Constant RUQ abdominal pain

[Pixie1969too]

Hello,
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.

[Kevin Pho, MD]

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.

Thanks,
Kevin, M.D.

[curious123]

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....

[curious123]

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....

[Pixie1969too]

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..

[woodman]

Hi.  Check out my last post under "Upper Right Quadrant Pain."  I've been dealing with this for about a year now.

[normy]

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!!!!!!!!!!!!!

[PAJ]

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.

[woodman]

Your bacteria and yeast infection.......how did it cause your URQ pain?  How did the doctors figure that to be the problem??

[woodman]

Also, did you have any other symptoms besides upper right quadrant pain??

[PAJ]

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

[krisg]

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.

[Pixie1969too]

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)

[krisg]

I started to have gallbladder attacks 5 yrs. ago.  I then was recommended for a lap chol. because of stones.  After the surgery and for the next 2 years, I had these "attacks" of severe pain, nausau, profuse sweating, and sometimes vomiting. My regular doc. switched me to prevacid for severe acid reflux.  I was finally hospitalized because I had an attack while driving, with all the above symptoms and trouble breathing. (Kind of felt like a heart attack, although I have never had one).  My liver enzymes were in the 300's and I felt very ill for 3 days.  I then was recommended to a (specialist) to have an ERCP to check for Sphincter of Oddi Dysfunction. The dr. preformed an ERCP with biliary manometry and said my pressure in the bile duct was fine.  He concluded that I had IBS.  I didn't believe him but what choice did I have. I was started on Levsin (anti-spasm drug)and elavil(anti-depressant) in low doses is supposed to help calm the digestive tract.  I then had 2 more attacks within a week and ended in the ER.  I went back to the specialist and he told me that nothing was wrong with me and he didn't have time for this!  To say the least, that was my wake-up call.  I then decided to gather all my medical records from the lap. chol., and from all the ER room visits, blood tests, etc.  I took all my records to another dr. (in another state).  He looked at my records and listened to my story.  He then referred me to a University Hospital with another specialist.  I went this past Feb. and the specialist was doing another ERCP to check out the biliary tree.  He found that my sphincter of oddi muscle was clamed shut, I had biliary stenosis(narowing of the bile dct) and was full of mucus.  He performed a generous biliary sphincterotomy.  I finally felt relieved that something was being done.  Although I have to say I have started to have attacks again. (3 since the surgery).  I saw the specialist again for another ERCP (we thought the sphincterotomy had scarred up.  Nothing was found and the sphincterotomy site was still open.  I have had 3 MRCP's in the past 3 months that all show a 3mm stone in the bile duct.  My current situation is:  a stone shows up on the MRCP but the Gastro. specialist cannot find it when he did the ERCP.  I continue to have painful attacks in the LUQ and RUQ.  Sorry for the long post, I tried to let you know what I've been fighting for 5 years now. I think you should definetly go to a university hosp. in NY.  Hopefully someone can help you get some releif.   I do feel better knowing what is happening inside me and I have medication that helps me get through too.

[krisg]

I forgot to say what med.s I take.  I take prevacid, elavil(20mg), and donnatal (anti-spasm).  When I have the bad attacks my doctor prescribed me mepergan (pain med. w/anti-nausau) so I don't have to run to the ER all the time.  I have finally found a family doc. who knows all about SOD, biliary pancreatitis, etc.  He has been a big help too.

[dlogan]

I can't believe there are so many people out there with such similar symptoms and not many concrete answers.  

I have an 18 year old daughter who has been having similar symptoms for 2-1/2 years.  She began bouts of vomiting and diarrhea when she was 16 years old.  She would vomit for a couple hours straight some nights.  Right after her 17th birthday she had her gull bladder removed because a hidascan (sp?) showed it was only functioning 20%.  Her symptoms never improved after its removal.  In fact, they got worse.

She had a colonoscopy which showed nothing, but shortly after was diagnosed w/c diff.  It took almost 5 months of flagyl and vancomycin to finally get a negative.  Her symptoms seemed to get better, but she still had diarrhea and stomach pain almost constantly. One of her Gliadin levels is up but not both which I understand rules out celliac disease.

She recently developed c diff again - only this time it only took 8 weeks to get a negative.  She just had an endoscopy yesterday, and her GI dr took biopsies but won't get results for a few days.  The endoscopy showed a lot of inflammation in her small intestine and a pin-size erosion in her stomach.  She tested negative for h pylori in September.

She has been on Protonix, but it only worked for awhile.  She just started Aciphex today.

In many of these comments I have seen SOD, MRCP, and ERCP mentioned.  Since I don't know what these mean, could someone please enlighten me?  I would also like to know how they test for yeast infection syndrome.

We are getting desperate for answers.  I have a child who has been healthy her entire life until now.  She is depressed, and just plain tired of being sick all the time.  She missed her entire senior year of high school and had to be home-schooled because she couldn't function in school.  She is now at a community college but had to take three Incompletes because of missing so much class.  Luckily her instructors have been very understanding.  I have to keep her in school or we'll lose her health insurance.  If she has to quit and loses her insurance, we will never be able to afford the medical bills!

