Have Had Abdominal Pain Moving To Back Mostly Near Liver. All Test Normal. What Else?

Posted on Mon, 9 Sep 2013

Question: Have had mostly upper right abdominal pain for 5 months. Pain occasionally moves to left or back but primarily in gall bladder/liver region.. All labs have been normal until recently found lipase to be at 105. Some labs call this "normal" my PCP is ready to call it pancreatitis due to the fact that ultrasound, and CT scan showed nothing. Any thoughts.

Very confused and scared

Answered by Dr. Hari Charan Perigela (29 minutes later)

Brief Answer:
It is not pancreatitis.

Detailed Answer:
Hi
As you are having pain since 5 months,it is chronic in nature.
Lipase value is normal.
Pancreatitis is confirmed by CT scan.As your scan reports are normal,it is excluded.kidney stones are also excluded.
Then,you have to get an Upper GI endoscope to rule out stomach ulcers.Posterior wall ulcers in the stomach radiate to the back.
If this is also normal,then it could be musculoskeletal pain.
Please stop alchohol,smoking,spicy foods,carbonated drinks,caffeine products if you are taking them.
If you come back with endoscope report, i will clarify further
Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Hari Charan Perigela (10 hours later)

I forgot to tell you that I did have an endoscopy done. The findings were mild gastritis. I am aware that this can cause pain in the abdomen, however the pain moves around a fair amount but is primarily further on my right side under rib cage. My doctor does not think that the gastritis is causing this pain due to its location.

I also wanted to ask you if eating and drinking the night before the lipase test could effect the results. I forgot that I was having blood drawn and had a few beers and a lot of food the night before the last blood draw.

Thanks for all of you input. I am glad that you do not seem to think that it is pancreatitis as my PCP seems to want to call it that.

Answered by Dr. Hari Charan Perigela (1 hour later)

Brief Answer:
Pain can be due to gastritis

Detailed Answer:
Hi
I saw your record thoroughly.
It shows that the pain was non specific in nature.
In acute pancreatitis,abdomen will not be soft and the BP will be low and pulse rate higher.But,your record shows that everything is normal.Apart from serum lipase,serum amylase will also be raised.Lipase of 105 is absolutely normal which goes against pancreatitis.All the scans are normal.So,Chronic pancreatitis,Acute on chronic pancreatitis are excluded.
Anatomically,just beneath the rib cage on right side,there will be liver,gall bladder.
If liver is lifted,there will be last portion of the stomach(Pylorus) continued with Duodenum(small intestine).Ulcers are more common here.So,pain below the right rib cage can be due to Gastritis/Duodenitis.
Eating and drinking heavily before night of tests does not affect Serum lipase levels.
Your doctor prescribed Nexium which contains Esmoprazole and it is a good drug.You can use it.
But,i prescribe Rabeprazole along with Itopride to my patients with similar complaints.
Stop alchohol,smoking,spicy foods completely for better results.
Eat frequent small feeds
Wish you good health
Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Hari Charan Perigela (29 minutes later)

Had a HIDA scan done last week and also appears normal. My PCP has indicated that normal Lipase for his lab is 60 or less and appears to be concerned about pancreas. Is there another test to ensure that it is not pancreas? Another main symptom I have been having is regular night sweats which I have attributed to the Benadryl I am taking to help me sleep. Is this possible?

Answered by Dr. Hari Charan Perigela (1 hour later)

Brief Answer:
Pancreas should be investigated

Detailed Answer:
Hi
Even the reference range is 60,it is not of much severity.
In some acute cases,the levels go upto 1000-2000.
But,you can further confirm the disease of pancreas with superior investigation like MRCP/ERCP.
Stop benadryl for sleep.
Regards

Note: Revert back with your health reports to get further guidance on your gastric problems. Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar