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Can anything else be wrong?

  I am a 17 year old female. I recently had 2 things diagnosed. One thing was hyperparathyroidism and the other was that my gall bladder might need to be removed. Along with a whole heap of other medical problems, one main thing that was wrong was that I had been getting a very sharp pain in my left side, right below my ribs.  The pain often traveled up through my back. My gastroenterologist had me go through the HIDA scan.  That test came back showing that there was no abnormalities in my gall bladder (no stones, growths, abnormal size, ect...) The scan showed that my gall bladder had a 23% ejection fraction (close to normal from what i understand) But, the scan produced the same pain that I had been having.  They just assumed from there that it was my gall bladder that was causing me so much pain, and they de My surgeon decided to have me do the parathyroid exploration first and see if that might make my gall bladder trouble.  After I had the parathyroid exploration (removal of the bottom 2 glands, and failure to find the remaining glands) my pain was gone for about 2 weeks.  It has now returned and i am scheduled to go back to the gastroenterologist again.  He might order the scan again and see if things have changed but, he thinks that i should just go through with the surgery.  It just makes me worried that my gall bladder is functioning very close to the normal range, and i have pain in the left side and the gall bladder is located in the right side. I have also had an upper GI done and that came back normal.  I have also gone through and ultrasound and everything looks great on that also.   Is it at all  possible that my gall bladder is not the main cause of my pain and is there another test or scan that i should have done, or another avenue that i should explore? I have already been through one surgery and i would like to avoid another surgery if it is at all possible.  It just seems strange to me that the gall bladder is the entire thing to blame, but nobody wants to search anything else.  They are all convinced that i should just do the surgery.  I would appreciate any ideas that you might have, or any comments and suggestions.
  Thank you    
Dear Jamie,
I read your letter with great interest.  Identifying the cause of abdominal pain can be difficult and frustrating for both physician and patient.  I have several thoughts regarding your problem.  First, gall bladder problems do not cause pain in the left side.  They cause pain on the right side, in the region of the ribs.  There are several types of pain.  Biliary colic is a right abdominal pain (often described as an ache) that starts approximately 30 -45 minutes after eating, increases in a step-wise fashion for about 60 minutes and then gradually subsides. Acute cholecystitis is a sharp and more severe pain that can radiate to the back.  Cholangitis pain is also sharp.  Patients with cholangitis often have fever and jaundice (yellow eyes).  Based on the information that you provide you do not appear to have any of these types of pain.
The HIDA scan excludes blockage of the bile ducts by stones.  To definitively exclude gall stones would require an ultrasound of the gall bladder, a simple noninvasive test.  I would not base a decision to have surgery to remove the gall bladder solely on the basis of a borderline low gall bladder contraction and the reproduction of pain.  If you received CCK to stimulate gall bladder contraction, you may have pain related to colon motility, a side effect of the CCK.  It has been my observation that many patients who have the gall bladder removed for an atypical pain (even if the gall bladder has stones, which yours apparently does not) will have a return of the pain within a few months of the surgery.
I would suggest that you discuss other possible causes of abdominal pain with your physician and possibly have additional tests searching for an explanation of the pain.  Although gall bladder surgery is done laparoscopically and the recovery is quick, the operation should not be considered until other possible causes have been excluded, there is  a strong belief that the gall bladder is the source of the pain and the doctors are confident that removal of the gall bladder will make the pain go away.
This response is being provided for general informational purposes only and should not be considered medical advice or consultation.  Always check with your personal physician when you have a question pertaining to your health.
If you would like to be seen at our institution, please call 1-800-653-6568, our Referring Physicians' Office, and make an appointment to see Dr Fogel, one of our experts in the diagnosis and treatment of abdominal pains.
*keywords: abdominal pain, gall stones, biliary colic, cholangitis

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