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Clean Labs, CT, Ultrasound and MRI

So, to get the ball rolling this is what I’ve been dealing with… I have a horrible pain in my right side that radiates over my liver and into my back. I can push on my lower right ribs to make the pain worse, or bend over left side and it makes it much worse. This pain has been hurting worse and worse for almost a year now. I have been to a few different doctors, and gastro doctor told me my liver was inflamed before I went in for my ultrasound. My ultrasound came back normal and the only thing on there that was concerning is that my extrahepatic bile duct is dilated to 1cm. They didn’t say anything else other than it’s dilated. I did have my gall bladder out 10 years ago which I have read can be a result from that. But I’m undiagnosed!!! It’s so frustrating because I’m in so much pain, all day every day. Nothing helps. I have quit drinking and completely changed my diet, nothing is helping. I quit drinking august 16th. The pain is worse today than it was even I quit drinking. I do not have any other symptoms, not really. I do have some gas issues, they have some what appeared more recently but I have had stomach issues for some time since having my gall bladder removed. I do have back issues and my doctor has told me my pain is coming from my back issues but I do not believe it. I have said since the beginning that something is wrong!  

Do any one have any ideas or what direction I should go down next?  
3 Responses
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683231 tn?1467323017
What your doctor is suggesting is something called referred pain.

“ Referred pain is pain perceived at a location other than the site of the painful stimulus/ origin. It is the result of a network of interconnecting sensory nerves, that supplies many different tissues.”
Helpful - 1
10 Comments
I appreciate you taking the time to answer me. I just cannot find an answer. I’m miserable and I feel it’s getting worse every day.
What kind of doctor are you seeing? Are you being treated for your back pain?
I have been treated for back pain for many years. I’m 36, was an athlete in college and ever since I quit playing my body has just eroded. But yes, I have been treated for back pain. This pain just seems different. It hurts where my liver is, and it seems to hurt worse when I drank alcohol. It hurts all day every day, and my back does too but it seems to have days where it doesn’t bother me. This just hurts non-freaking stop. It’s so sickening and scary and I cannot get relief. I just had a baby girl 7 months ago and a boy turning 8 in February. I’m so afraid I’m dying and can’t get a diagnosis.
Sorry about you pain and suffering I cannot begin to imagine how difficult that is. The only thing I could say if you don’t have evidence of liver disease or some other condition  you are not dying. If you had some kind of very abnormal test result that would be a red flag of serious illness. If you were dying from something it would show up on testing.

As far as liver disease I’ve been living with liver cirrhosis since January 2008 diagnosed with liver biopsy. I’m still here now 14 years later.

Again you have my sympathies about your pain keep working with your doctors to find out what is causing it.

You said you’re being treated for your back pain? Are you receiving pain medications?
Just another thought if it hurts when you drink alcohol perhaps you should abstain from all consumption of alcohol.

If it is difficult for you to stop drinking you may consider getting treated for alcohol addiction, meeting with a counselor, or joining Alcoholics Anonymous
I really appreciate you telling me that. I talked my doctor out of acetaminophen pain medicine a year ago and she put me on oxycodone without Tylenol. I know it’s not ideal but cannot currently smoke marijuana with my profession which I’m also working on. I quit drinking on august 16th. I drank one day between then and now and it made my pain worse which is why I make that note. I have made serious life changes to my diet and living choices in general.  I eat primarily fish and vegetables now and nothing is helping. I have read that the dilated extrahepatic bile duct could be serious, and could be causing the pain?  Have you any knowledge or experience with this?  Thanks again for this discussing it means an incredible amount to me.
“ When a blockage occurs in any of the bile ducts, bile accumulates within nearby structures. As bile builds up in the liver, it causes jaundice and other symptoms, such as nausea, vomiting, and upper abdominal pain. Depending on the cause, these symptoms can develop abruptly or slowly with time.”

How is a biliary obstruction diagnosed?

Various tests are available for people who may have a biliary obstruction. Based on the cause of the obstruction, your doctor may recommend one or more of the following tests.

Blood test

A blood test includes a complete blood count (CBC) and liver function test. Blood tests can usually rule out certain conditions, such as:

cholecystitis, which is an inflammation of the gallbladder
cholangitis, which is an inflammation of the common bile duct
an increased level of conjugated bilirubin, which is a waste product of the liver
an increased level of liver enzymes
an increased level of alkaline phosphatase
Any of these may indicate a loss of bile flow.

Ultrasonography

Ultrasonography is usually the first test performed on anyone suspected of a biliary obstruction. It allows your doctor to see the gallstones easily.

Biliary radionuclide scan (HIDA scan)

A hepatobiliary iminodiacetic acid scan, or HIDA scan, is also referred to as a biliary radionuclide scan. It uses radioactive material to provide valuable information about the gallbladder and any possible obstructions.

Cholangiography

A cholangiography is an X-ray of the bile ducts.

MRI Scan

An MRI scan provides detailed pictures of the liver, gallbladder, pancreas, and bile ducts.

Magnetic resonance cholangiopancreatography (MRCP)

Magnetic resonance cholangiopancreatography (MRCP) is used for the diagnosis of biliary obstructions and pancreatic disease.

