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Gall Bladder Removed, Pain, MRI, CT Scans, Mild Prominence Of The CHD, Liver Cysts, Colonoscopy, Fissure, RUQ Pain, Low Globulin, On Lortab. Suggestion?

Posted on Fri, 25 May 2012

Question: had Gb removed almost a year ago - Been having pain- a little lower than when my GB was killing me- Had MRI and CT scans - MRi said- very mild prominence of the CHD which is 7mm in diameter but- they said that was ok- also no filling defects pancratic duct nondilated- scattered intrahepatic cysts- CT w/ con showed 4 mm and 1 cm r lobe of liver cysts. mild prominenece of the intra and extrahepatic aspect of the bilary treet w. the CD 1cm in diameterreason for thsi is not readily apparant unless related to the GB sx. everything else checked. I have had upper scope - just had a colonoscopy - just removal of a small fissure- I was prescribed ursoldial 2x a day- which does help somewhat. Had blood work done- all was ok except globulin was a little low 2.1. Other than that I do have pain- RUQ pain but not like under my rib cage anymore- bit lower. I do take lortab 4x a day for back blown out- and was prescibed the amtza as well- bit onlu take it as needed- very expensive. So the RUQ pain feels like either someone is stabbing me or I get odd noises and it sounds/feels like giant air pockets of pressure

Answered by Dr. Vaibhav Banait (10 hours later)

Hello,

Thanks for posting your query.

Possible causes for post-cholecystectoy (after 1 year) right upper abdominal pain include

1. Residual common bile duct stone: MRCP in your case does not show

2. Common bile duct injury with a stricture (narrowing): upper portion of biliary system will be dilated. Person will develop jaundice. (Not present in your case)

3. Acid Peptic disease (ulcer disease): Your upper gastro-intestinal endoscopy is within normal limits

4. Sphincter of oddi dysfunction: The sphincter at the junction of duodenum and common bile duct is spastic or narrowed. Result is dilation of common bile duct above 10 mm, right hypochondriac pain and enzyme elevation. This is known as sphincter of oddi dysfunction. This disorder is more common in female. Biliary sphincterotomy helps it. Your query partially resembles it. I would suggest you to discuss it with your doctor.

5. More common is undiagnosed functional abdominal pain, which is not related to gall bladder stone but is thought to be due to it. Naturally it persists even after surgery.

I hope my suggestions will help you. I will be available for your follow up queries if any.

Wishing you good health.

Regards,

Dr Vaibhav Banait
MD (Medicine), DNB (Medicine), DM (Gastro-Enterology)
Consultant Gastro-Enterologist and Hepatologist
Therapeutic Endoscopist

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Vaibhav Banait (44 hours later)

So what further testing do you think I need to have?

Do u think it's IBS w/ constipation as 1 dr as suggested? I do not as I think my whole stomach area would hurt and not the same area over and over.

The pain is sometimes very sharp like stabbing- sometimes stabbing w/ pressure like air- sometimes just a dull constant pain- the urisdial that was prescribed does help but has not cured.

Please advise on the further tests u think I should have now ... Thanks again.

Answered by Dr. Vaibhav Banait (12 hours later)

Hi,

Thanks for your query.

As I mentioned previously, it is mostly a functional abdominal pain (eg IBS) which is mistaken as gall bladder colic. Naturally removal of gall bladder does not cure it.

Following are Rome III criteria to diagnose IBS. Evaluate yourself whether your symptoms resembles these criteria. If yes, you may have IBS.

Criteria: Symptoms of recurrent abdominal pain or discomfort and a marked change in bowel habit for at least six months, with symptoms experienced on at least three days of at least three months. Two or more of the following must apply:

•Pain is relieved by a bowel movement
•Onset of pain is related to a change in frequency of stool
•Onset of pain is related to a change in the appearance of stool.

So let me know whether you had these symptoms. Sphincter of oddi dysfunction should also be carefully considered in your case. This may require close follow up of your symptoms and repeated labs/ sphincter manometry to come to definite conclusion.

Regards,

Vaibhav Banait, DM

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Vaibhav Banait (24 hours later)

no I donr think it is IBS- I was wondering what tests I need for the SOI - That was the 1st thing I thought I had and when I ? the sx surgeon he was offstandish about it- 2nd question- would the urisiaol that I take help relieve that pain/pressure? because whe I don't take it- It is worse.

Answered by Dr. Vaibhav Banait (14 hours later)

Hi,
Thanks for the query,

Here are answers to your queries;

1.I was wondering what tests I need for the SOD ?

> SOD can be diagnosed if you have typical biliary pain, elevated enzymes and dilated Common bile duct.

Sphincter manometry is available at the specialist center to diagnose it. But manometry is not a mandatory for diagnosis. You should seek help from an hepatobiliary center in this regard.

2.Would the urisiaol that I take help relieve that pain/pressure? because whe I don't take it- It is worse

>If ursiaol helps you, continue it. Personally, I doubt it has any role.

Hope I answered your questions adequately. Feel free to ask if you have any query

regards

Vaibhav Banait, DM

Note: Revert back with your health reports to get further guidance on your gastric problems. Click here.

Above answer was peer-reviewed by : Dr. Radhika