Stomach, Digestive & Bowel Disorders

The more I think about my appt today the more in bothers me.  It was a first appt and i was in an out of there in 20 minutes.

I started having discomfort/pain in my right side, just below my ribs a about three weeks ago.  I saw my primary care Dr. last Thursday and he poke and prodded where my gallbladder is an it hurt.  He was pretty sure it was gallstones and ordered an upper right quadrant abdominal ultrasound.  I had that last Friday, when she pressed down it hurt like she was pressing on a bruise.  The scan showed no stones so I made an appt with the gastroenterologist  I have no diarrhea or constipation but have been gassy.  I start belching in the morning as soon as I drink water.  The dull pain in my upper right quadrant is constant.  I have had occasional sharper but fleeting pain in the center of my upper abdomen the last few days and am also tender there.

The gastro asked me a few questions, listed to my chest and abdomen, felt only in the center of the upper abdomen and thinks it's my stomach so next Friday he's doing an upper endoscopy.  He did not feel my gallbladder at all even though I told him it had been tender there and that was where most of the pain was.  He said if they don't see anything during the upper endoscopy then he will do a hida scan.  So now I have to take a day off and arrange transportation for this test.  I could understand doing this test if the hida scan was normal,  It seems like he's doing things backwards.  He also gave me Kapidex to reduce the acid and see if that helps.

You are right to be concerned about the time that you have to take out of your day to have testing done. Make sure that the doctor has asked all the right questions in order to make a diagnosis and do the test with the highest probability of giving the right answers. Pain in the abdomen is not like pain that you experience on your skin or in a joint like the wrist. Pain on the skin or in a joint often localizes exactly to the cause of the pain at that site and is called somatic pain. Pain in the in the abdomen and sometimes on the skin or a joint may also be caused by visceral or neuropathic pain and the localization of the pain may not alway be where the pain originates.

In order for the doctor to determine where the pain is coming from, they need to take a careful history and physical exam. Pain from the gallbladder is episodic and occurs after meals particularly fatty meals. Sometimes stones can get out of the gallbladder and get stuck in the bile duct. This causes crampy intermittent right upper abdominal pain usually brought on by a meal. If you are having the pain when you are in the doctor's office, the doctor can order blood tests that are sometimes helpful to make the diagnosis (liver profile, amylase and lipase). The physical exam is also important to help localize the pain and it is necessary to examine all parts of the abdomen. Patients on NSAIDs (nonsteroidal antiinflammatory drugs (aspirin, ibuprophen etc) are at increased risks for ulcers. In patients that are less than 50 and who I suspect may have an stomach ulcer, I start medication first to see if the pain improves before endoscopy. An educated individual is the best partner in medical care.