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Abdominal pain reduction - Online Doctor Chats

Date : 13-Jan-2012
User rating for this question
Very Good Posted in: Abdominal Pain
Answered by

General & Family Physician
Practicing since : 2009
Answered : 631 Questions

Doctor :   HI
Doctor :  
How can I help you?
User :   Hello Dr. I've had a long going issue with RUQ abdominal pain
Doctor :  
Ok
User :   I've had my gallbladder out in Jan 2007 and have had 4 ERCPs
Doctor :  
Ok
User :   MRIs, CT, Hepatic Scans, Xrays, and all the endoscopies
Doctor :  
Continue with your query
User :   I am on a time released morphine and taking diladid for when the pain becomes too bad
User :   and I know narcotics are not for long term
Doctor :  
Ok
Doctor :  
Yes, you are right
User :   I'm a premed student and I don't know what to do next because I keep missing school due to pain
User :   I feel like I'm going in circles and have no ideas for the next step
Doctor :  
Can I ask you a few more questions?
User :   yes
Doctor :  
May I know your age, gender, location?
User :   21, female, iowa
Doctor :  
Ok
Doctor :   Why was your gall bladder removed?
User :   During the scan it did not eject all of the bile i guess
User :   no gallstones
Doctor :  
Ok
Doctor :  
How about the liver?

Doctor :   Continue with your query
User :   sorry i had to do the payment thing
User :   all blood labs come back normal
Doctor :  
Ok
Doctor :  
What was detected on ERCP?
User :   he said i had a mild case of sphinctor of oddi dysfunction
User :   and microstones
Doctor :   Ok
User :   he also has done 2 sphinctorotomies
Doctor :   Ok
User :   I've been to pain management 2 times
Doctor :   Ok
User :   they've tried trigger point injections into the ribs thinking it could be inflammation of the costocartilage but that didn't help
User :   they haven't really helped me otherwise
Doctor :  
Ok
Doctor :  
Ok
Doctor :   How has the pain been?
User :   i've been missing class yesterday and today. Been in bed because it hurts more when I move
Doctor :  
Like does it fluctuate everyday or is constant
User :   I was in the ER last wednesdays for vomiting and sharp stabbing pain
Doctor :  
Ok
User :   flutcuates
User :   on intensity
Doctor :  
Have you had Gastroscopy done?
User :   pretty much always there. sharp stabbing. but sometimes i can handle it and sometimes not
User :   2 endoscopies and a colonoscopy and a capsule endoscopy
Doctor :   Ok
Doctor :   What did they show?
User :   at one point i had gastritis
User :   which i'm on omeprazole for
User :   other than that nothing
Doctor :  
Ok
Doctor :  
How is your hemoglobin levels?
User :   i'm lactose intolerant but not fructose intolerant and no celiac diseases
User :   sometimes i get anemic but i think my hemoglobin has been fine lately
Doctor :  

Were there any other positive results from Hepatoscan, CT scan, MRI?
User :   no
Doctor :  
Ok
Doctor :  
Is there any evidence of gastric bleeding?
User :   no
User :   no blood in stools nor vomit
Doctor :  
Ok
Doctor :   Have you had you liver function tests done?
User :   what is that exactly?
Doctor :  
It checks for liver enzymes
Doctor :  
like SGOT, SGPT
Doctor :  
Serum albumin, globulin
User :   blood tests?
User :   my amalayze and lypase is good
Doctor :  
I am on a emergency call, kindly wait for 2 minutes
User :   ok
Doctor :   Ok
Doctor :   Continue
User :   is that what u mean by liver function tests?
Doctor :  
That comes under Pancreatic tests
User :   i've had pancreatic tests after my ERCPs
User :   i've had pancreatitis 3 times
User :   (from the ERCPs)
Doctor :   Serum bilirubin is also a part of LFT
User :   if it's a blood tests i've most likely have had it and everything seems to be in the normal range
Doctor :   Yes that is a likely possibility
Doctor :   There are a quite a few causes for RUQ pain
Doctor :  
like cholecystitis, peptic ulcer,
User :   no ulcers
Doctor :  
Hepatitis
User :   they've tested me for hepatitis and nothing
Doctor :  
So the possibility in your case is Chronic Pancreatitis
User :   i've been tested for turberculosis, lupus as well
User :   wouldn't my enzymes be up then?
Doctor :  
Ok
User :   if it helps any i was adopted from south korea when i was 3 months old
Doctor :  
Chronic pancreatitis is commonly defined as a continuing chronic inflammatory process of the pancreas
User :   would that show up on an ultrasound?
User :   it's not the same kind of pain as when i had pancreatistis and it's not in the middle area but to the right, does that matter?
Doctor :   It can be detected in MRI scan
Doctor :  
No, pain site varies
User :   i've only had an MRI scan to look at my thoracic and lumbar spine
Doctor :   Ok
Doctor :   Have you undergone abdominal CT?
User :   to check for pinched nerves, so i bet they didn't look at the pacreas then...
User :   yes
User :   with contrast and without
Doctor :  
Ok
Doctor :  
Did show any pancreatic changes?
User :   they haven't mentioned any no
Doctor :   Ok
User :   i don't know if they were comparing them though
Doctor :   You have mentioned about pancreatitis?

Doctor :  
How was it arrived at?
User :   it was always after ERCPs when they were messing around the pancreatic duct
User :   my enzymes were up to 2000
Doctor :  
Ok
Doctor :  
Also may in know if you smoke?
Doctor :  
Do you consume alcohol?
User :   i don't smoke
User :   i socally drink maybe one or twice a month
User :   it's kinda hard to go out with friends when you're in pain all the time
Doctor :   Yes,
Doctor :   Other than pain killers, are you on any other medications?
User :   prozac 80 mg, trazadone 100mg PRN, nausea medications, omeprazole, gabapentin
Doctor :  
Ok
Doctor :  
Ask your doctor if exogenous pancreatic enzymes could be given to you?
User :   ok
Doctor :  
when you are for followup next time
User :   in two weeks i believe
Doctor :  
You can try with that
User :   i email with him though in order to talk about break through pain and pain conrtol
Doctor :  
and if it is still controlled then there is a
Doctor :  
procedure called as celiac ganglion blockade
Doctor :   to control pain
User :   what's that exactly?
Doctor :  
It is a process where in the pain signal transmission will be prevented
Doctor :  
and you wont feel the pain
User :   ...most of the pain management places here say i'm just hooked on the narcotics and those are causing the pain
User :   so they don't listen on any other options
Doctor :   But you can talk about this with your pain specialist
Doctor :  
next time you visit him
Doctor :  
Did you follow what I said?

User :   i see an internal medicine dr, do you mean him?
Doctor :  
No Pain management specialist
Doctor :   Is there any thing else I can help you with?
User :   i don't see a pain management specialist
Doctor :  
You kindly approach one
Doctor :  
Is it fine?
User :   like i said they all believe i'm just hooked on narcotics
User :   or it's mental
Doctor :   Ok

Doctor :  
You go with this information next time
User :   ok
Doctor :   Please fill the feedback form say done when done.
Doctor :  
Have you filled the feedback form?




User :   yes
Doctor :   Thanks for consulting HealthcareMagic. Bye for now. Please refer your friends to ur service.
User :   ok
User :   thank you
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