Brief Answer:
Dull intermittent-pain in right of belly button / Under Evaluation

Detailed Answer:
Brief Ans-Dull intermittent-pain in right of belly button / Under Evaluation.
Mostly from high concentrated bile acid induced biliary spasm,secondary to dyslipidemia.

Hi Dear !! Thanks for your query to HCM.
Read and reviewed your query in context to your health concerns.

My expert Comments on your health issues-
In the given scenario-where( the gold standard investigation to rule out any obstructing small ampulla growth) MRCP has come normal, with the persistent and or recurring intermittent right abdominal pain is there,I would suggest you to get your lipid profile done,as this pain is due to dyslipidemia with bile acid induced biliary system plasm in your case .This is needed in understanding the cause of recurring pain in right abdomen.

I took time to review your past history since 10 May,16,which confirms pain between shoulder blade with burps.Last year CT showed 4 mm opaque shadow -in duodenum with dilated CBD.

-In view of this all progressive history,My Impression is as follows-
a-The intermittent dull pain is from high loads of the bile acids and sludge in the gall bladder and gall bladder-causing reflux spasm in the upper duodenum and spasm of pyloric sphincter, accompanied with reflux gastritis ,in your case.
b-To find out the recurring intermittent right abdominal current pain and to treat it-I would ask for the drug treatment with -Cholestyramine resin(Questran) sachets-4 gm x 3 times a day+with low fat /non oily diet for 3 -6 weeks time.
This drug trial is to be done ONLY AFTER getting the Lipid profile test with LIVER Function test.This drug trial- would be diagnostic and therapeutic also, in your case.
c-Repeat the lipid profile after 3 and 6 wks time.Also review USG to assess the bile duct diameter-to see if its dilated still.

-Do's to resolve the Curiosity of this intermittent dull pain-
This drug trial with repeat-USG to asses bile duct dilatation and to assess right abdominal pain-after 3 and 6 weeks, would confirm that the bile sludge/or bile stones with accompanied-biliary spasm,was giving this intermittent right abdominal pain in your case.

-Explanation for the resolution of the curious intermittent right abdominal pain with above treatment-
With the lipid levels and the accompanied bile acid loads going down,the bile sludge with bile induced inflammation in the biliary system would resolve and would vanish the recurring intermittent pain in your case.

-Next appointment for Review-after 3-6 weeks
I would ask you to work on these lines suggested and come back to ME for a review on the updated progress you would experience,after a period of 3-6 weeks of cholestyramine treatment trial,for further evaluation of your treatment planning.

Dear,Hope this comprehensive and detailed reply would help you to resolve your health issues with help of your doctors there.

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Good Day!!

Wishing Good Healthy Life in time to come!!

Dr.Savaskar M.N. XXXXXXX Surgical Specialist
M.S.Genl-CVTS

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