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Nurse Susan
Nurse Susan, Nurse (RN)
Category: Health
Satisfied Customers: 1091
Experience:  RN, BSN, MSN-ED, Nurse Educator whose passion is helping people understand their health and wellness
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I have a stabbing upper right quadrant abdominal pain for

Customer Question

I have a stabbing upper right quadrant abdominal pain for many weeks now. I stick to bland non-fried good for you foods. I had major surgery on Auguest 30, 2007 (emergent hysterectomy) and then a pelvic abscess and surgery to remove it aftwards in September. I then took a lot of IV and oral antibiotics ending up with C deficile. Was treated for 10 days for C def and started eating again as I had lost 30 pounds in 3 weeks due to being very ill from all the antibiotics and the c def. Then they put my on remeron and klonopin for anxiety and depression after months of being ill. I now have developed a sharp stabbing pain in my upper right abdomin right under my rib cage. They did CT scan, checked for gallstones, upper GI scope and found "nothing". My liver enzymes are slightly elevated. Pain is worse as the day progresses. Radiates to my back as well. It''s becoming debilitating. Docs are doing my lab liver tests but other than that, nothing for the pain. one more thing, they tested me for h pylori and negative. tested for celiac and negative. tested for hepatitis...all negative. Thoughts?
Submitted: 9 years ago.
Category: Health
Expert:  Nurse Susan replied 9 years ago.

HelloCustomer

I am sorry to hear of your situation. I can relate entirely; I also wound up with C diff after surgery. Im reading alot of your liver, stomach, and gallbladder, and the normal testing of them, (except for elevated liver enzymes) but I have seen nothing here regarding your pancreas. And, the pancreas is a huge organ that sits in the top left and right quadrants. If you have not been assessed for pancreatitis, an inflamation of the pancreas, I do reccomend you discuss this possibility with your physician.

Signs and symptoms are the pain you describe, but in addition there is often nausea, fever, and the pain gets worse after food or drinking alcohol.

Pancreatitis can be found by doing blood work to check for levels of the enzymes amalase and lipase...in addition, with pancreatitis, liver enzymes can be elevated, and calcium levels can be decreased.

Here is more information regarding pancreatitis: http://www.mayoclinic.com/health/pancreatitis/DS00371/DSECTION=1

I do suggest discussing this with your doctor. If the pain becomes wracking and severe, it may merit a trip to the ER to be sure nothing horrid and acute is happening.

I hope I was able to help,

Sincerely,

Susan

Nurse Susan, Nurse (RN)
Category: Health
Satisfied Customers: 1091
Experience: RN, BSN, MSN-ED, Nurse Educator whose passion is helping people understand their health and wellness
Nurse Susan and 3 other Health Specialists are ready to help you
Customer: replied 9 years ago.
Reply to Nurse Susan's Post: I sympathize with you. I don't really ever have nausea and do not drink alcohol whatsoever. Ever since my first emergency surgery.They did a CT scan of my abdomen and all organs looked "fine". Would they see inflammation of the pancreas if there was something wrong with it? What makes you lean towards checking the pancreas? Thanks for quick response.
Customer: replied 9 years ago.
Reply to Nurse Susan's Post: I sympathize with you. I don't really ever have nausea and do not drink alcohol whatsoever. Ever since my first emergency surgery.They did a CT scan of my abdomen and all organs looked "fine". Would they see inflammation of the pancreas if there was something wrong with it? What makes you lean towards checking the pancreas? Thanks for quick response.
Expert:  Nurse Susan replied 9 years ago.

HelloCustomer

You are very welcome. I lean towards the pancreas because from what you write, its the only organ that has not been checked. And yes, your pain is not a textbook presentation but not all diseases present as the textbooks state. In many cases, pancreatitis CAN show up on a CT scan, but from what I am reading it needs to be a more focused CT scan.

I also venture this guess based on the many antibiotics you took. The sulfa class of antibiotcs can cause pancreatitis. Sulfa antibiotics include bactrin.

I also state this because of your diet. The pancreas secretes enzymes which help to break down fats...if you have pain after eating fatty food, it could be because of an irritated pancreas.

I admit though that it is a guess on my part. But once all other possibilities are eliminated, the ones left over are contenders (to misquote Sherlock Holmes).

Sincerely,

Susan

Nurse Susan, Nurse (RN)
Category: Health
Satisfied Customers: 1091
Experience: RN, BSN, MSN-ED, Nurse Educator whose passion is helping people understand their health and wellness
Nurse Susan and 3 other Health Specialists are ready to help you
Customer: replied 9 years ago.
They still can't figure this out. Please help. I will say prior to this I had to have iron infusions as I wasn't storing iron as I should. Even with all the meat I ate. Now, also after the C difficile and constant paing in upper right quadrant and just a feeling of malaise and fatigue, could I have some type of malsorbtion of key vitamins such as B12 or folic acid or other? I just still don't feel good and continue to have upper right quadrant pain. Doesn't matter what I eat it seems. All amylase and lipase tests show to be "normal". CT scans "normal". Gastric fluids "high". Anymore tests or direction? What are my doctors missing?
Expert:  Nurse Susan replied 9 years ago.

Hello Jreirson1,

This is puzzling...I am happy you had normal amylase and lipase. I am running out of ideas here and will opt out and refer this question to a colleage.

Sincerely,

Susan

Expert:  Dr. Hanson replied 9 years ago.

Neuromuscular pain feels "sharp" and "stabbing" and intensifies as the day progresses and especially with stress. You should have an MRI to rule out an impinged nerve root. http://www.backpain-guide.com/Chapter_Fig_folders/Ch06_Path_Folder/4Radiculopathy.html

Gallstones are a common cause of right subcostal pain; however, you had a CT that didn't show gallstones. Therefore, it's obvious that something is mimicking gallstone pain in your RUQ. An impinged T7 or T8 nerve root commonly mimics gallstone pain.

I recommend you ask for an orthopedic or neurosurgical consult. You should have an MRI to rule out compression of your T7 or T8 nerve roots.

If you have questions please ask me.

Dr. Hanson