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Having abdominal pain, nausea and lots of bleching. Positive Murphey's sign. Prescribed Prilosec. Should I go for test again?

Apr 2013
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General Surgeon
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I'm a transplant nurse and am a bit confused. I'm having mid-abdominal pain that radiates to my back - if it's severe it goes into my R shoulder - severe nausea, and lots of bleching. It's been coming and going for months. Often it would resolve on its own after a few hours. However now it's more persistent, occuring every day. Typically the pain starts after a meal, especially a fatty meal. Now the pain is becoming stronger and more present regardless if I eat. When my PCP examined me, I had a positive Murphey's sign and just about saw stars. My labs are normal (CBC, CMP, amylase, lipase, and H.pylori was negative). Ultrasound is negative for stones. HIDA with CCK recreated the pain (sent me to the ED later that day) but was negative. EF was 85%. Anti-acids do not relieve the pain. However oxycodone (10mg does). Was started on Prilosec but have not noticed any difference. My PCP told me it might be an ulcer but he's scheduled me with a surgeon just in case. My question: Surgeons cut. That's how they make their bread and butter. Should he be the one diagnosing or should I request to see an GI first? Thanks for your input. I understand you haven't examined me.
Posted Sun, 28 Jul 2013 in Digestion and Bowels
Answered by Dr. Ivan R. Rommstein 1 hour later
Hi and welcome to XXXXXXX Thank you for the query.

YOu have some typical symptoms of gallbladder stones attack and this is the first thing to think of. Such stones can cause biliary colic or pancreatitis attack. But if your US and HIDA were normal then gastritis or stomach ulcer is the next most common diagnosis. ALso, your back pain can indicate pancreatic disorder and it can be found even if there is normal lipase and amilase level. (pancreatic pseudocyst for example).
Of course that you need GI work up first. Sourgeon should not do anything without the exact diagnosis. The only thing when we can operate without diagnostic tests is when there are signs of acute abdomen and emergency and this is obviously not your case.
ALso, stomach ulcer is today treated initialy by conservative managment, second step is endoscopic treatment and the last option is surgery. If gallbaldder removal is indicated then you need surgeon's help,but i dont suggest cholecystectomy if there is no clear indication for it such as visible stone or polyp in gallbladder or GB motility disorder.
So you need to do definitely gastroscopy and I reccommend CT scan to evaluate pancreas and gallbladder more precisely. This would rule out most possible diagnoses.
WIsh you good health. If you have any questions I ll be glad to help.
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