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Gastroenterology  (Expert Forum)
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Pain in RUQ that radiates towards back
Answered by
Kevin Pho, MD - Internal Medicine
Kevin, M.D. Boston - MA
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
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MedHelp Member's Question

Pain in RUQ that radiates towards back

by gsue, Mar 21, 2004 12:00AM
I've had this pain on and off for past two years since my gallbladder was removed.  I've had 4 ERCP's to remove a stone and when they get there they say the stone must have fell out when they went in because they didn't find it and they just get sludge.  Then within a month the pain starts back up again and I'm in agony but for several months doctors say it is just IBS until the liver enzymes start acting up again.  About a month ago it started again and this time the ER doctor even said I looked yellow but liver test only showed slightly elevated enzymes.  For the past few months I've had diareria continuously, so bad that it caused hemoriods to bleed for two weeks.  This made gastro doc order virtual colonoscope but it showed only moderate distention of colon and small amount of fluid in right side of colon. I've had a cholecystectomy done I think it is called to widen the bile duct and open it due to blockage.  My question is could this pain be caused by this stone that could still be there?  Is it possible that they just pushed it up in there somewhere and are missing it somehow even with ct scans?  I'm miserable and would love to have an answer for this misery.  I have had the IBS symptoms before and this is nothing like it.  It is much more severe.  I've taken two vicodin 500mg for this pain and it doesn't phase it.  The hospital has also given me pain shots that didn't phase it when it hurts bad so I don't see how IBS can be that bad and does IBS elevate liver enzymes?  Also I've been losing weight over the past few months.  I've went from 160 to 140 pounds which is good but I'm tired all the time and sick at my stomach a lot.  Can't eat very much at a time.  Everything seems to make my stomach hurt.  This can't be normal for IBS is it?  Just seems like since my pancreatic duct first got blocked my stomach has never returned to normal.  It is like my pancreas is always hurting or I when I had pancreatis if that makes sense.  Is it possible that my pancreas has something to do with this?  I guess my main question is what else can I ask to have done I've had ct's don't know what to do? Should I just give up? No one here can seem to figure this out but I did schedule one more appointment with a university doctor in hopes to get an answer.  Still, I hate to keep wasting money if there is really no other tests to be done.  We do have a family history of cancer and fructose intolorance if that could cause any of this?T hey haven't really tested the pancreas but they did test the liver once and said it was fatty if that helps.
Doctor's Answer

by Kevin Pho, MD, Mar 23, 2004 12:00AM
One consideration may be Sphincter of Oddi dysfunction.  This is suspected in those with biliary-type right upper quadrant pain without any apparent causes.  SOD is most commonly recognized in patients who have undergone cholecystectomy (hence the name postcholecystectomy syndrome). The reasons for this are not well understood, but may be related to unmasking of preexisting SOD due to removal of the gallbladder.



To evaluate for this an ultrasound fatty meal may be considered.  If positive, Sphincter of Oddi manometry can then be done for further evaluation.  If negative, manometry may still be performed if the symptoms continue.  



IBS as well as carbohydrate intolerance may also be causing your symptoms and can be considered if the other tests are negative.



Followup with your personal physician is essential.



This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.



Thanks,

Kevin, M.D.
Member Comments (12)

