Constant Mid Upper Abdominal Pain

[amc776]

I am a 27 year old female who has been having pretty constant mid upper abdominal pain-moderate for 3 1/2 weeks now.  It started when I was on Zithrmax for a sinus infection.  It is usually worse at night.  I have a history of hemangiomas(largest is under 3cm) and possibly 1 hepatic adnemoma which my doc says he is not concerned about.  I had a CT scan done in October.  My general doc sent me in for an UGI which came back normal and have had numerous blood work(pancreas, liver, CBC and h.pylori) all came back normal.  When pain is at its worst, it sometimes travels to my back, below my shoulder blades.  I also had my gallbladder out 2 years ago and had an ERCP the day before the surgery.  The pain can sometimes run to either the left or right side under my ribs, but mostly its in the middle.  It is located high in the upper abdominal region.  I have also tried Protonix which has really done nothing.  Like I said, the pain is usually worse at night but I do have "tenderness" almost always.In the last 3 1/2 weeks, I've had 2 days without any pain.  When I lie down at night, I sometimes have an empty stomach feeling.  I even have a hard time taking deep breathes although I do have a history of anxiety.  I feel very bloated and distended all the time.  I also tend to drink a lot of pop(not caffefine free) and I do  smoke about 10 cigarettes a day.  My general doc told me to make an appointment with an internalist which I am in search of. I have no fever or nausea and otherwise feel fine, only stressed.  Could something be related to the antibiotics?  Or is probably just a coincidence?  Any ideas would be greatly appreciated.  I have had 2 CT scans done in the last 2 years since they found the tumors on the liver ( found incidently from ultrasound on gallbladder).  Showed no growth on hepatic adenoma and possible 1 cm growth on hemangioma but general doc had tests ordered and there was never a side to side comparison done.  Liver doc thinks there may have not even been growth.  I had just had a baby 4 months before having the 2nd CT scan and I know hormones can make them grow.  Is there also a chance it could be anxiety related?  I had moderate pain tonight, ate pizza which then made it worse, took 2 tums and then pain subsided somewhat but that is not always the case. There feels like there is always a heaviness as more so than pain during the day. I know I gave you a lot of info but I thought the more the better to explain to you.  Any input would be greatly appreciated.

[tuff case]

Just to follo-up with what Kristin said. I also was diagnosed with the SOD type II.  You can read my entry.  But one of things my GI Dr. just told me on 4/8 was that they have found SOD secondry to IBS. So if you do have IBS and had the ERCP before it may not have shown anything previously.  Also they cut my SOD once and put a ballon through it and thought that it was find and the third time they measured the pressured and were actuslly surprised and had to cut it again along with the pancreatic valve.  Unfortunately for me the procedures have not provided any relief and I maybe looking at yet a forth.  There was only a 30% chance that this may have helped. So unfortunately for me I fell in the 70% range.  You may want to weigh your options.  My 4th ERCP is for somethings that I am feeling since that third one.  Again please read my entry (cancer/tuff case).  Go luck to you.

[amc776]

What are the specific symptoms of SOD?  I can't really find much on it.  My pain is more bothersome than painful most of the time.  It does not wake me up at all- worst when I am standing or sitting forward.  Lying down actually helps lately.  Any input?

[tuff case]

Well I can what my symptoms have been, I have URQ pain that radiates to the back (occasionally), nausea everyday ongoing for over a year now.  My GI Dr. asked me if the symptoms were as if I never had my gall bladder out and I would have to say yes.  So fatty foods can sometimes set it off (however this also is not all the time). I generally wake up feeling very nauseated, after I eat the nausea will go away for awhile but will come back later in the day.  As for the pain it used to come about an hour after I ate but now there is no timing it as it comes and goes at will (this also started before the procedures).  My pain at night was bad enough that most of time I could not even lay on my right side. (This has improved) I also have been diagonosed with GERD which is one fo the other things that MD-NYP is suggesting you be check for.  Being that you ususlly feel this at night see if eluvating your upper body about 6-7 inches helps. Unfortunately doing this with pillows does not help.  They suggest putting bricks under the legs of the head of the bed elevate.  One way I did find is using Couch cushions and sleeping in almost an sitting postion.  This may give you some relief while you are waiting for some test results.  If it is GERD I have heard that people feel abdominal pain instead of heartburn.  I elevate myelf more for the Acid refulx relief as it does not help the abdominal pain.  But what does not help one person may not mean it will not help another.  And if this does help Great.  Good luck to you!

