Upper Right Abdominal Pain

[stacdliw]

I've been having sporadic pain, anywhere from mild to severe, in my right upper quadrant below the sternum for the past seven months. My symptoms are similiar to gall bladder problems, but a high fat meal meal NEVER triggers the pain. On the contrary, a cracker or even a drink of coke may initiate the pain.

I have moderate gastroparesis and after a severe pain attack last June, I made an appointment with my GI and he did an ultrasound which came back normal. After another attack in July, he performed an endoscopy to look for ulcers or another reason that could be causing the pain and found nothing. The severity of the pain attacks subsided and I didn't pursue a further diagnosis primarily because with gastroparesis, if the gall bladder is removed, digestion can be further impaired and nausea can increase. I'm frequently nauseous as it is, so I decided if the pain had subsided, I would just live with sporadic minor discomfort than frequent nausea.

In the meantime, my GI had referred me to Vandy for autonomic neuropathy, I was evaluated and officially diagnosed with Autonomic Neuropathy, POTS, and small fiber neuropathy in September.

In the past month, the frequent and severity of the pain has returned. When I made an appointment with my GI, he told me he didn't think the pain was caused by my gall bladder since I had a clean ultrasound and endoscopy. He believes the pain is due to abdominal neuropathy! I've never read of anyone having abdominal pain due to neuropathy. Does anyone have this pain? Where is your pain?

He is ordering a HIDA Scan of the gall bladder to make sure the gall bladder is healthy. Right now, I'm taking Tramadol for the pain, but it takes about 30-45 minutes to take effect. Because of my gastroparesis, I can't take narcotics since it slowers digestion.

Dang, which is worse, a bad gall bladder with surgery which may result in a life-time of increased nausea or a healthy gall bladder and this is neuropathy, so there's no cure and I have to live with the pain for the rest of my life? I don't like either choice!

Thanks!

Bev Ray

[Sallysblooms]

I am glad you are getting care. Don't get too sad. With POTS the symptoms can get better. Mine sure have. With Autonomic Neuropathy, I really got better with Alpha Lipoic Acid. Finding a good doctor that knows these things is important. This and other supplements have me SOOOO much better. I could not get out of bed for months. Finally got to see my CFS doc and began a regimine of good supplments.

Best of luck. Let us know how you are.

[zaks27]

Hmmm--I've been dealing with pain in the upper right quadrant also. Mostly mild to moderate. I had a cholecystectomy back in 1996--so it's not the gall bladder. I was seen in the ER for chest pain last summer that was relieved by nitroglycerin. I was told the nitro works on esophageal spasms (which was probably the cause of the chest pain. ) Your mention of gastroparesis is interesting. I had a vertical sleeve gastrectomy in 2/09 for weight loss. Now I'm wondering if I'm having problems with restriction of the pylorus or a problem with the vagus nerve. My only symptom is the pain. No nausea, vomiting. I 'm pretty sure the gastrectomy and subsequent weight loss is the reason for my POTS. Nothing else makes sense. Thanks for the heads up and hint on the possible cause!

[stacdliw]

Sallysblooms-- Thanks for the suggestion concerning the Alpha Lipoic Acid. Where can I purchase it? I am bedridden quite often and would love any supplement that would help.

Zaks27 Since you have had a cholecystectomy, your pain may also be a symptom of a disorder called Sphincter of Oddi Dysfunction(http://my.clevelandclinic.org/disorders/gastrointestinal_tract_disorders/hic-sphincter-of-oddi-dysfunction.aspx). My GI ruled it out for me since it is rare for people with a healthy gall bladder to develop the disorder.

[emadden514]

Hi! I'm sorry your dealing with this. I too have that issue and have had the pain in the upper right quad since having mono w/ jaundice in 97. I too have had my gallbladder out and have gastroparesis. I felt really good for about 2 months after having the gallbladder out and then things got worse. I do not have SOD or anything like that though. I've had what seems like a million GI tests. The GI doc said my chart reads like a text book. The POTS Neuros are trying to rule out autoimmune autonomic ganglionopathy because of the severe abdominal pain I experience. I'm still waiting on those results and a few others. I just fight through the pain and don't take anything because of being limited by the GI issues and POTS. I hope you get some relief. Good luck.

Elizabeth

[mwise]

I am sorry to hear you are having pain and do hope it isn't your Gallbladder. I had my Gallbladder out in 2005 and never was right after that. I had 2 Gallbladder attacks 8 months later because they left stones (pea gravel in the bile duct) along with acute Pancreatitis from the attacks. I continued to have stomach problems of discomfort, bloating and fullness on going. Finally, I was diagnosed with Gastroparesis and Diverticulitis. I continued with pain everytime I ate something even after eating a few bites. Being followed by a GI doctor, we exhausted Reglan, Erthromycin and finally settled on Domperidone 20mg before meals and at bedtime along with me seeing a Dietician who recommended a low fat/low fiber diet with 6 small frequent meals. Between the Domperidone, the low fat/low fiber diet and small meals my pain and other symptoms were pretty much gone. I definitely know fatty/fiber foods were part of the cause because now & than I sneak a few foods with a high fat/fiber content and yes the discomfort of fullness, bloating and pain will return. As long as I stay the course I am fine. I do hope they find out what is causing your pain so you can be pain free soon.

I also would like to know where you can get Alpha Lipoic Acid and/or any other supplements that may help .

[mixmeaj]

I have upper right stomach pain that comes and goes with my POTS attacks. I have had POTS since 2003 but wasn't diagnosed until 2010. Stomach pain has always been a part of it. From mild to very severe pain. Can last for days or only a few minutes. I just think its part of POTS.

[Joann]

I too have this upper right abdomen pain, but mine is not usually triggered by eating. It is by movement, bending, lifting, squatting, But I do think there is some GI component because after it is triggered I have really bad gas. It is really intense pain and pressure that once triggered, seems to trigger very bad pots and bp surges.

[Lethargic Smiles]

I just wanted to add that I get this too and was also put on Tramadol! My HIDA showed a very low ejection fraction, but still high enough that it was left up to me on whether I wanted my gallbladder out or not. I voted no. I don't have much wisdom on helping this problem other than small meals and digestive enzymes to ease digestion... but I just wanted you to know you're not alone.

[Guest maia]

Have you had your kidney checked?

[blueskies]

I had my gallbladder out a couple of years before I was diagnosed with POTS.

Although my gall bladder was 'full of stones' according to the surgeon who took it out, the episodes of pain continued for many years so it was not my gall bladder that was causing it. I wish I'd kept my gall bladder because I have slow digestion/constipation problems that dramatically and increasingly worsened after I had it removed.

If I'd been diagnosed with POTS I would have known to think twice before I had my gallbladder out.

After some years the attacks of pain settled and now I just get what I think of as 'echos' of the pain. Mild attacks that cause discomfort but don't have me writhing on the floor while lying on my side for about an hour that I used to experience.

blue

[TCP]

When the auto dysfunction (AN and PN) started in 2007 I had pain in that area. A scan confirmed a diagnosis of gallstone (although the med student at that time said 'is it a tumour?', rather loudly!). I think it was getting near 2cm in diameter. I recently had a very painful and traumatic withdrawal from Duloxetine/Cymbalta over a six month period and the pain flared up more than usual, as I only usually get it when I have the 'corset hug' around my middle when my bowel is full. Anyway saw the doc and I'm going for a gallbladder/liver scan which is a good idea. Needless to say the pain has subsided since I have been back on the Nortriptyline. It's best to know what's going on though. I believe there is a high incidence of gallstones associated with people with M.E./CFS, Auto Neuropathy and bowel disorders.

Good luck and all the best