[krisg]

SOD stands for "Sphincter of Oddi Dysfunction".  The sphincter muscle is located at the end of the bile duct.  Bile and pancreatic juices enter the duodenum through this muscle. It seems that some people (including myself) have increased pressure in this muscle once the gallbladder is gone.  My sphincter was clammed shut and was not opening when it was supposed to, causing a backup of bile into the liver. That resulted in elevated liver enzymes on a blood test.  The times that this happened were extremely painful if not debilitating.  It also took me almost 5 years to get a proper diagnoses.  The gold standard for testing is an ERCP (they put a scope down through the stomache and into the duodenum and inject dye into the bile duct and pancreatic duct to check for any abnormalities and then test the sphincter for high pressure).  Do a search under Yahoo or Google.  You will find alot of useful information to take with you on the next dr. appt.  A MRCP is just a MRI of the biliary tree.  They can also check for blockages and stones, etc. in the ducts.  The MRI is much safer and does not require any prep but a 4 hour fasting.  Also, I will mention that the ERCP does require a specialist to perform it.  Your best bet would be to go to a University Hospital if possible and seek a specialist there.  Good Luck

[dlogan]

Thank you so much for answering my questions.  I've researched further and have very high hopes that we may have some answers for my daughter's problems.  She has an appt at Johns Hopkins in March, so hopefully we'll get her straightened out.

[krisg]

glad I could help...........

[ricksca]

As a 25 year sufferer of URQ pain, all these stories sound familiar. I finally gave up and allowed my gallbladder to be removed last year. Of course, there was no problem found with it upon removal and the pain has gotten worse. Most likely that SOD is (and was) the cause of my pain. I have had two ERCP's that were inconclusive because the doc couldn't get into the sphincter. Only choice now is to proceed with Sphincterotomy. My question is, are there any people out there who have experienced lasting relief from this proceedure? Or lasting damage? Rick

[krisg]

My first ERCP was preformed by a so-called specialist.  According to his report, he had to try 5-6 times to access my bile duct. He neglected to tell me this when I woke from the procedure.  After gathering my medical records ( extremely important), and much further research, I discovered that dr.'s are not supposed to make repeated attempts to get through the sphincter muscle due to further damage being caused.  My 2nd ERCP (2003) was done by a dr. at another University Hospital and he tried to access the bile duct with the standard equipment, then when he could not, he performed a precut papillotomy.  A small cut in the sphincter muscle to allow access to perform the ERCP.  The dr. then performed a generous biliary sphincterotomy (a larger cut).  I did have relief for about 5-6 months.  I now have problems with small stones forming in the bile duct and getting temporarily caught around the bottom of the bile duct, giving me attacks of pain.  The stones are smaller than the bile duct itself so they pass after a couple of weeks.  My point is, that one dr.s  opinion is not necessarily the best.  My first dr. who did the ERCP told me nothing was wrong and to deal with it, i.e. diagnoses IBS.  My 2nd dr. found that the sphincter was scarred closed and the bile duct was full of mucous.  Good Luck and make sure you go to a dr. who performs many of these per week.  Also gather all your medical records and go over them yourself.  Don't know where you are located, but University of Indiana Hospital has a whole ERCP building and that's what they do all day and all week long.(my next destination)

[athompson]

Wow...I am glad to know that I am not crazy. I am a 38 YO female that has been suffering the same RUQ pain for 1 year.  I have had every test know to man, a TAH and my gallbladder removed.  I went to a gastro for a second opinion after my 1st gastro told me to "live with the pain."  Went to the doctor, my liver profile was elevated so he performed an ERCP with SOD MAN.  My SOD pressure was 120 and a sphincterotomy was performed and a temp stint was put in.  I had a wierd pain in my right shoulder for 4 days and now my RUQ pain has returned.  Has anyone had a sphincteotomy that didn't work?  If you did, what was your next step?  

Thanks so much for your help!  I know how frustrating this can be.

[krisg]

Hi, I had a biliary sphincterotomy done in Feb 03.  I still have attacks of pain but they are milder in nature.  Don't get me wrong, they are still quite painful.  I go through a certain process everytime I come down with pain, approx. every 6 weeks:  
1.  have attack
2.  get bloodowrk done
3.  have a MRCP done.

I have finally found a good relationship with a local primary physician.  This is the course of action he has recommended.  He also prescribed me pain med.s to take when I have attacks.  I only need to take them for approx. 2 days, then I feel better.  So far, my bloodwork shows normal but the MRCP shows a small stone in the bile duct.  Since the stone is smaller than my bile duct and since I have already had a sphincterotomy done, I am told (by a local gastro. dr) that I live with the attacks as long as my bloodwork is normal.  Apparently dr.'s will not do anything about the stones unless bloodwork shows elevated enzymes, meaning that the stones are blocking the flow of bile.  Then another ERCP would be in order.   It was very hard for me to accept this course of action at first.  My first response was why can't they take out the stone??  Well, they have tried, but by the time they schedule me for an ERCP, the stone seems to have passed.  I keep producing small stones in the bile duct and they cause intermittent pain for a couple of weeks, then pass.  So this is what I live with and hope that maybe some of my information may be of help to you.

[MTV]

Wow...in almost every post that I have read on this subject, I see myself.  Am 32 yrs old, non-smoker, exercise, part vegan.  Had gallbladder removed in April 2002 and have been miserable since.  I am sorry that we are all suffering, but it is good to know that I am not alone. I too, am going through a battery of tests, to no avail.  Can't get in to see my gastro until March, but I am definately bringing a copy of this to him.  Thanks for all the info!

Melinda

[krisg]

That's why I post on this board.....to constantly remind myself that I am not alone.   I'm a 36 yr old female.  Seems that alot of us have ALOT in common since our gallbladder surgeries...