[mymomissick]

About 10 months ago my mom had her gallbladder removed because the doctors thought that would relieve her pain. Well, her pain has gotten worse since. Now it's not just LRQ pain, but URQ also, accompanied by lots of nasea. A couple weeks ago she was so sick and dehydrated my dad, who is an internal medicine doctor, decided to take her to the hospital. (All the medicines he had been trying for her, as well has her gastrointestinal specialist, had not been working well up to that point.) She spent days in the hospital getting IV fluids and getting all kinds of tests. In short, all the tests are coming back normal. The specialists don't think it's cancer, but they also have no guess as to what it is, that is, besides SOD. That's the one thing that it might be looking like she has. On Tuesday she'll be going to San Francisco to get further tests for SOD dysfunction (ERCP? Manometry? something like that). So, Kristen, my question is mainly for you. You say you had SOD diagnosed back in 1998? What has been your experience? Did the treatment work and not cause you further complications? Are you mostly / entirely relieved from the pain you had felt? I'm so worried about my mom and REALLY want her to get better.

[tuff case]

Sorry to here about yout mom.  When I had my gall bladder out a few years back my biliary duct duct was enlarge from a normal about 3.5 to 7.3mm.  There was concern then that I may have release a gall stone that would have severe complications, which at that time I had not. When I was diagnosed with the SOD the duct size was also used as an indicator.  Not sure if you know from the ultrasound your mom had before she had her Gall bladder out or not what the size of the bile duct is but this may help.  Kristin and I have been emailing off line and if you go to string of comments under my section "cancer" you will find her email address.  I am sure she will not mind you emailing her off line.  Especially if you do not hear back from here.  Sorry if I can not offer you much more as at time have not had much relief but my symptoms may although daily for over a year are not severe as you mother.  Peace to you and your family!  If there is anything else I can help with let me know I have had 3 going on 4 ERCP's.

[krisg]

Hi, I actually was diagnosed one year ago with SOD.  From 1998 (gallbladder surgery) until 2-2003, I was told that I had IBS or severe acid reflux.  The doctors kept guessing.  I really thought it was SOD all along but it took alot of time to get a proper diagnoses.  Make sure your mom goes to a specialist.  By that I mean, a doctor who does ERCP's a couple of times a week.  It is very important that they are very knowledgeable in this area.  My SOD caused severe upper abdominal pain LUQ, and RUQ also my back hurt too.  Vomitting and dehydration were a part too.  Sometimes my liver enzymes would be elevated and sometimes not.  My first ERCP in 2000 was preformed by a so-called specialist.  He said I had IBS and nothing was wrong.  I knew better than to believe that so I pressed on.  I finally travelled out of state and saw another specialist who performed my first Biliary sphincterotomy. I was told I had high pressure in the bile duct and the sphincter muscle was not opening as it should be.  At that time I was not evaluated for the pancreatic duct pressure.  I got 5 months relief from that first procedure.  I started to have attacks again so I searched for another specialist and I found an excellent dr. in Indiana.  He performed the pressure measurement on the pancreatic duct and looked for signs of chronic pancreatitis.  He also checked and found out that I have celiac disease too.  The pressure was very high in the pancreatic duct so I had a sphincterotomy on that duct and he also enlarged the previous biliary sphincterotomy I had one year prior.  The dr. also placed a temporary stent in the pancreatic duct to prevent post-ERCP pancreatitis.  I did get the pancreatitis but I was told that it was mild.  I only stayed for 3 days in the hospital.  It has been 3 weeks yesterday, since my procedure, and I am finally pain free.  I can only speak from experience and say that it was a rough road to recovery.  I don't know if this procedure will "cure" all my pain in the future.  Only time will tell.  If you have any other questions feel free to e-mail me at ***@****.  Please put ERCP in the subject line or I might delete the message.  I hope this upcoming ERCP will be the answer to your mom's pain.  Lots of people get instant relief from sphincterotomies and never have pain again in their life.  Others take longer to recover from the procedure itself and can get months or years of pain relief.  Tell your mom Good Luck!!