Abdominal Pain

[llittle]

Thank you for taking my question.  My history: female, 44 years old, about 30 lbs. overweight.  I have been diagnosed with constipation prevalent IBS about 4 years.  Last year I switched to diarhea almost over night.  After more tests my Gastro/Ent Dr. found I had developed microscopic colitis.  I was treated with Asacol for approx. 6 mos. and things seemed to be back to normal (as normal as you can be with IBS).  I have been off the Asacol for about 7 months. I have also been told that my liver enzymes show I have N.A.S.H.(non-alcoholic seatohepatitis)

About 10 days ago I started having abominal pain in upper right-quadrant. Pain is up high under my ribs. This is totally different than anything intestinal. It ranges from mild discomfort to severe. I have tried Pepcid, levsin, librax.  Nothing helps.  The pain is worse after I eat. What I eat does not seem to make much diffence.  I have a hard time in a sitting position... it seems difficult even to breathe.  I am very bloated and any pressure on my abdomen is painful.  I have also been experiencing cold sweats, and waves of nausea.  No fever is present. I also have a hard time bending over. It hurts and I experience dizziness and a pounding sensation in my stomach.  

I have an appointment tomorrow to see the GP. (Can't get into Gastro Doc until next month)  I'm also trying to avoid the ER although the pain is getting to that point.  

I am hoping to get some suggestions for things to look at.  It seems to be gallbladder probs.  Over the years I have had at least one sonogram to rule out stones.  Is there some other test that is more accurate? Any other suggestions.

Thank you,

Linda Little

[krisg]

Hi, and hope you are well!  I feel totally confused all over again!!!  My pain now is left sided and then can migrate to the middle and center of my chest.  I have read that your pancreatic enzymes don't peak until about 24 hours after an attack?  Do you know if that is true?  Mine were checked at the ER and the range was 0-300.  My pancreatic enzyems were 287.  I then went to my family dr. 2 days later and asked for another blood test and he said, "No need to do another one".  Am I missing something here?  I have had these problems ongoing for over 5 years now.  Would a diagnoses of chronic pancreatitis be possible? (since my enzymes are not high) Anyway,  I'm trying to find out how many sphincters does one have in the pancreatic duct.  I guess it is back to the search engines for me..... take care
Kris

[beebug]

I don't know how my sphincters we have in that area.  But I would like to know too. My gastro has me on 600 mg. of Actigall a day for 6 months trying to keep my bile duct open. I was wondering if that would keep the sphincter from closing again too?  I am still having pancreatic pain and he has me on Pancrease for that. Sometimes it doesn't help much.  I wonder if one has pancreatic pain over a period of months, does that cause damage to the pancreas?

[krisg]

I just had another attack at 2:30am and had to go to the ER room again.  By the time the dr. came in the room the pain was down to about a 7.  Anyway, the attack was totally left sided and I thought I was going to pass out from the pain.  Much to my surprise, my pancreatic enzymes and liver enzymes came back normal!  Does anyone have any clues to help me figure this out???
I had a biliary sphincterotomy done in feb. 2003.  My last attack was in July 2003 and I had a repeat ERCP done.  The dr. said my bile duct was still wide open.  He did not check the pancreatic duct for fear of putting me in pain. ( which I had for 4 days anyway). I am scheduled for a MRCP in about a week.  If that is negative then I was told I would probably have to have manometry done on the pancreatic duct to measure the pressure to look for a motility problem with that sphincter!   How many sphincters do we have in that area?? Does anyone know???
Any comments would be appreciated.
thanks

[krisg]

Sometimes a repeat ERCP needs to be done by an expert dr.
My first one was done by a so-called specialist.  He told me there was nothing wrong.  My second one done was 2 1/2 years later by a different specialist at a "university hospital" because I was still having pain.  He found my bile duct was narrowed and scarred and he had to perform a sphincterotomy just to gain access to my bile duct.  Also, my liver enzymes were elevated only when I was in severe pain.  That is the time to have your blood taken. Good luck .

[beebug]

No, SOD won't go away on its own, to my knowledge.  My gastro doctor had to slit mine both times to open it.

[Kevin Pho, MD]

You note right upper quadrant pain with a negative CT scan, sonogram and HIDA scan which is pending.  Ensure that the HIDA scan is also done with CCK stimulation to evaluate the gall bladder ejection fraction.

The next steps would require an evalation for the various causes of dyspepsia - GERD, ulcers, or inflammation of the esophagus or colon.  An upper endoscopy can best evaluate for this.  I would also suggest testing for H Pylori - which is a bacteria associated with ulcers and inflammation that can cause your symptoms.  If present, the treatment is with antibiotics.  

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.

Thanks,
Kevin, M.D.

[llittle]

thanks for your comments.  I spent yesterday at the emergency room taking all the blood, urine, sonogram and CT Scan.  I went back today for a HIDA scan.  All negative.  So I am back to square one.  I can get in to see the gastro dr next week instead of next month so maybe he will have some answers.

[surgeon]

the simplest cheapest and safest test is sonogram, and it's likely to show the problem if it is your gallbladder. It's only if it's normal that some of the things mentioned above may need to be considered.

[paty91356]

P.S.  I should have added that I had my gallbladder removed many years ago.  My discomfort is on the left side, not the right..it's to the left of midline, about ther bottom of the sternum.  My liver and pancreatic enzymes sometimes go up when it's acting up.

[beebug]

Linda,

You may have a stone in your bile duct, or SOD (sphincter of oddi dysfunction).  I have had the upper right quadrant pain twice.  The first time it was SOD. The second time it was a stone in my bile duct, plus the opening into my bile duct was narrowing again.  My doctor did an ERCP both times.  I would urge you to get to an gastroenterologist!  I wish you luck!
Betsy

[paty91356]

Did your SOD go away on its own>  I have have it off and on for 20 years or more...lately, it seems to be more persistent.
I have also had a couple of ECRPs, an endoscopy and colonoscopy, MRI, CT scan both with, and without contrast dye...all normal.
I have just about decided it is something I have to live with.....