Tightness/pain beneath right rib radiating to mid and lower back

[revjr]

I'm a 37 year-old male. Approximately 6 weeks ago, I started feeling a tightness and pressure under my right rib. No fever or nausea accompanies it and it doesn't seem to worsen after meals. In the last few days, the tightness, which makes me visualize a golfball under my rib cage, seems combined with a pain in my mid and lower back. I also noticed that the area in my right rib is slightly tender to the touch now. It's most noticeable when I'm lying down. Really a ratcheting up or tightening sensation. My GP ordered a chest CT scan and RUQ ultrasound, both of which showed no "abnormalities." Now he wants to order a HIDA scan. I had a kidney stone in 2006 with radically different symptoms than those I'm experiencing now. My question - is it appropriate at this point for me to ask for a referral to an internist, gastroenterologist, or urologist? Each time my GP orders a test it takes about two weeks to get it performed, and I'm anxious about the length of time this is taking to narrow down and whether I might be in danger of a blockage or infection (if that's not what I'm already experiencing). I mean, what do I do next if the HIDA doesn't show anything wrong with my gallbladder other than wait for him to suggest yet another procedure?

[Leslie44]

Does anyone know if calcified gall stones show up on x-rays?

[mikcin]

Did they say where the mass was?  Hopefully you will get the results soon.  I hope they get it all taken care of soon.  I understand the feelings and pain you are experiencing which only gets worse as time goes on.  When I had all of my tests the technologists never uttered a word.  I was always in the hospital at the time of the tests (because of my pain level) and they ususally told me the next day.  Are you supposed to call to get results?  They are usually available the next day.  We live in a very rural community which does not have any real specialists and it took forever to get an appointment with a good gastro.  I had to go to three different ones before I had the right procedure to get rid of the pain.  It is so awful that it takes so long, and sometimes they look at you like you have two heads and you are just making things up.  But do not give up, there is hope.  I know how frustrating and nerve racking it all is just have the fear of the unknown.  I have ended up losing about 40 pounds thru all of this, but now for the first time in 5 years (so far)  I am able to eat without bloating.  The best thing to do when you go for an appointment is write up a list of questions before you go because the docs usually rush thru, then you leave not knowing what you need to know.  Let me know what you find out.

[Leslie44]

I had my ultrasounds and x-rays done today, hopefully will get the results soon.  After I had the x-ray the technologist was looking at the pictures and it appeared that there was some type of mass there but of course they never give you any info.  I'm a little worried.

[JimK3145]

Thanks for the info about the ERCP. I will definitely mention it to my new gastroenterologist. I do have one question for you. Did you ever have a HIDA scan with CCK stimulation done before your gallbladder was removed? This test will give an indication of the Gallbladder ejection fraction (GBEF) which tells how much bile the gallbladder ejects during digestion. Supposedly, a good gallbladder has a GBEF of about 70% and if this percentage falls below 40%, that this is an indication that the gallbladder is not functioning properly. The cause of this could be sludge (actually, tiny crystals) which from what I'm led to believe is not picked up on a sonigram. This sludge has the potential of eventually forming gallstones. I had a HIDA scan done but without the CCK stimulation and all the results said was that the gallbladder was functioning okay but it did indicate the percentage. I have seen a surgeon about having the gallbladder removed but he said that based on the tests that I had done, (abdominal sonigram, CT scan, and HIDA scan without stimulation) there is currently no surgical justification to have it removed, but he did mention that I might want to have the HIDA scan rerun but this time with the CCK stimulation. So when I see a new gastroenterologist at the end of May, I will mention the ERCP as well as the HIDA scan with CCK stimulation. Thanks again for the comments!

[JimK3145]

I've been following your comments as well as those of Leslie44. I have had similar symptoms of pain under my right front rib cage and well as on my back right rib cage. This started about 6 months ago. At first, it was really intense, happened about 1-2 times a week. Then in January thru March of this year, it became more frequent. But starting in April, it turned into more of a stiffness similar to what revjr is reporting. This stiffness is now very low level, lets me sleep at night, but I always know that it's there. I've had an abodomen sonigram, HIDA scan and CT scan and all say that my gallbladder and liver are okay. I had blood work done and that says that my liver seems to be okay also. My current gastroenterologist is stumped as to what is causing this pain/stiffness so he wants me to see another gastro doc at a teaching/medical hospital which I'm scheduled to do in late May. My primary care doc thinks it might be related to IBS but my current gastro doc doesn't seem to be convinced. I'll keep you both posted as to what the new gastro doc says at the end of May in regards to diagnosis, further testing , etc, Hopefully, the three of us will get this figured out.

[revjr]

It does sound very similar to mine. Mine is more of a tightness as opposed to pain, but I have become worried since it's spread through to my back and side now. Just like you, this doesn't affect my sleep. It's very noticeable when I'm sitting up or lying in bed...the hollowness you mention in your chest - I have had a sensation like a warm liquid spilling over my chest on occasion (not like reflux or GERD, though). I had a stress test and echo a few months ago for some tightness then but supposedly the results were normal. Now, oddly enough, the chest tightness has vanished and been replaced by this mess.