Endoscopic retrograde cholangiopancreatography (ERCP)

An endoscopic retrograde cholangiopancreatography (ERCP) involves the use of an endoscope and X-ray. It’s both a diagnostic and therapeutic tool. It allows your surgeon to see the bile ducts and it’s also used in treatment. This tool is particularly helpful because your doctor can use it to remove stones and take biopsy samples if necessary.

What is the treatment for biliary obstruction?

Treatment is aimed at correcting the underlying cause. The primary objective of medical or surgical treatment is to alleviate the blockage. Some of the treatment options include a cholecystectomy and an ERCP.

A cholecystectomy is the removal of the gallbladder if there are gallstones. An ERCP may be sufficient to remove small stones from the common bile duct or to place a stent inside the duct to restore bile flow. This is often used in cases where obstruction is caused by a tumor.
Complications of a biliary duct obstruction

Without treatment, biliary duct obstructions can be life-threatening. Possible complications that can arise without treatment include:

dangerous buildup of bilirubin
infections
sepsis
chronic liver disease
biliary cirrhosis
Contact your doctor if you develop jaundice or notice a change in color of your stool or urine.
What are the symptoms of biliary obstruction?

The symptoms of biliary obstruction can depend on the cause of the obstruction. People with biliary obstruction usually have:

light-colored stools
dark urine
jaundice (yellowish eyes or skin)
itching
pain in the upper right side of the abdomen
nausea
vomiting
weight loss
fever
683231 tn?1467323017
Have you had an ultrasound? They should be able to diagnose a dilated extrahepatic bile duct with ultrasound
Helpful - 1
2 Comments
Yea and that’s where I got this from, it was on the report. I had my gall bladder out and I read that can stem from that or something serious. Everything has come back normal other than that. My doctor said my liver looked inflamed when I saw her in person but nothing was verified on ultrasound. I have had MRI, CT and ultrasound. I’ve had all of the extensive blood work done and come back clean too. I can’t imagine how I can be in this much pain and nothing can be seen.
If your liver is inflamed one would expect elevated liver enzymes. I’ve no idea how a doctor would say your liver “looks” inflamed no idea what that even means without corroborating test results.

Are you seeing a gastroenterologist?
683231 tn?1467323017
Hepatitis literally means liver inflammation.

Hepa means liver
-itis  means inflammation
Helpful - 0
6 Comments
https://www.healthline.com/health/fatty-liver
Yes it was a gastroenterologist that made that comment to me, but it was pre-ultrasound. I’m imagining her inspection of my abdomen led to her saying my liver was inflamed, and she went back to look at my CT again, but when she came back she was it also wasn’t noticeable there either. All in all, the test results have all come back negative for anything seriously health related. However, just laying here on my side typing this I’m in pain and it’s not a typical “back” sore type of pain and has been gradually getting worse for a year. Just stinks not to have any answers.

Living with cirrhosis has to be challenging, but from what I’ve read 13 years is awesome. Just a couple months of extremely healthy eating no drinking etc has been a challenge. Headaches, no energy, etc.  I commend you on your hard work!
Just really odd inflammation wouldn’t be visible on ultrasound perhaps enlargement inflammation would be noted by elevated liver enzymes. Information indicates something is actively injuring your liver. Liver enzymes are produced when your liver is trying to repair itself.  So based on that if your liver is under attack and inflamed it should be trying to repair itself and thus producing elevated liver enzymes.

That being said none of that is helping you with your pain situation. I hope your medical team is able to find a cause for your pain and successfully treat you to relieve it.

Congratulations on your efforts to attempt to improve your health. One step at a time one day at a time.
Thank you. Seems like the pain gets worse every day and I’m sure the stress is not making anything better. Have you ever dealt with any pain in your long healing journey?  What types of things would I most likely be dealing with in terms of liver problems that isn’t just pain that I should keep attention for?  I know the big symptoms you read everywhere on the web but I have none of those… I had some bad gas for a while and get a headache every once in a while. Other than that it’s just ****** pain!
I have not experienced any pain really other than getting older.

The first symptom I noticed of cirrhosis was lower leg swelling called edema or putting edema which is often the first symptom people notice. The first blood tests that were abnormal were my elevated liver enzymes which were more associated with my chronic hepatitis c and which are now in normal range. A few years after I was diagnosed with cirrhosis I developed a low platelet count which is often the first lab test that indicates advancing cirrhosis. Low platelet counts are caused by increasing portal hypertension which is high blood pressure in the main blood vessel in the liver called the portal vein. This is caused by advanced liver scarring. Portal hypertension causes the spleen to enlarge and to sequester (hold onto) blood platelets. Portal hypertension can also cause enlarged blood vessels in the esophagus called esophageal varicies which can become dangerously enlarged to the point they can burst and result in a life threatening bleeding event.

I’ve had esophageal varicies back in 2012 that required banding to be done to reduce my risk of death.

“Another symptom of advanced cirrhosis is hepatic encephalopathy or HE. The loss of brain function when a damaged liver doesn't remove toxins from the blood.
Hepatic encephalopathy generally occurs in people with chronic liver disease, such as cirrhosis or hepatitis. Triggers include infection and dehydration.”
But really it doesn’t seem you have any indications of cirrhosis. Your test results are normal so it’s hardly surprising you don’t have symptoms.
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