Major Ache In Right Upper Quadrant Radiating around Ribcage and Down Back

[Sally1514]

I had a colonoscopy on June 30.  All seemed to go well, I have Diverticulosis but not bleeding.  The next day, July 1, I became aware of an ache at the edge of my upper right ribcage, radiating around my right ribcage and down my right back.  It's a sick ache, and when I stretch my right body, it really pulls.  If I sleep on my right side, it feels like I "push" off of the mattress.  I saw my Gastro about a week later and he took a blood test because he thought I might have a trapped gallstone in my biliary tract even though I have no gallbladder and what a coincidence that would be since I felt great before my colonoscopy.  I ended up in the ER last Thursday and they ran blood, urine, EKG, a ct scan of my abdomen, all negative.  I was concerned about a perforation of my colon but everyone says I'd be vomiting, feverish, and so on.  The ER doc said I could have a small perforation and it would require a couple days of IV antibiotics in the hospital.  But they sent me home.  I am miserable and hurting.  My abdomen is soft and not rigid and I'm not exhibiting the symptoms I'm supposed to be.  My gastro said because I wasn't as cleaned out as I should be that he had to "clean out" the right side of my colon and that's where I hurt.  Please, someone, help!!!!!

Sally

[TeleShane]

Do you feel as if you could "pop your back" and relieve this pain? Visceral (abdominal) organ pain shouldn't hurt when you "stretch" or change positions; however, thoracic(rib) nerve pain can present with all the aches and pains described, as the nerves "flow" to all the different areas mentioned. Have your spine assessed for bulging/herniated discs.

[kakk333]

you could try a medication that helps with colon spasms (bentyl or levsin) I gave it a try, works for some people. Unfortunately not for me though :(

[JimK3145]

The HIDA scan is done to test how well your gallbladder works. Since you don't have a gallbladder anymore, that's why you didn't have to have it done. I'll be injected with a chemical to fool the gallbladder into thinking that I've just eaten. Then the scan will measure how much bile the gallbldder will "eject" into the small intestine to help with digestion. Normally a good working gallbladder will empty about 40-70% of the bile into the intectine. The lower the number , the more non-functioning the gallbladder is. I'm glad to hear that your getting a second opinion. You might want to consider that in addition to getting an opinion from this internist, to also get another opinion from a second GI doctor. I'm sure this internist could recommend one to you. Good luck!

[Sally1514]

Hello again.  I am requesting all of my reports from the radiology dept and also from the ER.  Just by luck, where I work I ran into a customer who's dad is an internist that I saw once before years ago.  She suggested I take everything to him to get a 2nd opinion.  I may have said it hurts to sleep on my right side but if I did, it actually feels better to sleep on my right side.  This ache is like nothing I've ever felt before.  It's so deep and penetrating.  It doesn't wake me up at night and my appetite is the same as well as my stool.  My gallbladder was removed in 1981 and I have never had any stones since then.  The interesting part is I typed in "colonoscopy horror stories" in Google and got an allnurses.org website wherein those who have had colonoscopy problems and problems generated by the colonoscopy are posting.  I wish I had read that prior, I would never have had it.  I was concerned with the prep and that was a breeze compared to the procedure and the resulting RUQ ache.  I wish you well on your procedure tomorrow.  I don't know what a HIDA is, my doc never recommended it.

[JimK3145]

As to your question about further testing, I am having a HIDA scan with Stimulation done on July 24th. Then I'll be able to see what my ejection fraction is. So far, all other tests (MRI, CT scan , Abdominal sonigram says that my gallbladder is fine (no stones, no wall thickening) and that the common bile duct is within limits. Not sure if any of these test would show "sludge" in the common bile duct. To date, my first Gastro doc had no idea what could be causing the RUQ pain. My new guy is a lot more thorough and he's the one who ordered the new Hida scan, so I'll have to wait to see what the results are. I did mention the costochondritis to my GP and he said that he didn't think that I had it. He said that I would be able to feel it where the ribs join the breastbone. I do not feel pain there. There is a good web link at the Mayo clinic that you might want to look at about this costo thing: (http://www.mayoclinic.com/health/costochondritis/DS00626/DSECTION=symptoms)
So right now I'm as stumped as you as to what's causing this RUQ pain. Maybe you might want to get a copy of all your tests and get another opinion from a second Gastro doc. That's what I had to do. At least my first gastro doc told me that he was stumped and that I ought to seek out another opinion at a academic/teaching hospital and that's just what I did. So far, I think the new gastro doc is a lot more methodical and thorough. I've only seen him twice. Hopefully when I see him again, I'll have a clearer picture. I should tell you that when I got my first results back on the gallbladder, I went to a surgeon. He told me even though I'm in RUQ pain, based on the findings that said my gallbladder was fine, he could not justify removing my gallbladder. He said that he doesn't operate based on pain. I should say also that my primary care doc thinks that the RUQ is due to IBS which I don't buy, and the new gastro doc hasn't given me his thoughts on this yet.

