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Upper abdominal pain affecting both sides of rib, shoulder, back. Ultrasound, CT scan done. Prilosec taken. What is the cause?

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Practicing since : 2009
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I am a 38 y/o female. I've had very painful bouts of upper abdominal pain that extended up into my right side under my rib cage and right shoulder. This has been going on for 2 months and was intermittent until recently in the past week. The pain in my rib cage was a stabbing pain. Pain in my stomach was cramping and gnawing. Pain would get worse right after eating anything and sometimes woke me at night. Pain would come and go but at this time is constant. Now the pain is also over on the left side right under my breastbone and into my back on left side. I've had a gallbladder ultrasound where they found nothing wrong and an abdominal CT that came back clean. What could this be? I took some prilosec and the pain seemed to ease up by 50%. Could this be an also or what else could it be?
Posted Thu, 26 Apr 2012 in Abdominal Pain
Answered by Dr. Yogesh D 24 minutes later

Thank you for the query.

I understand your concern.

After going through you history very carefully, I strongly feel that you have a classical presentation of a gall bladder infection/inflammation of the gall bladder.

I understand that you have had an ultrasound of the abdomen and CT scan as well both of which have been normal.

But the reason I say you could be suffering from a gall bladder disease is that, there is an entity called acalculus cholecystitis, which means on investigations like an ultrasound or a CT scan no stones can be seen but still there would some amount of inflammatory process that is going on inside the gall bladder.

The reasons for this kind of inflammation are poorly understood, but exaggerated physical and mental stress are well known to cause such a condition.

Another important cause could be an infection in the gall bladder or the liver itself.

I suggest you get a complete blood work-up done like a complete liver profile, serum lipase and amylase levels and complete blood counts along with a repeat CT scan/MRCP(Magnetic resonance cholangeo pancreatography).

I would prefer an ERCP(Endoscopic retrograde cholangeo pancreatography) as it is a direct visualization diagnostic as well as a therapeutic procedure.

You should consult a surgical gastroenterologist for these investigations and procedures.

Hope I have answered all your queries. Please do write back to me if at you have any doubts or additional concerns.

Wishing you a speedy recovery.

I would be very thankful to you if you can update on your progress.

Above answer was peer-reviewed by
Follow-up: Upper abdominal pain affecting both sides of rib, shoulder, back. Ultrasound, CT scan done. Prilosec taken. What is the cause? 2 hours later
I appreciate your information. This is very interesting. My family Dr stated that she did not believe it was my gallbladder because of the results of the tests and the fact that my pain has been constant. She told me if it was my gallbladder even if there was a blockage it would be intermittent pain not pain that is constant. She suggested for me to try prilosec last night in case it was an ulcer. I did and within an hour my symptoms subsided by 1/2. As of this afternoon I still hurt but the pain has subsided quite a bit to where I can function. Instead of an 8 out of 10 it's about a 4 for pain. So I'm just wondering if I could have an ulcer? I read that with Ulcer's that over the counter medications to take are Zantak and Prilosec. Is this worth a try? Because of the endometriosis I have I have taken a lot of NSAID's, especially ibuprofen, so this is not out of the realm of possibilities. Also, about 3 weeks ago my Dr had ordered blood work all of which you mentioned and it was perfect. I also have not had any fevers with this. I have been combating this for 2 months, although this most recent episode was the worst it's been. I am still scheduled for a HIDA scan next week. Would this test reveal what you are speaking of? I am also having my family practitioner refer me to a gastroenterologist.
Answered by Dr. Yogesh D 3 hours later
Hello again,

Thanks for the follow-up and further information.

Gall bladder pain can be continuous when the inflammation is severe enough, it need not always be a cramping intermittent pain. Moreover cramping intermittent pain is also a symptom of gastric/duodenal ulcer disease.

Yes, there is possibility that it could be because of a gastric ulcer. But My reason for inkling towards Gall bladder is the type of pain and its classical radiation to the shoulder. I would be surprised if you do not have a band type of pain or discomfort in the right back just below the shoulder blade.

Prilosec and Zantak are fine for the gastric ulcer. But if gastric ulcer is what your doctor suspecting, I would suggest a better proton pump inhibitor Esmeprazole along with a prokinetic agent such as Domperidone and a good antacid suspension which also has a topical anesthetic agent in it to treat the basic ulcer problem.

To ease the pain you can ask your doctor for antispasmodic agents such as Hyoscine or Dicylomine.

If you want you can upload all your investigation reports with your query, so that I can have a look and suggest accordingly. There is an option to upload the reports on the right hand side of the query, please utilize it otherwise you can mail them to me at YYYY@YYYY with the subject ""ATTENTION --TO DR.YOGESH".

I am limited by my inability to examine you in person to give a precise information. But please do consider getting an endoscopy done. You gastroenterologist should do it. It will help in diagnosing the ulcer also.

Hope my answer has been of some help. Please revert back if you have additional concerns.

If you have no further concerns, you can accept the answer or else if you wish to update me regarding your progress(Which I would appreciate greatly), you may keep it open.

Wishing you a speedy recovery.

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