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jmccarth2007 02-24-2008 10:26 AM

Severe URQ pain & nausea, undiagnosed for 2 months
On Dec. 29th, I started experiencing URQ pain, starting just below the right ribs and extending around my side and up my back, to the shoulder blades. The pain in the URQ was sharp, while the pain in the shoulder was dull. I went to the ER the following night because the pain had persisted. The ER ran a blood test & urinalysis. Everything came back within the normal range. I was given something for the pain and nausea and told to follow-up with the GP. Both the triage nurse & the ER doc said that I probably had something wrong with my gall bladder.

I went to my GP, who ordered an upper abdominal ultrasound. During the ultrasound, the techie stated that she saw "areas of inflammation", but didn't elaborate where or how inflammed those areas were. I didn't hear from the GP's office for over a week, and even if I called, I was told that someone would call me back later (they never did). I received a form letter in the mail with my name and a checkmark in the box "results normal". There was no indication of follow-up care and no request to see the GP again.

I decided to go to my OBGYN because I do have a history of ovarian cysts and tend to get them on the right side. While I know that the pain I'm experiencing is too high, I have also heard of cysts attaching to the abdominal wall or organs, which can cause severe pain. The OBGYN called for a pelvic ultrasound, which had normal results. During this time period, the URQ pain & nausea continued, spiking particularly after mealtimes.

I requested to see a different GP. Two days before I was supposed to see the new GP, I went back to the ER with sharp URQ pains and nausea. My blood tests were again normal, so I was again given morphine & anti-nausea medication and sent home.

The GP referred me to a surgeon. The surgeon called for one test, a HIDA scan. I was given the nuclear medicine through the IV and told to wait. They started taking me back every 10-15 minutes and, around 45 minutes, my gall bladder appeared on the scan. that's when they started the second part of the test, with the CCK infusion. The doctor introduced the CCK slowly and I experienced URQ abdominal cramping & nausea each time he introduced the CCK. The HIDA test came back normal, with a 67.8% ejection rate.

The surgeon was out of town when my results came back (during the normal range of 24-48 hours after the scan), so I didn't find out my results until 5 days after the exam. When I did, the surgeon said that there wasn't anything else he could do except refer me to a gastro specialist.

After about a week, I'm able to get in to see the gastro specialist. During that time, I started experiencing pain elsewhere (in addition to the usual URQ): on my mid to lower back, at about kidney level. I explained my symptoms and the tests that had been done. At this point, I was pretty frustrated with how little my doctors were telling me, and the long length of time between visits or contact with the doctor, so I had been researching possible complications of the gall bladder online. During the appointment, I requested an ERCP. The doctor called for a series of blood test, telling me that an ERCP would only be called for if my liver enzymes were off. The doc called for a CBC, metabolic, and tests on the liver, kidney and pancreas. Everything came back as normal, so an EGD was called for instead.

The EGD found three minor issues, all of which the doctor assured me wasn't serious enough to be causing the pain I was experiencing (which would be a steady 6/10 on the pain scale, with spikes at the 8-10/10). He found non-erosive esophagitis, a hiatal hernia, and gastritis. He took some biopsies (results are still pending on those).

My follow-up appointment to hear the results is March 3rd. The doctor won't do any other tests until those results come back. He put me on an acid reflux medication and told me to take Alleve for the pain. If the Alleve doesn't help with the pain; or the pain gets worse; or I spike a fever, I should go back to the ER. Well, I went back to the ER on Tuesday because the Alleve didn't help with the pain.

The good thing about going back to the ER was that I had the same doctor as I did during my last ER visit. Because he knew I'd been there before, he took a lot more care with examining me. He called for more extensive blood tests. He couldn't find anything wrong with my blood test. He did find a UTI and wrote me a prescription for that. He asked what tests have been done with me and then made the following suggestion: perhaps my pain wasn't caused by my gall bladder, but rather by a floating rib that rubs against the gall bladder when it slips, thus causing the URQ pain and nausea. What's funny is that I've tried eating normal foods since the ER visit and found that my pain is more dependent on my activity (such as lifting things or stretching my right side) than on my diet.

Has anyone else experienced this? When I see my GP on Monday, are there any tests I should request (like a CT or MRI)? Is what the ER doc said even feasible? Are my docs just not doing enough to diagnose a problem with my gall bladder? Should it be taking this long to determine if my gall bladder is or isn't messing up? And if it's the slipping/floating rib thing, what kind of treatment would fix that? How could it even be diagnosed?

I'm frustrated and tired of being in pain. I'm also worried that, if it is my gall bladder, it might burst while my doctors are dragging their heels about figuring out what's wrong with me. My doctors are very reluctant to refill any medication for me without a week-long fight, even if it's for my nausea. I just want to find out what's wrong and how to fix it.

Momof2sons 02-24-2008 02:34 PM

Re: Severe URQ pain & nausea, undiagnosed for 2 months

With the symptoms you have described I would have swore gall bladder! Very strange. When I had my Abdomonal CT scan they could see that my gall bladder was swollen, so my suggestion for you would be to go to your GP's office and get a copy of the report (they HAVE to give it to you) , so you can see for yourself what they had seen. While your at it I would suggest getting copies of all the tests that had been done so far.
I think at this point with pain like your describing, a CT scan is in order, Im just wondering if it should be a Chest CT rather than a Abdomonal CT? As I said, with me my gall bladder issues where found on an Abdomonal CT. It MAY be higher in your chest? But you are having "refered pain"? Coming from somewhere else. A CT would give them MUCH more detail.
I sure hope you get some answers soon, sounds misserable!

Take care and GOd bless,

P.S. DONT give up, You know your body, and when something is wrong!
Don't be affraid to be your own advocate! Please let us know how you make out!

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