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Suggest Remedy For Pain When Having Decreased Gall Bladder Function Test
Question: I have been experience pain in my upper right side for 2 years. My gallbladder function test showed that it was functioning at 21%, so they removed it, about a year ago. I continued to have the pain, sometimes more severe than other times. They recently did a Contrast Ct and it said I have "fatty infiltration of the liver" my ALT-8, AST-15. On ultrasound 2 years ago they measures my Liver at 15.7cm, but didn't seem alarmed. My other levels were slightly off as well. I am not overweight (115 lbs) I drink maybe once a week(3-4 beers). I have however had abnormal levels of EBV for many years as well as having recurrent mono over that past 10 years and believe this may be the cause. What are your thoughts???
Brief Answer:
Further investigations to confirm or rule out the causes .
Detailed Answer:
Hi.
Thanks for your query and an elucidate history.
To recapitulate : Female / 31 - pain right upper 2 years - gall bladder removed but no relief from pain - CT abdomen - fatty liver - was 15.7 on ultrasonography 2 years ago - abnormal levels of EBV and recurrent Mono 10 years - and believe this may be the cause...
To clear some points in advance, the person who has abnormal levels of EBV may have recurrent Mono. These may cause enlargement of the spleen and liver in turn, as seen in your case. What is the normal range of ALT and AST on your reports I hope 8 and 10 may be within the normal range Liver enlargement 2 years ago might have been due to EBV and / or Mono. Yes these two may be the cause of your problems.
The causes of pain in the right upper abdomen:
-The gall bladder is removed and hence ruled out.
-Inflammation of the liver can not cause pain for such a long time.
-Colitis : inflammation of the colon in this part of the abdomen can be the reason with or without associated features of altered bowel habits.
-Problem with the bile ducts, Opening into the duodenum (Sphincter of Oddi).
-Pancreas problems.
-Gastric and / or Duodenal problems like erosion, ulcers, strictures can cause pain in he upper right abdomen, but may also associated with other symptoms like nausea / burning sensation / GERD and so on.
-Neurological problems like disc compressing the nerve roots or spinal cord at the thoracic level.
- Stress and / or anxiety can be the instigating factor or enhancing factors.
IBS - Irritable Bowel Syndrome can present in various forms and is suspected if all the relevant investigations appear normal.
- Sometimes this is called Idiopathic , meaning no certain cause can be found in spite of all the tests.
I hope this answer helps you to get started on the appropriate course of action to get a proper diagnosis and treatment at the earliest.
Please feel free to ask for further relevant questions if you feel so. You may please give feedback on any of the points that you might have missed in pointing out earlier.
Further investigations to confirm or rule out the causes .
Detailed Answer:
Hi.
Thanks for your query and an elucidate history.
To recapitulate : Female / 31 - pain right upper 2 years - gall bladder removed but no relief from pain - CT abdomen - fatty liver - was 15.7 on ultrasonography 2 years ago - abnormal levels of EBV and recurrent Mono 10 years - and believe this may be the cause...
To clear some points in advance, the person who has abnormal levels of EBV may have recurrent Mono. These may cause enlargement of the spleen and liver in turn, as seen in your case. What is the normal range of ALT and AST on your reports I hope 8 and 10 may be within the normal range Liver enlargement 2 years ago might have been due to EBV and / or Mono. Yes these two may be the cause of your problems.
The causes of pain in the right upper abdomen:
-The gall bladder is removed and hence ruled out.
-Inflammation of the liver can not cause pain for such a long time.
-Colitis : inflammation of the colon in this part of the abdomen can be the reason with or without associated features of altered bowel habits.
-Problem with the bile ducts, Opening into the duodenum (Sphincter of Oddi).
-Pancreas problems.
-Gastric and / or Duodenal problems like erosion, ulcers, strictures can cause pain in he upper right abdomen, but may also associated with other symptoms like nausea / burning sensation / GERD and so on.
-Neurological problems like disc compressing the nerve roots or spinal cord at the thoracic level.
- Stress and / or anxiety can be the instigating factor or enhancing factors.
IBS - Irritable Bowel Syndrome can present in various forms and is suspected if all the relevant investigations appear normal.
- Sometimes this is called Idiopathic , meaning no certain cause can be found in spite of all the tests.
I hope this answer helps you to get started on the appropriate course of action to get a proper diagnosis and treatment at the earliest.
Please feel free to ask for further relevant questions if you feel so. You may please give feedback on any of the points that you might have missed in pointing out earlier.