[boron]

Again, you should find out if the pain is from the abdominal/chest wall, or from inside (biliary duct/colon). You've mentioned that pain occurs when you "strech your right body". One doctor thought it was costochondritis (rib pain). You say, it hurts when you sleep on the right side. All this speaks more for external, rather than internal pain.

So, if you press over the painfull spot, and pain increases, than the problem is on the surface, rather than inside.

[Sally1514]

Well, I'm devastated.  I just got a call from my primary doc and my gastro and they say all my tests are "normal".  Normal for whom?  They aren't walking around with this RUQ pain every day.  I don't know what to do now.  They aren't even offering to go back in to look and see what went wrong with the colonoscopy.  

[Sally1514]

I'm still trying to get the results of my wet reading of the ultrasound done yesterday.  My RUQ ache is more in my right side and upper right rear shoulder area but is still very tender under my right breastbone.  It is always there but not constantly paining me like in the beginning. It seems to be moving around.   A recent poster here said his colonoscopy gave him appendicitis.  That's the problem.  No one tells you the complications following a colonoscopy for some people.  Others breeze right through them with flying colors.  I wish someone had told me this would happen and I would have never had one.  How is yours?  Do you have further tests planned?

[JimK3145]

Sally,
As Boron had mentioned, gallstones can still form in the common bile duct even after your gallbladder is removed. How long ago was your gallbladder removed? My Gastro doc says that this stone formation happens in about 10% of all the people who have had their gallbladder removed. My Aunt had this problem. Her gallbladder was removed 30 years ago and the stones formed. She's 96 now and recently had the stones removed endoscopically during 2 separate procedures. They didn't want to do surgery since they felt the surgery might kill her. Thank goodness that these endoscopic procedures are available. The colonoscopy would never go as far up as to get near the common bile duct. As to your Diverticulosis, I am not familiar as to where that area would occur, so I'm not qualified to say whether the colonoscopy would irritate that area. Hopefully, Boron might be able to answer that. I would think that the ultrasound should be able to show stones in the bile duct. Hopes this helps.

[Sally1514]

I had absolutely no RUQ pain/ache, NOTHING, prior to the colonoscopy on June 30.  If I could go back in time, believe me, I would NOT have had the colonoscopy.  Sure, the gastro doc says I have no cancer/polyps, but not I have THIS.  I had a chest and abdominal x-rays last Thursday and my third round of bloodwork.  I just this morning had an ultrasound.  I already know I have cysts on both kidneys but they have been causing me no grief.  It was a "wet reading" so the results were supposed to be available to my primary care doc today and I already called.  Valley Radiology where the tests were performed said I can call them on Wednesday and they will send the printed results to my home.  The constant ache in my upper right rib area has lessened and now I feel it in my right rear shoulder area.  I'd prefer having it there if anywhere.  I notice that I "ache" after I eat, as if the food is passing through a tender area of my colon.  

[JimK3145]

Thanks for the feedback. I am getting a HIDA scan with stimulation on July 24, so I'll at least know what the ejection fraction is. Somebody had sent me a link to a medical paper presented in 2005, which indicated that sometimes long term use of PPI's (prevacid, prilosec, etc) can reduce gallbladder motility function, even leading to RUQ pain. I've been on PPI's for 11 months so it'll be interesting to see what my gallbladder ejection fraction number will be.

[boron]

You should exclude/confirm skin/muscle/rib as an origin of pain. From inside, it may be liver, gallbladder, or bile duct. If no stones was found, it may be biliary sludge, or there is a motility problem of gallbladder OR bile duct. This can be checked only by functional tests: for gb, it is HIDA scan, for bile duct is manometry of sphincter of Oddi.

