Right Upper Quadrant Pain

[reinejessica]

I am a 27YO female, relatively healthy, have lousy allergies, but am otherwise fine.

I have been dealing with right upper quadrant pain for the past 5 years. It is a dull pain about 3 inches below my last rib. My whole core is tender when pressed, but especially in that spot. It also hurts when I breathe in deeply. The pain happens daily usually in the late afternoon and lasts through the evening but comes and goes in waves. When the wave of pain leaves, I cannot stay awake no matter how hard I try.

It lasts for 2 weeks - 4 months and then leaves. The "down time" can last for 2 weeks-10 months.

In the weeks leading up to the pain returning I have low-grade fevers, nausea, heightened white blood cell count and a blood sediment test shows inflammation. Stress seems to be the only thing that brings on the pain. Bumps in the car and walking seem to aggravate it. It does not seem to be affected by food or anything else.

On a pain scale of 1-10, it is generally 4-5 but increases to 7-8 with stress or bumps. It has gone to 10 only once, when I was in the E.R. There was never a diagnosis. They admitted me and gave me I.V. antibiotics and pain medicine. I was released after 2 days. But was not conscious for most of the time I was there.

I have had 2 hidascans, several ultrasounds, CT, MRI... everything is negative. I am at my wits end, no one can help me and I feel crazy. I am looking for any suggestions or avenues that my doctors have not yet thought of, or even the right specialist to see. I can't keep living with this quality of life.

[John Kenyon, CNA]

Hello-

I can't help but wonder, with all the imaging tests you've had done, if one of them was a cholecystogram (which looks at the gallbladder). While you state the episodes of pain don't seem to be affected by food intake, and while a food connection is common with gallbladder problems, it is not always the trigger, and in other cases it's just not very obvious.

The area you describe and the sensations you describe do sound most like liver/gallbladder related problems, specifically biliary colic such as comes with attacks of the gallbladder. If this possibility has been positively ruled out then I'm at a loss unless there are more facts you can supply. Hopefully this is helpful.

Please let us know if there is anything you might have left out which could have a bearing on this problem. Meanwhile I'll try and ponder this and see if I can come up with any other suggestions.

[reinejessica]

I can't thank you enough for responding to me!!!!!!!

I have not had a cholecystogram that I am aware of, I have never heard of it. I will definitely bring it up with my doctor.

With my last hidascan (according to the tech, but it was not in the final report) my gallbladder waited until the last POSSIBLE second to "dump," after they had me stand up. Stored it all and then gushed it all at once while I was standing and not under the machine. So, they called it ruled out... I came in with side pains and they were present throughout, so I don't think that I could have just caught it on a well-behaving day.

I really can't think of anything I am leaving out except that I also have IBS. They don't seem related in the least, in fact my worst digestive symptoms are mercifully in the off time for pain. Probably because I tend to eat significantly less when I have side pains. The next step from my primary care physician was a colonoscopy for Chron's Disease, because two of my aunts have it. Insurance denied it. I plan to try again since I now have different insurance, however my aunts do not seem convinced, neither did my primary care physician. I think he's out of ideas too.

I tried to get a second opinion, but the doctor I went to said I needed to go back to the doctor who knew the history of it and wouldn't work with me, but it didn't sound life-threatening... gee, thanks.

Otherwise, I think you know everything I know... which isn't much unfortunately. What would happen if I had one of these big expensive tests on a day that I didn't have pain, would it still find something?

[John Kenyon, CNA]

Hi, and thanks for staying in touch.

While the family history of Chron's disease certainly does warrant a rule out there, it is more difficult to determine for certain without a biopsy, whether or not this is present. But the odd behavior of your gallbladder suggests to me that it may have some sludge or stones which stay put most of the time and allowed the contrast media to escape when you changed position, which is really rather odd and just adds to my suspicion about that. It sounds as though the findings from the HIDA scan were not recorded 100 per cent accurately because of the way things went, and a repeat may be in order. Something about that whole sequence of events seems odd and worth further exploration and I think the cholecystogram is perhaps more telling in some cases. I think it might be in your case because of the odd behavior noted by the tech. Being tested on a day with no symptoms shouldn't normally make any difference.

Please keep us apprised of how things go. Best of luck to you. Feel better!