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Diagnostic puzzle
May 5, 2002

Re: Diagnostic puzzle

Dear Doc

I have been reading your responses which speak loudly of your great knowledge and experience in this field. I hope you might have come across several messages from me on this board and must be having an idea about my problem. Anyhow, I am narrating it from the beginning uptill now in order for you to diagnose it.

Two months I felt some mild pain on the right upper quadrant, due to which ultra sound and blood tests were done. The report is as under :

HAVAB Igm : -

HBsAb-Num : 21.4 HBsAb : Reactive

HBsAG-Num : 0.73 HBsAG : negative

HBcore Ab-num: 0.104 HBcore Ab : Reactive

HCVAB Num : 0.08 HCVAB : Nonreactive

T Billi (mg/dL):0.7 (0.1 - 1.0) D Billi (mg/dL):0.2 (0.0 - 0.4) T Protein(g/dL):7.2 (6.0 - 8.0) Albumin (g/dL) :3.9 (3.5 - 4.8) Alk Phos (U/L) :114 (50 - 140) SGOT (U/L): 22 ( 7- 41 ) SGPT (Dim)(U/L): 48 (20 -65) LDH (U/L): 119 (100 - 190) GGTP (U/L):29 (5 -85)

An ultrasound scan of lever shows normal size with fatty changes.

Another ultrasound reports says "Normal in size, shape and position, Uniform and normal echo pattern. No intrahepatic biliary dilatation. No mass lessions.

Another ultra sound report says "Normal lever - CBD / PV - normal

Gall bladder showed some tiny stones measuring 6.6 mm.

Another blood test has been done one week before, which shows HBsAg:Negative.

I feel mild pain/rather discomfort and it is localized on the upper quadrant under right side ribcage, which sometimes travels to left side under the ribcage also. When I feel pain on the right side, it causes belching. I also feel pain in the back ribs of both right and left. Initially, I felt great pain on the right side on a bumpy road, while driving a car. I have gastrointestinal problem also and has unusal amount of gas and belching, I hear sounds of gases in my belly. One of my tea-boy (office peon) has been having the same symptoms for the last 10 months. I doubt that may be I got it from him through saliva, since he might have tasted the tea before serving. My urine and stool tests are normal. This mild pain/discomfort on the right side is intermittent/almost continuous. In the beginning, this pain was very severe and I used to get pain killers, which used to give me relief.

Now, the diagnostic puzzle is as to what is causing this pain.

Is the liver causing pain: No, because I am cleared of infection. I did not know about history of HB, when I contracted and when I recovered.

Gall stones: No, because its pain is very very severe. In my case, it is continuous and mild and also moves towards left side sometime.

Gases or IBS: This could be the possible suspect, as I hear sounds of gases. If I am full of gases, can i feel the pain on a bumpy road, while driving. I also feel pain on the back of my right and left ribs while standing from a sitting position on a chair.

Please advise me what to do ???

Response from Dr. Rodriguez-Torres

It seems that you do not have liver disease.I would not rule out that the Gall bladder is the cause of the majority of your symptoms.You have documented cholelithiasis,and only when you have an episode of frank cholecystitis you may have severe pain.The rest of the time you may have gastrointestinal disorders,and some colic and pain,mostly on the right side.Go to see a gastroenterologist and a surgeon and have another opinion.Good luck!!.



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