[JimK3145]

I've read with interest your postings. I've been having RUQ pain for awhile. Sometimes it feels as though the whole area is stiff, sometimes, like the skin is tight or constricted. There is no soreness to the touch but the pain is there. I've had MRI with Contrast, Abdominal Sonigram, and Cat scan done. All indicated no gallstones and gallbladder was okay. I've had a HIDA scan done which indicated that it was functioning okay but it was done without stimulation, so I don't know what the ejection fraction is. I'm having another HIDA scan done next week but this time it will be done with stimulation. Last August when I exhibited abdominal pain, bloating, no constipation or diarrhea, I had an endoscopy done, was diagnosed with slight gastritis, no H.Pylori and was put on Prevacid. I've been on it for about 10 months with no improvement to my abdominal symptoms. About 8 months ago, the RUQ pain started.  My original gastro doc said that he couldn't figure out what was going on, so he recommended that I switch to a new gastro doc at a teaching hospital. The new Doc thinks that what I really have is non-ulcer dyspepsia, although he hasn't said as to whether the RUQ pain is related. He was more concerned with my abdominal bloating, and slight nausea, etc. If my upcoming HIDA scan shows a low ejection fraction (say, less than 40%) could this be the cause for the RUQ pain. If not, could the dyspepsia be causing it? Thanks for any input!

[Sally1514]

Still bleeding, bright red, not a whole lot, but concerned.  Saw my PCP's assistant yesterday who did a digital rectal exam and saw a bad hemorrhoid, her finger did not return internal blood, she said.  She ordered a chest x-ray, looking for air that would mean perforation, and an abdominal series.  I will have an ultrasound on Monday the 21st.  My regular Gastro doc returns Monday also.  What are gold standard for detecting a gallstone(s)?  Thanks for all your help.  

[boron]

Gallstones may be in the gallbladder for years without causing any symptom. Colonoscopy is "event" which may trigger these symptoms. Colonoscopy may even trigger IBS. Anyway, you can't really know without investigation. Again, it could be gallbladder or biliary duct, which are two different things, and especially bile duct disorders often don't show with regular ultrasound.

[Sally1514]

Well, I'm bleeding from the rectum when I wipe, hope it's just a hemorrhoid.  Pressing BELOW the breastbone is where it's at radiating across my right ribcage and into upper shoulder and down lower right side.  But a COINCIDENCE like this when I had NOTHING before the colonoscopy is what I can't buy.

[boron]

I've finished medical faculty (GP level), am not working as a doc currently though.

That rib thing is costochondritis. It feels like pain if you press over the RIB. The cause is not always known. Pain from biliary tract is felt, if you press on the soft part BELOW the bottom rib. Gallstones usually don't cause pain when you change body position. Gallstone pain is like a spasm - it grabs you, holds you for minutes/hours and goes away. Gallstone pain tends to radiate into right shoulder or upper back.

MRCP is not painful, is just like any other MRI.

Other investigations mentioned are like upper endoscopy, now you can imagine.

[Sally1514]

Hi, thanks for replying.  No, I'm not burping very much at all.  If I were, I wouldn't probably think much of it because I burp quite a bit anyway.  My major concern is having been to the ER and just last night to my Gastro's associate, who's a colorectal surgeon and one of the "top docs" according to his plaques on the wall, that he probed and poked at my abdomen and when he got to my right side, he said it seemed to him to be "rib related" and said some long name like costocondriasis or something like that.  My question was: how coincidental, given that I was perfectly healthy without aches or pains of any kind when I had my colonoscopy and now I am left with this big toothache-like ache throughout my left side.  Too coincidental for me.  The only doc I haven't seen is my primary doctor who I should probably make an appt with since I can't seem to get any logical answers from anyone else in the medical community.  One question:  are you a doctor or someone with great medical knowledge and how painful are the tests you mention?

Thanks -- oh, BTW, I did start taking Amoxicillin, I figured it couldn't do any harm.

Sally

[boron]

- biliary tree - it means biliary duct, which you still have, can be blocked by a small stone or biliary sludge. Endoscopic ultrasound or better MRCP (MRI of biliary duct) can show this. It may also be biliary dyskinesia which is a functional disorder and is not easy to diagnose. One test is manometry of sphincter of Oddi.
- kidney/uretheral stone: this would be seen on x-ray of abdomen, but not necessary on CT. since CT only catches a portion of abdomen
- trapped air following colonoscopy. Well, this should go away in few days. Infection, perforation and such really isn't likely with your symptoms.

Are you bloated in your upper abdominal area? Burping?