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Thank you for the information. To address some of your response..... I had a full endo/colonoscopy 1 month prior to having my gallbladder removed, to make sure nothing else was wrong before having surgery. It was found that I have GERD, and a hiatal hernia. None of the others mentioned. However, I had a hard time believing/understanding that either are all causing the pain that I'm having. My previous ALT levels are as follows.
Oct 02, 2014- 8 IU/L Range- 12-70 L
Jul 26, 2013- 9 IU/L Range- 12-70 L
May 14, 2013- 14 IU/L Range- 12-70
May 03, 2013- 15 IU/L Range- 12-70
Apr 18, 2013- 12 IU/L Range- 12-70
Jul 17, 2011 - 14 IU/L Range- 12-70
MY AST-
Oct 02, 2014- 15 IU/L Range 15-44
Jul 26, 2013- 21 IU/L Range 15-44
May 14, 2013- 19 IU/L Range 15-44
May 03, 2013 - 23 IU/L Range 15-44
Apr 18, 2013 - 19 IU/L Range 15-44
Jul 17, 2011 - 23 IU/L Range 15-44
Also, my Neutrophils % have constantly been beyond range (40-60), and are usually between 65%-85%
My most recent lab in Oct 2014 my Albumin & Albumin/Globulin ratio have both been slightly higher above the range in which I should have. As well as my RDW being slightly below normal range.
I had an MRI of my lower spine(because my pain radiates there) and they noticed annular tears and faucet & ligamentum flavum hypethrophy, I'm assuming now that my large liver presses on these nerves and causes pain, because I have went through 2 rounds of spinal injections.
As far as my history with MONO and EBV, I get confused with all the lab reports and struggle to understand what the lab levels mean(and so do most doctors I've came across). I first had mono at 16, then again in 2008(followed by shingles), and again in 2011. I have not had a doctor check my levels of either since.
After recent studies of the EBV/MONO, and myself never feeling fully recovered, I have always struggled with my health and believe it is a large cause with my medical problems. Finding a doctor to see that understands my cause for this belief is also a large struggle. Please respond, your insight is very helpful.
So, to conclude with my second response, with the information provided, should my doctors look further into the issue of "fatty infiltration of the liver" based on my previous lab information and past medical history???
Oct 02, 2014- 8 IU/L Range- 12-70 L
Jul 26, 2013- 9 IU/L Range- 12-70 L
May 14, 2013- 14 IU/L Range- 12-70
May 03, 2013- 15 IU/L Range- 12-70
Apr 18, 2013- 12 IU/L Range- 12-70
Jul 17, 2011 - 14 IU/L Range- 12-70
MY AST-
Oct 02, 2014- 15 IU/L Range 15-44
Jul 26, 2013- 21 IU/L Range 15-44
May 14, 2013- 19 IU/L Range 15-44
May 03, 2013 - 23 IU/L Range 15-44
Apr 18, 2013 - 19 IU/L Range 15-44
Jul 17, 2011 - 23 IU/L Range 15-44
Also, my Neutrophils % have constantly been beyond range (40-60), and are usually between 65%-85%
My most recent lab in Oct 2014 my Albumin & Albumin/Globulin ratio have both been slightly higher above the range in which I should have. As well as my RDW being slightly below normal range.
I had an MRI of my lower spine(because my pain radiates there) and they noticed annular tears and faucet & ligamentum flavum hypethrophy, I'm assuming now that my large liver presses on these nerves and causes pain, because I have went through 2 rounds of spinal injections.
As far as my history with MONO and EBV, I get confused with all the lab reports and struggle to understand what the lab levels mean(and so do most doctors I've came across). I first had mono at 16, then again in 2008(followed by shingles), and again in 2011. I have not had a doctor check my levels of either since.
After recent studies of the EBV/MONO, and myself never feeling fully recovered, I have always struggled with my health and believe it is a large cause with my medical problems. Finding a doctor to see that understands my cause for this belief is also a large struggle. Please respond, your insight is very helpful.
So, to conclude with my second response, with the information provided, should my doctors look further into the issue of "fatty infiltration of the liver" based on my previous lab information and past medical history???
Brief Answer:
Further information as asked , please.
Detailed Answer:
Thanks for your feedback and trying to understand the problem patiently.
Nice to know that Upper GI Endoscopy and Colonoscopy were performed prior to Gall Bladder removal.
Noted the presence of GERD and Hiatal Hernia. These probably is not the reason for the pain you have.
