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Forum Name: Gastroenterology Topics

Question: diferential diagnosis


 pmjbeardies - Mon Nov 15, 2004 10:28 pm

Mild upset stomach prior to bed last night. Awoke at 6 am with acute abdominal pain (8/10 scale) located in upper right hand quadrant of abdomen. It felt almost exactly like the one other incident with gall bladder pain I had, so I assumed it had caught up with me again. At nine am I just could not deal with the unremitting pain any longer and checked into the ER. Treated with demerol and phenergan (sp?) and D5W drip. The surprise is that the blood tests did NOT show an increase in amylase and the other one (I forget the name). I was told that was sufficient to rule out gall bladder. They also took a CXR but I did not hear of the results. I am home again, nine pm and took a hydrocodone 5 mg just to keep some level of control but am no longer in distress. As far as I know my liver is fine - palpated okay within last three months and no noted lab abnormalities then or today.

My question is obvious, I guess - what the heck can cause pretty darn similar symptoms as an acute gall bladder attack if its not a gall bladder attack? Frankly, the ER doc sent me home with the comment "I really don't know what's wrong" - a pretty useless diagnosis. Any ideas? Thanks.
 Dr. Russell M - Wed Nov 24, 2004 12:34 am

User avatar Hi!

Possible other causes of pain on that side, apart from gall bladder and liver, include pancreatic, renal, and intestinal causes. I am not aware of raised amylase being a pointer towards gall bladder disease, unless complicated.

But the list is exhaustive and include:

Abdominal Abscess
Abdominal Angina
Abdominal Aortic Aneurysm
Angina Pectoris
Appendicitis
Colonic Obstruction
Diverticulitis
Duodenal Ulcers
Esophageal Spasm
Esophagitis
Gastric Ulcers
Gastritis, Acute
Gastroesophageal Reflux Disease
Irritable Bowel Syndrome
Mesenteric Venous Thrombosis
Myocardial Infarction
Myocardial Ischemia
Opioid Abuse
Pancreatitis, Acute
Pancreatitis, Chronic
Pericarditis, Acute
Sphincter of Oddi dysfunction
Spinal nerve root compression
Nonulcer dyspepsia

Hope this helps.

bill
 pmjbeardies - Mon Nov 29, 2004 11:35 pm

What a list; however, I shall not just shoot myself. I have been informed by my regular pulmonologist that the doc in the ER doesn't know his amylase from his . . . that amylase and lipase are indicative of pancreatic stuff. Oh well. So I spect it was the gall bladder attack I originally thought it was. Thanks ever so for writing though - it is appreciated.

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