URQ pain normal tests, help!

Posted , 6 users are following.

I have been suffering upper right quadrant pain since september 2015, it is now august 2016.

It started with pain under my right rib which would come and go, very intense pain and also in my right shoulder blade.  It would come and go.  I saw a doctor in spain and he said gallbladder problem so i had ultra sound which was normal.  i was then referred for a ct scan (initially mri but due to having metal fragments in my eye it was ruled out) and the ct scan was normal.

Pain gradually got worse and now is constant, it doesnt go away only changes between extreme pain and mild pain.  I am 83kg and have a very or should i say had a very active life.  exercised 6 days per week and taught martial arts.  I am now house bound, have lost my business and im going around the bend.  Had atleast 10 trips to AE for pain and feelings of having a heart attack.  any exertion at all causes further pain and spasm in the aera under my rib and has at times taken my breath away.  Im 34 years old, dont smoke but used to drink alcohol most days in small amounts but have not drank at all for 3 months.

All bloods are normal, amylase, bilirubin only very slight raise in ALT liver.

When i breathe in and pull my tummy in i can put my finger on the exact spot of the pain, and when i touch it its like ive been stabbed or shot.  Pain changes between the front and into my back and sometimes up into my neck and down into my leg.

Ive seen several different GPs, its difficult to see the same doctor more than once in my surgery.  I am now under the care of a gastroenterologist who has me scheduled for a HIDA scan but i fear that will come back normal also.

I feel like im going crazy, in the space of 9 months ive gone from super active, healthy, happy individual to constant pain, miserable and feel like im dying.

The gastro isnt convinced its my gallbladder and all the doctors do is give me pain management in the form of nefrapam and buprenorphine.  

Has anyone else experienced this?  I feel like cutting my abdomen open and turning up to AE so they will have to look inside....

0 likes, 16 replies

16 Replies

  • Posted

    Ps im now being treated in the UK.
  • Posted

    Hi Stephen,

    Sorry to hear what you're going through sad.

    Have you had an endoscopy to check your stomach?

    • Posted

      yes had endoscope also and stomach was normal.  i also dont suffer from acid but i do feel nauseas contantly.
  • Posted

    Hang in there Stephen. Don't give up hope. I am in the same boat as you but after having the HIDA scan it was dyer mined that the gallbladder was abnormal! But I also have stomach pain so when they remove the bladder they will be doing a full thickness biopsy of my stomach. In your case have you seen a heart doctor to explain the pain in your shoulder? But hang in there, you will get relief soon. Keep your faith also!!

    • Posted

      yes i had to wear a heart trace tape but they didnt find anything.  all ecg's normal.  did you have ultra sound and endoscope prior to HIDA and bloods?  were they normal or off?  atleast you have some answers now, good luck.

  • Posted

    Hi this sounds just like what is going on with me Iv had plenty of trips to a and e and surgical assessment wards was told it was my gallbladder then ruled that out after ultra sound had every blood test going and no luck. I'm having more pain towards my breast bone but every other symptom is the same as yours every time I see a doctor they just say they have done all tests. Iv started taking msm powder to heal myself my dad self treats and it's worked brilliantly on him.

    • Posted

      what is msm powder. im in so much pain constantly now. the pain i can deal with, its no being inactive thats even worse. ice never sat still in my life and now im confined to the house as anything remotely physical bothers it. if the hida scan is negative for gall bladder i will push for explorative surgery. i am prepared to take the risk as right now i cant see past tomorro.
    • Posted

      Iv gone down the herbal route if you google it it literally helps with everything in your body heal also been taking vitamin c I'm feeling a lot better then I was just trying to get on and deal with it since there not doing anything else. A wheat bag helps with my pains swell

  • Posted

    Re CT scan.

    A CT scan can miss gall stones.

    Your bile duct seems not blocked (bilirubin normal, enzymes), but sometimes stones can still irritate the bladder itself or gall bladder can be irritated without stones even (cholecystitis?).

    A HIDA scan showes the bile flow from the liver into gall bladder, not only from gall bladder to bile duct and into guts,

    so it can pick up a cholecystitis without bile duct obstruction, too.

    I don't think with your parameters that your bild duct is obstructed, but an inflammation/irritation of gall bladder still possible?

    Who knows, since HIDA scan doesn't hurt, is not invasive, go for it.

    It's a good function test, which no organ structure imaging can picture.

    On poster once said, that his via skin ultrasound and  scans came back normal regarding bile duct and gall bladder and only an internal dye test diagnosed his bile duct problems (some stones cannot be seen). Test was called ERCP (Endoscopic Retrograde Cholangio-Pancreatography) and EU (endoscopic ultrasound) and from there finally was treated successfully.