Your ALT and AST are not elevated.
Rest of the blood reports also do not correspond with the pains you have.
It is necessary to know the MRI reports as this may be the reason for the pains you have. Probably the MRI needed is for the Thoracic spine.
Please post the report and if the thoracic spine is not included, you will need the new one.
Yes, Shingles - you had it in 2008 and post-herpetic (Shingles) may be one of the reasons for such pains if all other reports do not correspond with the pains you have. Was Shingles on the right side ?
EBV reports will be positive for lifelong, hence I think there is no point in getting reports again and again. And presence of EBV itself is the reason for repeated Mono you have.
Fatty infiltration does not cause such a pain and in the presence of normal ALT and AST there may not be any point to look further into fatty liver infiltration.
I hope this helps.
I would like to know the exact site of the pains and the site of Shingles and the MRI report.
Further information as asked , please.
Detailed Answer:
Thanks for your feedback and trying to understand the problem patiently.
Nice to know that Upper GI Endoscopy and Colonoscopy were performed prior to Gall Bladder removal.
Noted the presence of GERD and Hiatal Hernia. These probably is not the reason for the pain you have.
Your ALT and AST are not elevated.
Rest of the blood reports also do not correspond with the pains you have.
It is necessary to know the MRI reports as this may be the reason for the pains you have. Probably the MRI needed is for the Thoracic spine.
Please post the report and if the thoracic spine is not included, you will need the new one.
Yes, Shingles - you had it in 2008 and post-herpetic (Shingles) may be one of the reasons for such pains if all other reports do not correspond with the pains you have. Was Shingles on the right side ?
EBV reports will be positive for lifelong, hence I think there is no point in getting reports again and again. And presence of EBV itself is the reason for repeated Mono you have.
Fatty infiltration does not cause such a pain and in the presence of normal ALT and AST there may not be any point to look further into fatty liver infiltration.
I hope this helps.
I would like to know the exact site of the pains and the site of Shingles and the MRI report.
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
My exact site of pain is directly below my rib cage, almost feels like it could be under it. It is approx. 2 inches north, and 2 inches to the right on my naval, if I was looking down at it. It basically feels as if it is directly close to where my gallbladder was.
I have attached my MRI report and I have also attached images from my recent CT.
my shingles were on my right hip/buttocks
I have attached my MRI report and I have also attached images from my recent CT.
my shingles were on my right hip/buttocks
Brief Answer:
Review Endoscopy
Detailed Answer:
Thanks for your feedback and a sorry for a bit late.
Understood the site of pain: 2 inches north and 2 inches to the right on the naval, and as you say below rib-cage feeling as if under it - directly close to where the gall bladder was...
Seen the MRI report - it is of the lumbar spine.
I would advise for an MRI of the thoracic spine as the nerve supply of this area is T8, hence the MRI of the area of Thoracic spine will help to know whether there is any compression in the area around T8 (Thoracic 8).
Seen the blood reports: Marginal increase or reduction has not much of a clinical significance unless corroborated clinically. So I do not think of much value in the present problem. Blood tests also date back to last years.
Please provide CT scan reports.
Shingles having on right hip and buttocks is also a rare site. Commonest is on the thoraco-abdominal area. Was there a twinge in the area affected now ?
Does the pain increase on touching or swiping the finger on the skin ? Or is elicited on deep pressure ?
Is the pain pointed, meaning at a particular spot only or on a larger area ?
Does the movement of the abdominal musculature increase or reduce the pain ?
Any associated symptoms of nausea, vomiting, bloating, change in bowel habits ?
Any relation to the food ?
Please elucidate any small point you think which may or may not be associated with the present problem as it may help me to help you more.
I think a fresh upper GI endoscopy may help to diagnose or to rule out any problems. The area you mentioned is also a site of gastric or duodenal problems. And the previous one was done 1 year ago.
I hope this helps , awaiting for your feedback .
Review Endoscopy
Detailed Answer:
Thanks for your feedback and a sorry for a bit late.
Understood the site of pain: 2 inches north and 2 inches to the right on the naval, and as you say below rib-cage feeling as if under it - directly close to where the gall bladder was...
Seen the MRI report - it is of the lumbar spine.
I would advise for an MRI of the thoracic spine as the nerve supply of this area is T8, hence the MRI of the area of Thoracic spine will help to know whether there is any compression in the area around T8 (Thoracic 8).
