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]

The tight uncomfortable feeling is constant for me except while asleep, but it makes it very difficult to get into a comfortable position at night.  Yesterday it seemed that this uncomfortableness was more moderate and is now not half as bad as it was in the beginning, but still there.  I also noticed that it feels like I have some muscle strain in my lower back right side, maybe due to the continuous clenching.  Hope we can all resolve this sooner than later! Regards

[JimK3145]

I also have experienced the muscle strain in my lower back on the right side. During the day, the stiffness is very low but when I wake up after sleeping, I often note that the stiffness is more pronounced. After I'm up for about an hour, the stiffness returns to the low level state. Like I mentioned in my earlier post, my primary care doc thinks it might be related to IBS, but I would think that if it was, the stiffness would come and go rather than be present all of the time. Lets keep our fingers crossed that one of us three gets some good explanation!

[mikcin]

I like you and Leslie44 went thru like symptoms for 5 years only after the GB removal.  It took this long for anything to surface.  I would definately go to another gastro who should consider an ERCP.  I just had to have 3 of them done to clear the CBD.  The first attempt to get the impacted stones failed, then on to another gastro who could get them, then had to go back 6 weeks later and have yet another to clear out sludge in the CBD and this sludge did not show up on the last CT scan either, but CBD was full of sludge.  Believe me I had been thru every test in the book before this was done.  Several hospitalizations and trips to the ER in pain.  Evidently this was built up for quite some time and my liver enzymes finally went very high when the stones were impacted.  So I would keep trying to get to the bottom of this before you have to go thru all the pain.  It really sounds like you are experiencing something disfunctioning in your GB.  I also had the knot just before the emergency GB removal.

[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!

[mikcin]

No they did not perform the HIDA scan before the emergency GB removal and I believe if they had I would not have suffered all of this for 5 years, they only did a sonogram.  I am not a Dr by any means, but I just am stating what all unnecessary pain that I suffered.  A year and a half ago I was admitted thru the ER where they performed all the tests including the HIDA scan and all tests came back fine. My GB was removed 3 1/2 yrs prior.  They ended up diagnosing me with messentary lymphrodonitis, which is something that children get.  There were 6 docs standing around scratching their heads not know what to do.  None of them were gastros.  Some even mentioned IBS.  Let me tell you it took 5 years and 3 different gastros to get to the bottom of it.  Not to mention all the bills and trips to ER and pain meds.  I am hoping that this last ERCP cures everything.  I hope you also can get to the bottom of this to be pain free.  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.