    Those tests are bit invasive since endoscope is needed, but you had a gastroscopy before. Just to keep those tests in mind if gall bladder was still not ruled out to be the culprit.

    As to ALP it depends in context,

    if it was just slightly over the upper reference range, it could be just your individual normal range

    (the lab reference range printed is a guide, a range, which 95% of tested healthy people had, meaning 5% are normally and healthy outside of range),

    but also mean being elevated due to multiple reasons,

    depending also how the other liver enzymes were and the liver struggling with something. Your AST was normal, right?

    There is range for interpretation with one ALT slight raise from no nothing to yes monitor.

    You surely have researched, that the enzyme ALT is in other tissues too, other tissue than liver cells, (skeletal muscles, cardiac muscle, in red blood cells....meaning, if your serum was hemolytic = red blood cells burst, the ALT is wrongly elevated too due to freed ALT from red blood cells. BUT the AST would be almost same raised value too since both enzymes are in those tissues/cells.

    ALT seems more specific for liver origine, but less sensitive than AST.

    If it was due to some bile flow problem, your GGT and ALP would be higher rather than your ALT. = Hence not much will most likely come out from HIDA scan regarding bile duct, but as said keep cholecystitis in mind.

    You need to see the whole spectrum of liver enzymes and how they fit in.

    Your doc is able to interpret.

    Were your kidneys tested too? (I guess so: urea, creatinine)

    Having said that I like to think outside of the box.

    Have you had tests for liver infections like a HepC, HepB or

    genetic problem: iron overload haemochromatosis test?

    Just for peace of mind since you have joint pain.

    did you have leucocytes and CRP tested? (inflammation parameters)

    Another outside of box and very far fetched:

    Did radiologist look at mesenteric artery and especially celiac artery (angle) in the CT scan (mentioned in result), not only organs, if some blood supply was squeezed. (please look up celiac artery syndrome, mesenteric artery syndrome (SMA) symptoms, if they fitted at all with symptoms, celiac artery sounds a bit like it, SMA not that much)

    Also harmless non-invasive abdominal doppler ultrasound is very good to see that ischemia of those arteries. 

    Sometimes such existing CT pics can be reviewed,

    but you usually need a doc's push or call to CT scan institute, where pics were done or referral to differrent radiology institute with your digital CD of pics (I had to pay privately for a re-assessment and was worth it) since this question of artery/blood supply was maybe not on original referral as a question for CT. (radiologists often look very specifically for each referred question since making a result is a matter of time = money)

    Yet to be honest: the joint shoulder pain does not fit in.

    Good good luck, there is something that needs to be sorted.

    Yes, keep alcohol away for now,

    just to make sure liver parameter do not go up due to toxin alcohol. If you took other medications, they can actually influence the liver enzymes too. Liver enzymes are very sensitive markers for cell distruction due to anything, including alcohol and drugs and if it was just a one off at that time and nothing chronic at all (meaning enzyme levels return to normal once toxin is removed)

    All the best,

    your story sounds very heartbreaking and frustrating. 

    Hope the reason is found soon, no matter what, so that it can be tackled.

    Good is, that via CT no tumor was seen, that is a relief.

    (I had a liver tumor, benign and enzymes, GGT, AST, ALT were all together slightly raised and continuously over years until an ultrasound was hence ordered since I always could say to not have had any alcohol, that is always quickly blamed for liver enzyme raise, showed a mass. I had no symptoms.....)


    • Posted

      thank you for lengthy reply. there are some good points there. ive had kidneys checked. but no AST liver only ALT. Not sure why that is.

      I will have the HIDA scan then will go from there. everything takes so long here.private may be the next step.

    • Posted

      "as to ALT" level of course not "ALP" at that point of text. rolleyes Two different enzymes, such similar abbreviations. My bad, but you understood anyway what was referred to.

    • Posted

      ALT elevated slightly. in bloods from 2011 my ALT was in the 'normal' range. i dont know what the number was. i just saw a red flag next to it.

    • Posted

      I highly recommend that you always ask for a printed out version of your blood result or scan results.

      You are entitled to have them.

      Keep them in a folder and you can also take them so much easier with you in case you see a specialist or change docs or simply move.

      The red flag btw comes even if only 1U/L (which is nothing) above the so called normal range and has no red flag if just barely 1U/L under upper normal range. ;-)

      AST and ALT (GGT, ALP) are low cost tests, there is no need to single one out.

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