Seen the blood reports: Marginal increase or reduction has not much of a clinical significance unless corroborated clinically. So I do not think of much value in the present problem. Blood tests also date back to last years.
Please provide CT scan reports.
Shingles having on right hip and buttocks is also a rare site. Commonest is on the thoraco-abdominal area. Was there a twinge in the area affected now ?
Does the pain increase on touching or swiping the finger on the skin ? Or is elicited on deep pressure ?
Is the pain pointed, meaning at a particular spot only or on a larger area ?
Does the movement of the abdominal musculature increase or reduce the pain ?
Any associated symptoms of nausea, vomiting, bloating, change in bowel habits ?
Any relation to the food ?
Please elucidate any small point you think which may or may not be associated with the present problem as it may help me to help you more.
I think a fresh upper GI endoscopy may help to diagnose or to rule out any problems. The area you mentioned is also a site of gastric or duodenal problems. And the previous one was done 1 year ago.
I hope this helps , awaiting for your feedback .
Above answer was peer-reviewed by :
Dr. Ashwin Bhandari
There is no tingling at current pain site. Fatty foods, alcohol, quick movement(lifting, vacuuming, etc.), bending, position of sitting in the car, all irritate it, and make the pain come back. When pressing on the site of pain(when it is not severe) I can feel a tender spot, when pain is severe it radiates around to the right side of my abdomen and to the back. I don't have heartburn, however..... I have always had bouts with diarrhea, and irritable bowels throughout all of my 20's, have had some recent boating. Recently over the past month I have switched to eating beans, and have cut out red meats, and I have noticed a difference. I have 2 children and my last was in 2010, and year after that I got endometriosis, and had to have a uterine ablation, I have had numerous uterine cysts, and those have been ruled out by a recent OBGYN this past January 2015. I have not seen a doctor since I have received the CT results, I have an appointment with a GI doctor on Wednesday, Feb. 18, and hopefully they will address the new findings of "fatty liver". My belief is that my EBV, has been a main cause in most of my medical problems, (endometriosis, irritable bowels, fibromyalgia, shingles, chronic fatigue, gallbladder problems, & possibly my fatty liver) I did a little research and found that there is a lot issues that EBV can cause, including most of my issues.
I will attach my CT report from 2/9/2015
I will attach my CT report from 2/9/2015
Brief Answer:
Noted the CT scan and your history.
Detailed Answer:
Thanks for your feedback.
Seen the CT report: says Small Ovarian cyst- which obviously is not the cause of your problems and Diffuse fatty infiltration of the liver (not written in the impression- probably though not significant to cause the pains you have).
You are also giving history of the Irritable Bowel in past, Endometriosis, uterine ablation, Gyn exam in XXXXXXX 2015, the factors which enhance your problem, tender spot and radiation.
Good to know that you have an appointment on 18 th and I will be happy to know the opinion of your Gastro (GI) Doctor.
I can understand your concern about EBV and please discuss this in detail with the Gastroenterologist.
Please let me know the progress so that we can discuss further.
What worries me is the irritation with fatty foods and alcohol on one side and the quick movement, position of sitting in a car, bending as these two are unrelated yet irritating and make the pains to come back. This makes it difficult to say whether this is an internal problem with the upper part of GI system as related to something to eat and drink or local skin and / or muscle problems due to sort of a neuralgia of some sort as the external factors are also causing the pain .
Well, will be waiting for the opinion of your GI.
Noted the CT scan and your history.
Detailed Answer:
Thanks for your feedback.
Seen the CT report: says Small Ovarian cyst- which obviously is not the cause of your problems and Diffuse fatty infiltration of the liver (not written in the impression- probably though not significant to cause the pains you have).
You are also giving history of the Irritable Bowel in past, Endometriosis, uterine ablation, Gyn exam in XXXXXXX 2015, the factors which enhance your problem, tender spot and radiation.
Good to know that you have an appointment on 18 th and I will be happy to know the opinion of your Gastro (GI) Doctor.
I can understand your concern about EBV and please discuss this in detail with the Gastroenterologist.
Please let me know the progress so that we can discuss further.
What worries me is the irritation with fatty foods and alcohol on one side and the quick movement, position of sitting in a car, bending as these two are unrelated yet irritating and make the pains to come back. This makes it difficult to say whether this is an internal problem with the upper part of GI system as related to something to eat and drink or local skin and / or muscle problems due to sort of a neuralgia of some sort as the external factors are also causing the pain .
Well, will be waiting for the opinion of your GI.
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
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