current PCP has no idea of what to do for me or whom to refer me to.  

I also frequently experience fatigue (though that may be related to accidental gluten ingestions) and lately I feel like my stomach is full even when I am hungry and it is 'growling'.  My stools have also gotten more frequent (several times a day) and soft, but not diarrhea though it is accompanied by cramping.

I mainly want to know if there are other tests I should ask for.  What types of things should they be looking for in bloodwork?  I can't continue to live this way and I want to solve the problem if at all possible.  I feel like there have to be other avenues to explore.  

Thank you for any advice you can give,
Carrie

[laurabrazeale]

A related discussion, surgical clips???? was started.

[scooty]

I would consider consulting a naturopathic doctor!

I have been mis-diagnosed for over 2years. When my naturopathic doctor was able to tell me what was wrong with in one meeting.  My (former)primary care doctor is out of practice (i think) diagnosing anything that isn't a cold or flu type illness.

After having an ultra-sound it took my (former)primary care doctor 3weeks, to contact me... and it was me that made the initial call to find out the results of the ultra-sound... I have enough gallstones that my (former) primary care doctor suggested immediate surgery.

There are 14 states that honor naturopath's as primary care doctors.

Check out : http://www.naturopathic.org/

Good luck.

[nitesco]

nitesco
12/01/2005
C2  .

Hi All. I have been reading the comments posted here on this site for about the past month and would like to obtain some support or direction as to what I should do next. Originally started with a visit to urgent care about 7 weeks ago. Labs - ast and alt were elevated 4-5 times normal - everything else okay except residual pain that left the "gall bladder area" vey tender to the touch for 3-4 days. Tested for all the heps - came back negative. Referred me to an internal medicine doc who thought it sounded like "classic gall bladder" and set me up for lab check (now returned to normal), and ultrasound. Came back normal (negative for any stones). Indicated that just because there were no stones did not mean that there wasn't a problem with the gall bladder so scheduled me for a HIDA Scan with CCK. Just receieved the results from the RN - she happily told me that the test came back great! Ejection fraction was 87% - therefore ruling out gall bladder.

I am somewhat frustrated as I have experienced these symptoms off and on over the course of the past 3-4 years. Had all the GI tests 3 years ago - all came back indicating no problems. HIDA Scan/CCK 3 years ago came back with ejection fraction of 32% then (I've improved!). Guess I am first wondering if any of you have had "normal" tests (and an overachieving gall bladder!) but still experienced ongoing symptoms...? This past HIDA/CCK left me feeling pretty crappy - cramping, nausea, and very tender area when the pain subsided. I realize that this is a side effect sometimes, of this test. Last "attack" was about 3 weeks ago. Never know when it's going to hit - wakes me up - can't get comforable, radiates to the upper middle back/shoulder blade - right side and after the pain subsides - I am always sore in that reas for at least 2-3 days.

I am 44, female, "fat" (okay - about 20 pounds overweight), a vegetarian, and otherwise healthy - non-smoker - don't drink caffeine, chocolate, etc. Am a regular exerciser - take good care of myself. I feel like I am nuts and acting like a hypochondriac wanting someone to find something wrong so I feel like I am not imagining these symptoms..... Comments? Thanks - I do appreciate any input.

[malcom]

i have been having the same problem with pain but in my left side of stomack, i did every test there is, with no result. i feel yr frustration. I am on effexor too. it didnt help except it make me tired. good luck

[Kevin Pho, MD]

You have had a pretty comprehensive workup for the right upper quadrant pain.  Most of the possible causes (GERD, ulcers, gallbladder/liver disease etc.) would have been picked up with the tests you have had.  

You can consider more specialized testing.  This can include an MRCP to evaluate the biliary ducts, as well as a gastric emptying scan to evaluate for gastroparesis.  

If these tests are negative, then a GI cause of your symptoms is less likely.  

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_b

[RDGMOM3BOYZ]

I forgot to mention that all of my testing was done over a year ago except for the endoscopy to rule out celiac and blood testing for liver function--that was done in September.

Carrie