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Pain In The Right Flank , Shoulder Blades And Right

Posted on Thu, 22 Aug 2019

Question: Pain in the right flank , shoulder blades and right side of upper abdomen with excessive belching and flatulence.

Is this related to some bile duct issues or something less worrisome as gastritis or Gerd or ibs?

Follow up: Dr. Bhagyesh V. Patel (0 minute later)

Pain in the right flank , shoulder blades and right side of upper abdomen with excessive belching and flatulence.

Is this related to some bile duct issues or something less worrisome as gastritis or Gerd or ibs?

Follow up: Dr. Bhagyesh V. Patel (5 minutes later)

I don’t drink or smoke. Diet is pretty normal, weight is normal. Have this issue for the last 6 months. The symptoms come to life more when I eat something fatty in nature. The pressure on the flanks and shoulder blades are like always there.

Done lot of tests but still the symptoms remain.

I have done CT scan with contrast, MRCP, US of abdomen, Endoscopy- ALL NORMAL.

I have done Lft, Ggt, lipase,amylase, CBC - ALL NORMAL.

I have also done stool test for h-pylori, candida, fat malabsorption, elastase - ALL NORMAL.

Don’t know what’s wrong or what else should I do to get to the bottom of my troubles.

3 questions I have:
1. Is this some bile duct issue(like growth or something more serious or stones)?

2. Is this due to GERD or GASTRITIS or IBS or SIBO?

3. Is there anything else I should do for evaluation or just focus on lifestyle changes and diet?

Follow up: Dr. Bhagyesh V. Patel (0 minute later)

Answered by Dr. Bhagyesh V. Patel (1 hour later)

Brief Answer:
no serious bile duct system disorder. control excess thoughts.

Detailed Answer:
Hello XXXXXXX
Welcome again to Ask A Doctor services.
I have read your query and here is my advise.

1. As MRCP and associated investigations mentioned above are normal,
there is absolutely no chance of your system having growth, stone or any
other serious issue regarding bile duct system.
Because these tests are highly proven for their specificity and sensitivity
to detect even most minor disorders of the system as well.

2. I quote more of GERD related manifestations rather than IBS as per my
surgical experience.

3. There is no recommended further evaluation and focus on lifestyle
changes with diet will reveal best results over period of time.

* One additional quote I would like to tag, that repeated pressurised
thoughts about any disease may lead you to develop Illness Anxiety
Disorder and I hope you do not end up with the same.

Wish you great day.
Regards.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Answered by Dr. Bhagyesh V. Patel (0 minute later)

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Bhagyesh V. Patel (35 minutes later)

Does GERD/Gastritis cause pain under the ribs,flanks and shoulder blades?

Follow up: Dr. Bhagyesh V. Patel (0 minute later)

Does GERD/Gastritis cause pain under the ribs,flanks and shoulder blades?

Answered by Dr. Bhagyesh V. Patel (1 hour later)

Brief Answer:
follow up .

Detailed Answer:
Hi
Yes, many of the GERD or gastritis patients do present with pain under ribs, flanks or shoulder blades apart from routine pain in upper abdomen region.

Thanks.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Answered by Dr. Bhagyesh V. Patel (0 minute later)

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Bhagyesh V. Patel (4 hours later)

One final question, could this be due to gallbladder dysfunction or motility issue or something related?

Follow up: Dr. Bhagyesh V. Patel (0 minute later)

One final question, could this be due to gallbladder dysfunction or motility issue or something related?

Answered by Dr. Bhagyesh V. Patel (56 minutes later)

Brief Answer:
GB dysfunction can present with functional dyspepsia.

Detailed Answer:
Hi
Welcome for the follow up.

* Very few cases of functional dyspepsia do present with lesser contractions of
gall bladder.

You can discuss the role and need of HIDA scan for the same during your next scheduled visit to gastro specialist.

Thanks.

Above answer was peer-reviewed by : Dr. Kampana

Answered by Dr. Bhagyesh V. Patel (0 minute later)

Above answer was peer-reviewed by : Dr. Kampana

Follow up: Dr. Bhagyesh V. Patel (4 hours later)

Could a musculoskeletal pain last for 4 months without aggravating ? It’s pretty constant and feels like it’s always there.

Does this sound more like a referred pain or a functional pain, I am not able to distinguish between the 2?

Will Tylenol cause reflux or acidity?

My doctor has asked me to take an antibiotic for bacteria overgrowth for 2 weeks (xiaxfin- not sure if I spelt it right) , should I take the medicine

Follow up: Dr. Bhagyesh V. Patel (0 minute later)

Answered by Dr. Bhagyesh V. Patel (5 hours later)

Brief Answer:
follow up .

Detailed Answer:
Hi

1. Musculoskeletal pain may last for long , but there is always association
with aggravation via muscle movements which is not striking in your
case.

2. This sounds more likely to be referred pain via certain nerve irritation
from underlying GI disturbances.

3. Tylenol is usually not causing reflux or acidity, but there are reported
instances for the same in some of the individuals.

4. Xifaxin can be taken for gut bacteria control, provided proton pump
inhibitor as omeprazole or pantoprazole is simultaneously consumed to
avoid drug related stomach upset.

Thank you.

Above answer was peer-reviewed by : Dr. Prasad

Answered by Dr. Bhagyesh V. Patel (0 minute later)

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Bhagyesh V. Patel (5 hours later)

What should I do as my next course of action? Should I take the medicine or do more investigations to see if all the following tests missed out on something?

Does a MRCP miss any small growths/lesions like smaller than 0.5 mm with normal blood parameters?

Just asking this again for my sanity, can we rule out all sort of cancers or precancerous conditions?

Sorry to bother you with all the questions, I am very stressed out and borderline depressed due to my symptoms. Not sure if they will ever go away.

Follow up: Dr. Bhagyesh V. Patel (0 minute later)

Answered by Dr. Bhagyesh V. Patel (2 hours later)

Brief Answer:
follow up .

Detailed Answer:
Hi
Welcome for the follow up.

Kindly find my most professional guidelines for your case as per experience of 20 years in this field.

- Your next course of action is to control the anxiety and excess thoughts till
best possible and as I had previously told, meditations would remain your
prime factor of recovery.

- A quote to quit smoking and alcohol ( if consuming )

- You start medications as per doc advise and do not opt for new
investigations which will turn out negative and increase your anxiety for
the issue.

- No investigation ( including MRCP ) in advanced science is capable of
identifying microscopic changes of many body parameters in pre cancer
conditions or else.

* The most vital in clinical science are symptoms and reports are always
supportive only.

* Have faith in treating physician, contribute best of yours with his or her
efforts to bring you back in best shape of your health and give nature time
to heal certain matters which may take a bit time ( but as we think more
and more , we unintentionally delay our recovery time for sure )
or genetic changes at subclinical levels

You can ask endless number of questions till you are not satisfied for the query, so I am not bothered by any of your doubts. It is my moral responsibility and your basic right for the same.

Wish you nice day.
Take care.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Answered by Dr. Bhagyesh V. Patel (0 minute later)