by krisg, Mar 21, 2004 12:00AM
To: gdavis teacher
Hi, I'm in the same boat you are, only for 6 years now.  Had my gallbladder removed in 1998 and have been having these severe attacks of pain ever since.  Was hospitalized 4 years ago when they discovered the elevated liver enzymes.  I was then told that I have Sphincter of Oddi Dysfunction.  I went to a local University Hospital and had the ERCP w/manometry. I was then told that I had IBS and everything was fine with the bile and pancreatic ducts.  I bought that diagnoses for another year and then started to have attacks again.  I finally went out of the state to another University Hospital.  The GI doc did a biliary sphincterotomy.  I had relief from pain for about 5 months.  Since last July I have had attacks again (some mild and manageable, and some extremely painful).  I am going to another University Hospital in Indiana on Tuesday for another consult.  I have a nagging feeling that my pancreas is the problem now. Please feel free to ask for my e-mail.  I take comfort that I am not alone in this battle and that there are others that have been through the same thing.  IBS seems to be the diagnose of choice from doc.s when they cannot figure out what's going on with you from a textbook view.  I will stress on one thing and that is to gather all your medical records from all you ER visits and ERCP's , etc.  Go over them yourself and educate yourself on the whole biliary system.  The web is a great source of information.  Everytime you go to a GI doc. bring copies of your records with you and a list of questions and concerns.  Make sure you keep copies of everything for yourself too.  One important thing that I have recently discovered is that sometimes we come to an "end of the road" situation with our current doc. and then we need to realize that if they can no longer help us then it is time to move on and go to a new doc.  I hope this information helps you and that you find a good doc. to help you work through your troubles.  Take care.

Kris

by gsue, Mar 22, 2004 12:00AM
I'm beginning to think it is true that we have to take charge of seeing to it they find out what is wrong.  We know when something isn't right with us I think.  I have had that biliary sphincterotomy I think done too because the duct closed completely off even though they didn't think it was possible for it to after the first ERCP.  When they went back in it was closed back up and full of sludge.  I'm just praying I can get to the bottom of this before I go broke.  With all my family has been through this past 3 years we can't afford to keep experiementing.  Between my brain surgery, stomach surgeries, and my husbands recent cancer surgery I can't afford to be sick too. Need answers.

by Bev_IN, Mar 28, 2004 12:00AM
Well Howdy I know just what you all are saying it all sounds soooo much like what I have been going through. I had my galbladder out 2 yr ago and had a ERCP done just last Thursday March 25, 2004. they put a stent in my pancreatic duck and they checked my entire biliary tree and found it to be normal.

I have had this problem before the galbladder was removed and it still continues, even last Thursday it was right there right away following the ERCP. Mine can be felt at times right below or under my lower rib cage on my right side. At times I can even feel it jiggle when I walk. When it is realling hurting bad it hurts all the way through to my back. When I can feel it with my hand I can only feel it when standing, if I set or lay down it can not be felt. I have showed it to doctors and they don't seem to be able to find it. I have had MRI and CAT done too when they was checking my galbladder and they couldn't see it on those either. Some times I think I need to just set up camp at the doctor office so that when it is bulging out and jiggleing when I walk that I could just go inside and show them right then and there. Setting up an apointment just don't work it never makes an apperence when the time comes. Hmmmmm that is a thought I just may try that, spring has sprung so it would be nice weather to set up camp. Anyone want to join me in Indiana?? LOL

Getting really tired and aggervated.

Bev_IN

by Bev_IN, Mar 28, 2004 12:00AM
Well Howdy I know just what you all are saying it all sounds soooo much like what I have been going through. I had my galbladder out 2 yr ago and had a ERCP done just last Thursday March 25, 2004. they put a stent in my pancreatic duck and they checked my entire biliary tree and found it to be normal.

I have had this problem before the galbladder was removed and it still continues, even last Thursday it was right there right away following the ERCP. Mine can be felt at times right below or under my lower rib cage on my right side. At times I can even feel it jiggle when I walk. When it is realling hurting bad it hurts all the way through to my back. When I can feel it with my hand I can only feel it when standing, if I set or lay down it can not be felt. I have showed it to doctors and they don't seem to be able to find it. I have had MRI and CAT done too when they was checking my galbladder and they couldn't see it on those either. Some times I think I need to just set up camp at the doctor office so that when it is bulging out and jiggleing when I walk that I could just go inside and show them right then and there. Setting up an apointment just don't work it never makes an apperence when the time comes. Hmmmmm that is a thought I just may try that, spring has sprung so it would be nice weather to set up camp. Anyone want to join me in Indiana?? LOL

Getting really tired and aggervated.

Bev_IN

by krisg, Mar 29, 2004 12:00AM
To: Bev
Hi, where did you go to have the stent placed in the pancreatic duct?  I just got back a few days ago from IN and I had a stent placed in my pancreatic