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Dr. Andrew Rynne
Dr. Andrew Rynne

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What causes pain in the right upper quadrant, painful respiration, nausea, dry heaves?

Answered by
Dr. Raju A.T

General & Family Physician

Practicing since :2008

Answered : 4017 Questions

Posted on Mon, 29 Aug 2016 in Digestion and Bowels
Question: I had gastric bypass in 2007, no issues till fall of 2015, when a very bad pancreatitis attack sent me to ER. Admitted, had lap/choly 9/8/15, with many small gall stones noted. My liver enzymes returned mostly to normal--however my Alk Phos, both before and after lap cholecy, is consistently high, sometimes just above reference range, sometimes 50 or so Points above ref range.
In May 2016, the abdominal pain reoccurred, dr ordered ultrasound, fatty liver noted (already knew that from gastric bypass) and slight splenomegaly noted. Alk Phos and an ALT were slightly elevated again. I have been waiting for nearly 3 months for referral to GI specialist, the abdominal pain continues, mostly right upper quadrant, hurts to try to take deep breath, nausea, dry-heaves.
On occasion of 2 bad attacks, I got to ER, did ct scan, said swirl pattern noted in lower abdome, surgical adhesions noted, also some strangulation in lower intestine. They said my labs were normal, even though, once again ALT and Alk Phos were elevated. Sent me home with Med for nausea, told me to wait to see GI specialist is completed.
I have been struggling with incompetent office staff at the clinic, they didn't send all paperwork so insurance rejected request. I then spent three days playing middle man btwn dr's 'referral" coordinator and SWMed Assoc to tell dr's referral RN that she missed some paperwork, she argued, no I faxed it all over. They should approve it any day" called SWMed Assoc back and was told that I needed viral hepatitis panel and liver function tests done withno last 90 days. It had been 6 months, so called the RN back and told her what they said. Finally got scheduled to have lab work done that Friday, but when I got their, phlebotomist was sick, no one who could draw my samples.
Next Monday, I cam in, got the labs drawn-week later, I got email results from Quest, viral hep panel all non-reactive; ALT and Alk Phos again about 1.5 times top of reference range. Called office 2 days later, the same RN tells me labs aren't back yet. I said, well I got them in my email, so surely you guys got them too. By now, I am crying in frustration, if I hadn't called office, who knows how long would have taken for her to get them sent to SWMed. A day later, I get a phone call from SWMed saying they are all booked for next 90 days. I had to call my dr and ask him what the hell was going on, the referral was ordered as stat by the internist because I had 10 pound weight loss in 2 weeks, history of family pancreatic cancer. He told me to call back to SWMed and ask them to refer me to one of their lesser used clinics. Finally get a call back from Digestive associates and they tell me September is earliest appt. I told them this had been ordered as an urgent referral 2 months ago-best they could do is Aug 18 and that I should be able to schedule ERCP at that appt.
In the meantime, I had a moderately bad attack,mental to ER, again,shooting, stabbing pain in right side, they gave me morphine, took me to CTscan and again just end noted adhesions from surgical scars. On top of that, the second dose of morphine caused an anaphylactic reaction, throat swelled almost completely shut in about 30 seconds.mthey gave me epinephrine, oxygen till it subsided.
An hour later they said, well we cannot give you any more painkiller (I have allergies to more than a dozen antibiotics and painkillers). They gave me script for some liquid Gastroenterology medicine And discharged me.
Aug 5 in AM, I had appt with the surgeon who did my lap choly last year. Hevsaid I have palpable hepatosplenomegaly and he is trying to get MRI stat and was pissed that this has been going on for months and I still haven't gotten to see GIvspecialist. I went from that appoint to appt pcp-his staff had screwed up my FMLA paperwork. I told him what surgeon had just told me and somehow I need to get a sooner appt. Dr Yoo came back to exam room w/paper saying I was to gonDrSharma at 12:15 pm today, Saturday, August 6th,mbecause theyvsee patients on Saturdays.
I got there early to fill out paperwork as new patient.moffice was unlit,moors locked. By 12:30, I was just beside myself, no what else could go wrong. I called answering system for their after hours operators, she makes a few calls and finally called me back and said she spoke tonDr XXXXXXX and he wasn't scheduled to see any patients today.'
I am so upset right now. I now have to call my dr in Monday and start this all over again. At this point, I don't even care if it turns out to be cancer, I just want to know what is going on. It is now 3v1/2 months of the pain, nausea, constant bile taste in my mouth. Can only eat fresh fruit, yogurt and even that gives me the dry heaves. I am so sick of this, it is so depressing to have this sword hanging over me for 100 days and no one cares.
Answered by Dr. Raju A.T 16 hours later
Brief Answer:
Please attach your reports

Detailed Answer:

Thanks for your query.

I m sorry for what you are going through.

Let me assure you, most of the cancers specially one in pancreas gets detected by contrast enhanced CT scan. Its not easy to be missed out.

Said that, I would like to have a look at your recent blood and the ct scan reports. I shall have a look and opine specifically .

I believe the problem is trivial here, but has to be attended at the earliest because as of now its affecting you mentally more than physically.

Please share the recent blood reports. Please include pancreatic lipase and amylase test reports too.

Waiting for your response,
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

The User accepted the expert's answer

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