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Constant RUQ abdominal pain

I'm a 33 year old female with a myriad of problems.  The biggest one right now seems to be constant abdominal pain on the right side, sometimes it seems that it is just below my ribs and others it is closer to my waist area.  This pain does not leave.  Ever.  And it is not relieved by anything I've tried. There are some days it is worse than others, but I can no longer sleep on my right side due to it. It is not affected by food.  I had this pain before my gallbladder was removed (lap choly 10/01) and it seems to be worse now.  I've been told it is from IBS but honestly I don't think it is.  I also have severe abdominal cramping following my first meal (which is sometimes just crackers or something like that) almost every single day that will usually lead to several bouts of explosive diarrhea unless I take Immodium preventively every day (which doesn't always help).  Very often when I am having these bouts of diarrhea I notice that as the diarrhea bathroom trips go on it becomes completely clear and watery and an intense bright yellow color - and to describe how badly it burns is impossible.  Then the next trip to the bathroom will consist of just mucus.  It makes me want to die.  

My ALT (72) and AST (36) are slightly elevated (have been for years). I also have Fatty Liver. Had an MRCP to rule out problems with the duct and it was normal. Over the past couple of years have had many various imaging scans, barium studies, colonoscopy, EGD, was tested for Mastocytosis (have dermatographism and flushing episodes) and Carcinoid Syndrome (5HIAA was 6.8 first time then neg. 2nd time), both neg.  History of polyps in colon (1 was an adenoma) and polyps in stomach; gastritis, GERD, esophagitis, hiatal hernia. Also have PCOS/Stein Leventhal Syndrome with insulin resistance which is getting worse. Protonix is the latest med for acid that I'm trying, the others have either stopped working or ended up making the burning/gnawing feeling worse. One of my biopsies during the last colonoscopy showed "Ileal mucosa with congestion" and that doesn't seem to be too far away according to the diagram from where my pain is but I could be way off on that. The picture looks like it is right near where my appendix is, just above it.

Current meds are Glucophage XR 1500 mg, Protonix, a multivitamin, and last night started Flaxseed Oil due to severe dry eyes following Lasik Surgery.  

I don't dispute the fact that I have IBS.  Although I do predominantly have diarrhea, there are occasions where I am constipated (mostly due to taking lots of Immodium though I think).  But this pain seems to be independent of the diarrhea; it's not relieved by it nor does it seem to cause it nor be caused by it.  It is constant.  My gastro suggested last visit that he may have to send me to a university hosp. in NYC. I'm all for it at this point; my quality of life stinks.  

Can you offer ANY insight or give any direction?  I'm at my wit's end..  Thanks so much in advance.
34 Responses
233190 tn?1278553401
There has already been a comprehensive evaluation including MRCP, EGD, colonoscopy, "various imaging scans" (I assume CT scans) and tests for mastocytosis and carcinoid.  Certainly, if there is no revealing cause, the symptoms may be indeed due to irritable bowel syndrome.  

One consideration would be Sphincter of Oddi dysfunction.  An MRCP can evaluate for this (as you had), but you may also want to consider endoscopic ultrasound or ERCP with Sphincter of Oddi manometry to definitively rule this out.  

If these tests are negative, you may want to optimize treatment for IBS - which may necessitate treatment from an academic medical center.  Possibilities would include
Lotronex (for diarrhea-predominant IBS) or antidepressants.

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.
Avatar universal
These are exactly what my complaints are exactly... They cant figure out why my right side hurts i first thought it was from Apendasidous. And i do hurt up around the ribs also from time to time it comes and goes. But now i have just recently been diagnosed with intestinal metaplasia..I dont know if this causes all these simptoms or not. My spelling isnt the best sorry...Just wanted to share with you....
Avatar universal
These are exactly what my complaints are exactly... They cant figure out why my right side hurts i first thought it was from Apendasidous. And i do hurt up around the ribs also from time to time it comes and goes. But now i have just recently been diagnosed with intestinal metaplasia..I dont know if this causes all these simptoms or not. My spelling isnt the best sorry...Just wanted to share with you....
Avatar universal
Curious 123, thanks for the comment.. I was once diagnosed with Barrett's Esophagus a few years back but then last year at a followup EGD no Barrett's was found.  I'll be looking up more info on intestinal metaplasia now, hadn't read up on that in a long time.  Thanks..

