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Q: Gall bladder pain
asked by: DoctorQuestion on February 24th, 2008
What can cause sharp URQ pain, dull right shoulder pain, and nausea, and not show up on any of the "classic gall bladder tests", like an ultrasound or HIDA scan? An ER doc suggested that I may have a problem with a slipping rib, which may make sense because I've always been a little sensitive about pressure on my lower right rib cage (ever since I can remember).

Should I be demanding more tests on the possible gall bladder diagnosis? What tests should be done? I requested an ERCP and was told no because my liver enzymes were normal, but is it possible for something to still appear during an ERCP with normal liver enzymes? Or should I start asking that they try this alternate slipping rib theory by doing CT scans or MRIs on my rib cage?

I'm frustrated and tired of being in pain and experiencing nausea. I was a very active person before the pain started and I had been training to run a marathon. I ate a healthy diet. Now, all I can do is sit or lie down (and still be in pain).


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Dr. Nikola Gjuzelov , MD
replied on March 11th, 2008
Appendix, Appendicitis, Gallbladder Disease Answer A3762
YOU WROTE:
Current medical treatment: 4 CBCs, 3 metabolics, 1 BUN hepatic pancreatic blood tests multiple urinalyses (last one found a small UTI, for which they prescribed an antibiotic) 2 ultrasounds, upper and lower, which came back as normal. 1 HIDA scan, ejection rate 67.8% 1 EGD, found small traces of acid reflux, but the doc stressed that it was nowhere near enough to be causing the pain that I describe. I'm currently on phenagran, lortab 7.5, and protonix (for the supposed acid reflux)

An ERCP (endoscopic retrograde cholangio-pancretaicography) is used to explore the pancreatic and bile ducts. ERCPs are usually used when doctors assume for that a tumor or stone is present in the bile tract. You can request an ERCP but I doubt that it the diagnostic test will reveal anything because your laboratory results do not indicate that there stasis is present in the bile flow. Pain in the upper right ribcage can originate from the shoulder joint, muscles, ribs, lung covering (pleura) or from the nerves themselves. You can request a CT-scan or an MRI of the chest and spine and shoulder to identify the cause for your pain.




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