URQ pain normal tests, help!

Hi Stephen,

Sorry to hear what you're going through .

Have you had an endoscopy to check your stomach?

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!!

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.

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.....)