Oh I should also mention (ran out of room in my rambling original post) that I previously posted under the ID Pixie1969too but I couldn't remember my password to post under that ID again..
Avatar universal
Hi.  Check out my last post under "Upper Right Quadrant Pain."  I've been dealing with this for about a year now.
Avatar universal
My wife has had all that you explained!
Our specialist told us that the MRCP is not 100% conclusive
and if all fails go the other route ERCP but it comes with
it's own complications. But it is the most accurate!
She has had Pain (more on than off) for 1 1/2 yr. now and I am convinced that she has "SOD" and it needs to be treated. Our quality of life also has been less than desirable. for she is a 37yo and we have two young girls. I have found that for the most
part all of the specialist's we've seen are rude uncaring and refuse to listen to reason. I am a fairly intelligent person that has researched this inside and out, but the unfairness is it is their choice and that is it! I feel without question that SOD is the problem, only because all other avenues have been sought. The only one left is a ERCP. Also if you notice IBS is always the lazy and easy answer. Sorry for the ranting but the frustation is getting old as you know!!!!!!!!!!!!!
Avatar universal
Your bacteria and yeast infection.......how did it cause your URQ pain?  How did the doctors figure that to be the problem??
Avatar universal
Also, did you have any other symptoms besides upper right quadrant pain??
Avatar universal
You are describing yeast infection symptoms . Nothings for sure & symptoms do overlap  but yeast infections are endemic & are responsible for much unexplained illness, I would consider it first , check it out  .The healthy awareness candida forum attracts more traffic than any other health site at up to 3000 hits a day.

Try a google search, use the words healthy awareness to access archives then one of your symptoms each one has been discussed at length
If you need more info post

look up my post on 12/4/03
  My URQ pain turned out to be a bacterial co-infection common with a chronic yeast infection .
You may relate to this
Biliary pain is common symptom  with Candia infections.

This extract from : Chronic Fatigue Syndrome: The Hidden Epidemic, by Jesse E. Stoff, M.D., and Charles R. Pellegrino, Ph.D. may also be relevant
The liver is one of the primary targets of Epstein-Barr Virus (EBV), Cytomegalovirus (CMV), and some other viruses associated with Chronic Fatigue Syndrome. Indeed, most people suffering from acute EBV disease (mononucleosis) or chronic EBV (CEBV) develop subacute hepatitis. The liver is also one of the major powerhouses of the body and, when it is badly infected, disruption of both the metabolism and the immune system results, followed by fatigue - a main hallmark of CEBV disease, and depression. Thus, it is essential that the liver be treated.

Avatar universal
I developed a liver ache/pain whilst suffering a yeast infection I now know I have suffered with the infection for many years with IBS to the point of surgery.  Many tests to try & find the cause of the ache  including ultrasound & a hida scan failed to diagnose the problem , when my yeast symptoms finally succumbed to the drugs after 18 months of therapy curiously my ache was still there , other symptoms replaced the yeast symptoms , headaches extending down the neck, aching joints , muscles, toothache & eventually slurred speech  . I concluded, wrongly as it turned out that I had local area where yeast still lingered, Eventually I took bacterial antibiotics for a suspected tooth abscess,[ affecting systemically]  All symptoms responded to the drug ,but the symptoms returned on stopping medication, tests followed for chlamidyia [sp] Hepatitis, HIV , plus others all negative . I asked if Mycoplasma could be considered. the consultant I was under agreed it may be a contender, he added it may also be
Avatar universal
I know EXACTLY what your wife is going through.  I am 36yr female with SOD and biliary problems.  All started after the removal of my gallbladder.  It took me almost 5 years to find a dr. willing to really listen to my symptoms and my descriptions of my attacks.  Good luck to you and your wife.  Let me know if I can be of any help.
Avatar universal
Hi Kristin,

Please let me know more about your history - what your symptoms are and what you went through.  I am so frustrated with all this... maybe you can give me some insight!

Thank you,
Tracy (SweetSaudade)
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