
Upper Abdominal Pain Affecting Both Sides Of Rib, Shoulder, Back. Ultrasound, CT Scan Done. Prilosec Taken. What Is The Cause?

Thank you for the query.
I understand your concern.
After going through you history very carefully, I strongly feel that you have a classical presentation of a gall bladder infection/inflammation of the gall bladder.
I understand that you have had an ultrasound of the abdomen and CT scan as well both of which have been normal.
But the reason I say you could be suffering from a gall bladder disease is that, there is an entity called acalculus cholecystitis, which means on investigations like an ultrasound or a CT scan no stones can be seen but still there would some amount of inflammatory process that is going on inside the gall bladder.
The reasons for this kind of inflammation are poorly understood, but exaggerated physical and mental stress are well known to cause such a condition.
Another important cause could be an infection in the gall bladder or the liver itself.
I suggest you get a complete blood work-up done like a complete liver profile, serum lipase and amylase levels and complete blood counts along with a repeat CT scan/MRCP(Magnetic resonance cholangeo pancreatography).
I would prefer an ERCP(Endoscopic retrograde cholangeo pancreatography) as it is a direct visualization diagnostic as well as a therapeutic procedure.
You should consult a surgical gastroenterologist for these investigations and procedures.
Hope I have answered all your queries. Please do write back to me if at you have any doubts or additional concerns.
Wishing you a speedy recovery.
I would be very thankful to you if you can update on your progress.
Regards.


Thanks for the follow-up and further information.
Gall bladder pain can be continuous when the inflammation is severe enough, it need not always be a cramping intermittent pain. Moreover cramping intermittent pain is also a symptom of gastric/duodenal ulcer disease.
Yes, there is possibility that it could be because of a gastric ulcer. But My reason for inkling towards Gall bladder is the type of pain and its classical radiation to the shoulder. I would be surprised if you do not have a band type of pain or discomfort in the right back just below the shoulder blade.
Prilosec and Zantak are fine for the gastric ulcer. But if gastric ulcer is what your doctor suspecting, I would suggest a better proton pump inhibitor Esmeprazole along with a prokinetic agent such as Domperidone and a good antacid suspension which also has a topical anesthetic agent in it to treat the basic ulcer problem.
To ease the pain you can ask your doctor for antispasmodic agents such as Hyoscine or Dicylomine.
If you want you can upload all your investigation reports with your query, so that I can have a look and suggest accordingly. There is an option to upload the reports on the right hand side of the query, please utilize it otherwise you can mail them to me at YYYY@YYYY with the subject ""ATTENTION --TO DR.YOGESH".
I am limited by my inability to examine you in person to give a precise information. But please do consider getting an endoscopy done. You gastroenterologist should do it. It will help in diagnosing the ulcer also.
Hope my answer has been of some help. Please revert back if you have additional concerns.
If you have no further concerns, you can accept the answer or else if you wish to update me regarding your progress(Which I would appreciate greatly), you may keep it open.
Wishing you a speedy recovery.
Regards.

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