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Forum Name: Gastroenterology Topics

Question: Negative HIDA, CT & US - Still in pain. What should I do?


 abbygrl33 - Sat Nov 01, 2008 8:06 pm

I have been having severe RUQ pain that comes and goes in waves since Tuesday (I have had these pains before, about an hour after eating a heavy meal, but usually they go away after an hour or two). The pain wraps around my side and feels like my skin is going to burst open. Went to the ED Thursday night. Had a positive Murphy's sign. They did an ultrasound, a CT scan & HIDA scan. All tests were negative for gallbladder problems. They gave me pain meds and I was ok for a bit, but now I am in pain again... What should I do? If the pain is not from my gallbladder what could it be? I am tired of this; please help.
 Dr. Safaa Mahmoud - Sat Nov 29, 2008 6:20 pm

User avatar Hello,
Causes of Pain in the Right side of the abdomen include:
-Gall Bladder or Billiary disease cause right upper quadrant or in the upper middle of the abdomen and occur mainly after meals (fatty) and may be associated with nausea and vomiting. The pain may radiate to the back or below the right. US, CT scan and HIDA scan are the tests used for diagnosis.

- Other diseases that can give similar pictures and have to be excluded are Gastritis, GERD, and peptic ulcer. They are usually associated with GIT symptoms like nausea, loss of appetite, diarrhea. Upper endoscopy would confirm diagnosis.

- Colitis whether infectious or inflammatory may give similar clinical picture. Stool analysis would be a good initial test.

-Pancreatitis usually presents with severe acute abdominal pain that is felt in the upper abdomen and or in the back. In mild cases the pain is mild and becomes more severe with eating and is associated in many cases with nausea and vomiting, fever and tachycardia. Ultrasonography and CT Scan show characteristic changes in the pancreas. Serum amylase and alkaline phosphatase are usually elevated.

- IBS:
Commonly people who have IBS complaints of abdominal pain or colic, gaseous distension, either Diarrhea or constipation or an alternating between both of them and mucus containing stool. Diagnosis is made by exclusion of other causes.

- Renal pain (less likely) is usually felt as colicky pains and radiates down to the groin. It is commonly associated with other urinary symptoms, like burning micturition or urine frequency. CT scan can detect renal stones as well as kidney changes.

Required investigations include:
Complete blood picture CBC, Blood chemistry: like serum amylase lipase, liver enzymes and stool analysis. Upper endoscopy may be needed if symptoms persist.

I would advise you to follow up with your doctor, update him with your symptoms and discuss with him your concerns.
Please keep us updated.
Best regards.

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