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Dr. Andrew Rynne

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Severe pain in liver, pancreas and gallbladder areas. What treatment is required to get cured?

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Dr. Charles S Narasi

Gastroenterologist

Practicing since :1962

Answered : 693 Questions

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Posted on Tue, 8 Jan 2013 in Digestion and Bowels
Question: I am in horrible pain throughout my liver, pancreatic, and gallbladder areas, with no obstructions or masses showing on ultrasound. HIDA score (my gallbladder ejection rate) indicates 15% function (a normal rate is 35 to 75, so mine is not working), and I get very ill when I eat fat and spend days running to the bathroom. I have long-time silent GERD, so GI did an upper endoscope 11 months ago to test for Barrett's and Celiac (both were clean) and now he wants me to take PPIs again (already did several months) and to do another upper endoscope to look for Celiac, and test stool for parasites, etc., before he will send me to a surgeon for my gallbladder. It is the Christmass holiday, so I can't even get my next visit to arrange testing with him until after the first of the year. (FYI, gluten is not a problem for me). These tests will cost a lot of time and money and take weeks according to his schedule. He has already assured me within seconds of walking into the room that he'll make sure it goes onto next year's deductible. Is this all really necessary when it's obvious that the GB is not working?

My pancreas is inflamed and and I can feel it swelling against my ribcage and my urine has been swelling sickly sweet for several days. I'm afraid I might have ballbladder-blockage induced pancreatitis. I have heart palpitations, dizziness, and feel faint several times a day. I am a thin 44-year-old female. I appreciate any insight you can give me. FYI my family doctor ordered the ultrasound and HIDA when she noticed the sore swollen area between my ribs a few weeks ago during my annual checkup...then ref. me back to GI.
and the HIDA procedure 2nd part was beyond excruciating. They told me it wouldn't hurt at all!
Thanks.
doctor
Answered by Dr. Charles S Narasi 4 hours later
Hello, XXXXXXX
I know Round Rock very well since I have a relative ther
and I love the area !
I know it is very hard to be feeling sick at this time of the year.
I am glad that your Celiac blood tests and your endoscopy were
negative.
The fact that your ultrasound exam was normal indicates that
you don't have large stones in the gallbladder. But, it is possible
to have sand like cholesterool crystals and with chronic inflammation,
you can have same symptoms.
The gallbladder ejection fraction certainly indicates dysfunctioning
gallbladder contractions or "Biliary Dyskinesia". The fact that you
had so much pain during the second part of the scan almost
confirms it. You do have GERD and that might require a PPI for
control of acid damage to the esophagus lining. Your endoscopy
did not show ulcers or evidence of inflammation of the lower
esophagus, which is good. That means the PPI is helping that
part of it but has no effect on the gallbladder problem.
It is also possible that you might have symptoms of IBS.
Sometimes these two are associated.
You mention about your pancreas being inflamed. Did you
have blood tests that showed elevation of Serum Amylase, Lipase
etc. If there was any question about the pancreas, the GI specialist
might suggest ERCP (Endoscopic Retrograde Cholangio-pancreatography)
which can show the bile ducts and also pancreatic duct.
This may be very helpful.
So,long as you are not acutely ill with fever,vomiting,jaundice,
you can probably hang in there after the first of the year to XXXXXXX
the deductible. But you might want to discuss this with the insurance
company, since they are all different in different States.
You can ask your doctor to prescribe an anti-spsmodic medication
to tide you over the holidays.
I wish you well.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Charles S Narasi 43 minutes later
Thanks Dr. Narasi...yes, Round Rock is a great place to live. As you mentioned as a possibility, I do have IBS and have lived with it most of my life. My younger brother just had a liver transplant this last year after 20 years of Primary Sclerosing Cholangitis.

I have not had the Lipase and Amylase tests, etc, because the GI wanted to order them in tandem with another plain upper GI endoscopy, which I feel will just waste time since I am not having reflux problems any more. Last year he had me take the upper endo--which was clear--and a manometry--and was going to send me for a BRAVO test as well, which made me feel like he was all about testing and not about getting down to treatment. It tooks four months to go through all of this, which I was mainly doing because I had silent GERD and bad tooth decay. All I ended up getting was the PPIs, which help just fine.

The GI gave me Bentyl and told me to stay on the PPIs and that should address the pain, and it's definitely not...if anything, the Bentyl makes my BP drop even lower. It's not the deductible I'm worried about...it's about doing all the tests to find other things that might remain after the gallbladder is out, and in the meantime I am suffering so much and would really go ahead and get the gallbladder out ASAP. I have an appointment with a surgeon on my own next week without a referral.

I can hang in there, but just want to see if it is reasonable to want to go ahead and get the gallbladder removed without all these other test to check for other problems. I can't even pick my son up from school or wrap presents, and I'm ready to move on if it needs to come out...I'll deal with comorbid issues afterwards.

Thanks for any thoughts you have...you are an excellent communicator.

--XXXXXXX
doctor
Answered by Dr. Charles S Narasi 8 minutes later
Hello, XXXXXXX
Removing the gallbladder wil help in most cases.
Small percentage of patients may have recurrent
symptoms after a few months after surgery.
In your case, I feel that you will be one that
will respond very well. I will not be surprised if
they find cholesterol sand in your gallbladder.
One good news is, it is done through laparoscope
and same day surgery and recovery is faster.
Years ago, patients stayed in the hospital for 10-15 days
after open abdominal surgery. You will be sent home
with few band aids on your belly.
I wish you well.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Charles S Narasi 24 minutes later
You help is so totally worth the expenditure for the consult. Thanks for explaining things in a clear and concise manner. Have a fantastic holiday season with your family!

With gratitude,

XXXXXXX
doctor
Answered by Dr. Charles S Narasi 1 hour later
Dear XXXXXXX
Thank you so much for your kind comments and
I certainly wish you and your family a wonderful
holiday season as well.
God Bless.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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