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Back, gallbladder, appendix, urinal problems. CT, blood test done. Gallbladder removed. Prescribed norco 7.5. Suggestions?

I had a baby in September . Since then I have had back issues and gallbladder issues. For the back I have been prescribed norco 7.5/325mg. For the gallbladder, it had gotten worse. US showed numerous stones. Gallbladder was removed in February. Was doing well and then I started having right upper quadrant pain (and in the back as well...same area) about a week ago. Wednesday night/Thursday morning I had an "attack". Full on upper abdominal burning, stabbing severe pain with severe nausea. Went to ER and had CT and blood work. CT showed appendix with slightly hypersense material and at upper limits of lumen diameter. Blood showed AST 192 ALT 109 BUN 22. Was told that higher liver enzymes are possible after cholecystectomy. But that's pretty high! Also, urine showed trace leukocyte esterase, trace protein, WBC 2-4, RBC 0-1, trace bacteria, moderate squamous epithelial cells, many urine mucus. Does this indicate a UTI? Surgeon seems to think a stone may be stuck in duct, although nothing showed on test at time of surgery. Is that possible? Also, are my liver enzymes high due to gallbladder removal, norco use for 4 months, or a combination of both? Should I worry about my appendix?
Asked On : Tue, 2 Apr 2013
Answers:  1 Views:  46
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General Surgeon 's  Response
Hi ! Your pain in right upper quadrant radiating to the back could be due to a stone in the CBD which may or may not be associated with inflammation of the pancreas. Please go for a serum Amylase, and Serum Lipase estimation on consultation of your doctor. CT scab is good to exclude pathology of organs, but is not a very good investigation for stone, and still ultrasound is a good investigatiion for diagnosing stones in the hepato-biliary tract. Your doctor may suggest you for a MRCP which is specific for detecting pathology of biliary tract which might have got missed in an ultrasound or CT scan.
The site of your pain does not go very much with the pain of appendicitis unless the appendix is a subhepatic in its position.
Your upper abdominal burning, stabbing and nausea all could occur due to both the conditions mentioned above, and each has to be excluded by clinical examination in combination with the investigations noted. The AST and ALT levels you have mentioned are not very significant to conclude on any hepatic problem. The findings of urine test also do not seem to be of much significance in the absence of any urinary symptoms.
I hope your querries are answered to . Wish you good luck.
Answered: Tue, 30 Apr 2013
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