Friday, July 20, 2012

Chronic Abdominal Pain

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.

My wife has been suffering from pain in the solar plexus and accompanying pain to the center right on the her back.  All treatment and medication has not achieved any relief.  This all started with a glad bladder removal and maybe other procedures to find the cause. Dr's have prescribed medication which only has temporary relief.  She had had CT scans, X-rays, endoscopy and more.  Most all test come back negative, but pain is daily and persist even through medication.  We now have Tylenol 3 codine and Celebrex, still minimal relief.


Any type of prolonged Sitting and wearing a bra's cause daily discomfort.

What should be our next course of action?
What / who should we see next?
Any help or direction would be appreciated.

Gender: Female
How tall are you (feet and inches)?: 5' 6"
What is your weight in pounds?: 155
How old are you?: 46
How long has this been going on?: More than a year
Check all symptoms you are currently experiencing:
Abdominal Pain
Chest Pain
Musculoskeletal Pain
Weight Loss
Please list any chronic medical problems and also list any prior surgery : None
Please list any medication allergies that you have : : None
Please list any medications you are currently taking (and dosage if known) :: Tylenol 3 codine
Celebrex
Diovan
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

What should we do nextWhat type of Dr should we go see
_______________________________________________

This is a really hard question for an online discussion. It is possible that your wife has a post cholecystectomy syndrome. This is a very difficult diagnosis and somewhat controversial. She needs to be seen by a very good GI doc and her surgeon should also know that she is having these problems. The thing is, it seems from what you are saying that she has had a VERY thorough workup since this started. The problem here is that her pain is so suggestive of pain originating in the area of the gall bladder that it's hard to think of another cause, especially with the tests she has had and the results obtained. I wish I had a 'magic bullet' solution for you but I simply do not. You said the tests have been 'mostly normal'... can you tell me what tests have not been normal? Please respond in the comment section.

1 comment:

Space doc said...

space doc said...
Dear Chronic Abdominal Pain:

I agree with MEDSTAT ER DOC 1 that this sounds very much like a post cholycystectomy stndrome.

The cause is Usually a stone (or biliary sludge ) that has created a blockage of the common bile duct 0r the cystic duct which are not removed along with the gall bladder.

There is a juncture at the small intestine where the common bile duct joins the pancreatic duct (called the sphincter of Oddi) where a blockage can occur and give you pain that could mimic gall bladder &/or pancreatic pain.(often also felt in the mid to right upper abdomen.)

Stones or any blockage of the ducts are difficult to diagnose. If the ultrasound and C-T scans have not picked anything up the ideal next step would be to see a gastro-enterologist and have an ERCP (endoscopic retrogade cholangio-pancreatogrraphy) where they get a real definitive picture of the ducts from the gallbladder and pancreas. This is a an endocopic exam that puts some dye iinto the ducts. (Usually they give a mild sedative (e.g. Versed) and numb the throat with some xylocaine to negate the gag reflex.

A gastric surgeon or a gastro-enterologist can perform this procedure

It would e great to hear how this all turns out.

Best of luck! Space Doc

July 21, 2012 6:32 AM