Monday, June 25, 2012

Recurrent Abdominal Pain (absent gall bladder)

I AGREE TO USE MD STAT FOR EDUCATIONAL PURPOSES ONLY, THAT NO DOCTOR PATIENT RELATIONSHIP IS FORMED BY MY PARTICIPATION IN THIS EXCHANGE, AND I UNDERSTAND THAT MY QUESTION AND ANSWER(S) WILL BE POSTED ON THE WEBSITE AND WILL BE VIEWABLE BY VISITORS TO THE SITE.: Yes, I agree.

I have been having horrible pain 4-5 inches above my belly button midline of my abdomen.  The pain is always an achey pain, but then I get attacks of horrible pain that are severe and are similar to previous gallbladder attacks that I had when I had my gallstones years ago. I  had my gallbladder removed in 1995. The pain starts suddenly and intense and lasts from 4 or more hours. The severe pain goes through to my back and up into my chest to the point where I can't take a deep breath because of the pain. I feel like my heart is fast. I have had nausea and occasional vomiting during this time.

I also have been having some floating stools that don't hold their form and are grainy and fat floating in toilet. No light colored stools though. No fevers which I usually don't run a fever due to my hypothyroidism.  I feel full after small amounts of food and the severe attacks usually occur after eating. The first attack occurred while in a restaurant.   I felt immediate abdominal pain, nausea, became very hot and my face appeared flush.  I felt like I was going to die.

I didn't say anything to my husband but he asked me if I was ok and I told him how I was feeling.  I felt better the next day, but it happened again the next month so I went to the ER.  I had another severe attack while there and they admitted me.

They ruled out a heart attack and all other serious problems. I take 24 hour prevacid for stomach pain, levothyroxine, prednisone 10mg a day for back pain (have been taking this for 6 months), hydrocodone 10/660 3x a day prn for back pain, soma 4x a day prn for back pain.   I have had bloodwork, CT scans, and ultrasounds. One of my previous scans showed a dilated bile duct and mild fatty liver.  I have only drank 10 alcoholic beverage in my life and I don' t drink or do drugs. I am scheduled for an ultrasound on Monday to try to find out why I hurt so bad.  Any help would be greatly appreciated!  Thanks!

Gender: Female
How tall are you (feet and inches)?: 5'7"
What is your weight in pounds?: 250lbs
How old are you?: 40
How long has this been going on?: More than a year
Check all symptoms you are currently experiencing:
Vomiting
Nausea
Describe associated symptoms not listed above:  Pain radiating into chest and back. Floating Stools not formed with floating fat. So painful that I can't take a deep breath. Fast heart rate. The pain is a achey pain with  some throbbing pain also. When the severe attacks start it is a severe ache that doesn't let up. I  get full after eating small amounts of food. The severe attacks usually occur after eating.

What have you done so far to remedy this condition? Please include tests and relevant studies here.
I have had CT scans, ultrasound and bloodwork. I will have another ultrasound on monday. One test showed dilated bile duct and fatty liver.
Please list any chronic medical problems and also list any prior surgery (lacerations don't count!): medical problems: hypothyroidism, possible gastritis or ulcer, previous tracheal stenosis of unknown cause, and Degenerative disc disease and arthritis.

Surgeries: Tubal ligation, gallbladder removal, tracheal resection/anastomosis surgery.

Check all conditions present in your immediate family... :
Cardiac Disease
Hypertension
Please list any medication allergies that you have : : N/A

Please list any medications you are currently taking (and dosage if known) :: Levothyroxine 137mcg 1x a day
24 hour prevacid 1x a day
Soma 350mg 4 x a day as needed
hydrocodone 10/ 660 3 x a day as needed
Prednisone 10mg 1x a day
When was your last menstrual cycle?: 3 weeks ago
Are you currently using or do you have a history of tobacco use?: No
Are you currently using or do you have a history of illegal drug use?: No
Please describe your alcohol consumption :: Rarely

HOW QUICKLY DO YOU NEED THIS TO BE ANSWERED?: As soon as possible

What conditions could cause the symptoms that I am experiencing?
Could it be pancreatitis?
Can gallstones form after gallbladder has been removed?

__________________________________________

Well, you certainly are having a rough go of it. I am only now able to post your question after a couple of days on the road. Your ultrasound was today. I hope it is diagnostic. This is unlikely to have anything to do with your gall bladder unless you have a reatained ductal stone, and the only way to find that is with a procedure called ERCP (an upper endoscopy).

You are young for intestinal ischemia.... pain in the abdomen due to lack of blood flow to the abdominal organs, usually triggered by eating, though it should be on the list. 

The striking thing to me is the pain's relation to eating.

A couple of things you said triggered something though, and I do not wish to scare you, but there is a rare condition called 'Cardinoid Syndrome' that is associated with some cancers and a rare tumor of the GI tract (intestines). If everyone is drawing a blank you might suggest this. 


Given its rarity I wouldn't mention it at all as it will, no doubt, make you worry, but it does seem that your doctors are trying to knock out all the usual suspects and simply haven't solved this one yet. I would mention this at your next appointment and see if they have already checked for it (they probably have). 



1 comment:

space doc said...

To recurrent abdominal pain:

Sounds very much like post-cholectomy syndrome (can be present in 10-40& of patients who have had their gall bladders removed)

The causes can be the formation of stones in the cysic &/or common bile ducts (which are not removed by the gall bladder surgery (cholycysectomy)



The common bile duct enters the small intestine at a juncture with the pancreatic duct (called the sphincter of Oddi) If there is a stone at that juncture it can cause some pancreatic inflammation as well as preventing any bile entering the small intestine.

If the bile can't get into the intestine your ability to break down fats is compromised and this can result in fatty, floating, stools

The fact that one of your tests showed a dilation of the bile duct(s)-- could be caused by a stone in one of the ducts (or a blockage at the sphincter of Oddi).

Sometimes the ultrasound does not give a clear picture of stones in the bile ducts and the ERCP (endoscopic retrograde cholangiopancreatography)
done by your gastroenterologist or surgeon iis the best way to diagnose this condition (and to remove a stone )

Another blood test that often goes along with a blockage of the ducts is the alkaline phosphatase--which they probably already have done)

Hope this will be cleared up soon for you.

Best of luck!! Space Doc