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Avatar universal

Looking for some input re gall type attacks

My wife has been suffering from attacks of intense piercing right side/flank pain just below her ribs but not really well located.  This has been 2 months of this and 3 emergency room visits with basically constant varying dull to medium pain between "attacks".  The last attack March 5 was severe and she basically collapsed, she described the pain as the worst she has ever felt.

She is 26, no kids, healthy weight (5'6" 130lb) excercises every day even with the pain, vegatarian and has eaten a low fat diet for about 3 years or more. Eats 6 small meals a day, drinks about 2L of water daily.  She finds since first getting the pains she can't eat any nuts or peanuts nor anything with any significant amount of fat.  Her stools are lighter coloured tan but has assumed this has been due to veg diet.  Recently she has noticed the area around her mouth takes on an orange hue most days the last 2 weeks, eyes are white.  We have not travelled outside of North America.

The pain begins shortly after rising in the morning and continues through the day, usaully worst around 8-9 in the evening continuing into sleep.  Heating pad is constantly with her in bed trying to help the pain.  Eating and drinking doesn't seem to affect it as she has tryed every combo of foods thinking it was an alergy.  When the first attacks happened we had a terrible time getting her to eat because she thought that caused the pain.

Her white cell count is normal, her urine analysis came back clean.  The first and only RUQ ultrasound didn't show anything.  She is not pregnant (actually impossible due to some complications of long term depo-provera use)  No fever, bp normal.

The latest attack the ER doc prescribed strong acid suppressant to try to rule out the collection of ulcer related issues but she has no gas, burping, dirarea heartburn etc.

Her family doc sent her for blood tests but we don't have any results yet.  The previous two ER visits resulted in docs thinking she was pregnant despite not having sex in the last 6 mo due to the depo problems, once the neg results on the urine sample came in they just sent her home and told her to try and solve it with her family doc.  She is begining to resist going to the hospital when an attack comes on because she feels they don't believe her and aren't going to help her.

Since the most recent attack the following day the whole area that was in pain was sore and ached, she described as "tired sore" turning into pain again in the evening after bending over to do some stretches after we excercised.  The next morning (today) she took her vitamens and drank a glass of cold water which started the pain.

Any ideas?  Everything I read points to gall related problems but as soon as we mention it the doc's say US was fine and they steer the conversation elsewhere.
18 Responses
233190 tn?1278553401
A normal ultrasound does not completely rule out gallbladder disease.  

You can consider a HIDA scan with CCK stimulation to evaluate the gallbladder ejection fraction.  If low, there are some small studies that suggest that removing the gallbladder can help with the symptoms.

If that test is negative, you can consider evaluating the upper GI tract with an upper GI series or upper endoscopy.  Conditions like ulcers, inflammation of the upper digestive tract or GERD can also lead to the symptoms.

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.
Avatar universal
Her PCP needs to order a hida scan of her gall bladder..This will show her ejection fraction. It sounds exactly like gallbladder problems. Her URQ ultra sound does not rule out a non-functioning GB. It will usually show stones if there are any.
Avatar universal
A further note, she drinks no caffine, when the pain is bad it hurts to inhale and lastly when the pain is bad, it hurts when the doctor sticks his fingers below her rib cage on the right side (is this called a murphy sign or something?)

We were able to get her an appointment today with her GP's partner, unfortunately she said, "well the US is fine so its obviously not serious".  Upon finding out my wife exercises she decided it was muscular-skeletal (We both dropped out jaw as we know it is deeper inside her than that and have both had musclar injuries before!)

The doctor did propose to schedule a CT scan incase something else might show up and to take Robacecet.  Very frustrating, I am 100% certain it is not a pulled back muscle and so is my wife.
Avatar universal
The previous commenter was right on target. A hida-scan is the next step, and make sure they give her the drug to make her gallbladder contract. This will show a lot. If that test comes back normal, INSIST on a gastrointerologist consult. If all else fails, go to the ER, and refuse to go home until they do the testsyou want, and let her see a gastro. You are right, they are wrong. Afterall, even Dr.'s are subject to the limits of their own intelligence and experience.
Avatar universal
Another note was the last attack last about 2 or 3 hours.
Avatar universal
Some attack can last hours or even all night. I had to take a narcotic to combat the pain. I wish I could offer more help, but I'm still waiting for my gastro appointment. I stopped having the severe pain, but I never got a diagnosis.
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