Atypical gallbladder symptoms and second opinions from distracted gastro
August 25, 2017 9:18 PM   Subscribe

Hello AskMeFi, I know YANAD! But a second opinion from a gastroenterologist about gallbladder issues has me confused. Have you had my symptoms? What would you do?

I've had recurring episodes of mild to moderate upper right quadrant pain for 4ish years now (in my early 30s, so starting in late 20s). Most female family members have had gallbladder issues, so I'm pretty sure the pain location is gallbladder or very close, but my symptoms do not (always) seem to be the same as other gallbladder conditions - I remember finding my mother lying flat-out on the hallway floor, swearing like a pirate and sweating buckets, during what turned out to be a gallbladder attack due to stones (she was promptly given surgery).

Symptoms: It's a dull, persistent ache right under the lower right ribs that comes and goes for hours and often days at a time. At times it's sharp but usually not. Although the episodes are not totally debilitating like my mother's were, they are pretty damned distracting and uncomfortable. It seems to bring on bloating, nausea, and mild diarrhea, and the very first episodes years ago also came with a very mild fever.
The most striking thing about it is that it gets much more intense in certain positions, almost unbearable. During these episodes, I can't sleep on my left side because my right ribs then "dig into" the painful spot and wake me up. It also starts acting up during exercise and when I slouch at the computer (nice side effect - I sit up straighter!).
I can't really tell if it's food-related or not because I also have moderate to severe chronic GERD that flares up regularly (even with meds) which has similar symptoms.

I mentioned these pains during the first routine physical I've had as an adult (I'm late-20s, early-30s), and given family history and symptoms my GP recommended blood work and an abdominal ultrasound. The results:
1. Most organs look very good. Yay! Blood work was mostly normal.
2. No signs of gallstones or sludge but
3. "Moderate distention," wall thickening of gallbladder. Diagnosis was "adenomyomatosis" (I don't have the full report but it was mentioned in a message from my health care provider).

My GP gave me a referral for surgery due to pain and because adenomyomatosis indicates a slightly higher risk of gallbladder cancer. I don't really want surgery if it's not really necessary, so I asked for a second opinion and met with a gastroenterologist ("gastro" for short).

This is where the confusion starts for me. Although the gastro was nice and knowledgeable, I'm pretty sure he didn't read my chart and certainly had the feeling he was distracted that day. He asked me what the ultrasound report said, and I couldn't remember the details and definitely not "adenomyomatosis" so I just said "moderate distention." He said it was completely normal if I had fasted before the ultrasound (I had, 12 hours), which was a bit in contradiction to what my GP had told me - she implied that the distention was out of the ordinary, or maybe I misunderstood her.

He ultimately diagnosed these episodes as a sort of "abdominal migraine/nerve issue" and prescribed me a very low dose of norotryptiline to use daily for 3 months, which I will start using soon (can't start it right away, long story).

The pain is bothering me quite a bit today and I'm wondering two things:
1. Have you or someone you know ever had similar "atypical gallbladder symptoms", and if so, what was your diagnosis/solution?

2. I'm fine with the proposed treatment for now but I feel uncomfortable with the way the appointment went. I don't know if it's normal that the patient "reports on the report" - maybe he did read it but really thought it wasn't an issue? I just don't know. I'm debating going back and getting his opinion on the actual problem (wall thickening and adenomyomatosis), or trying another gastro (expensive and not sure I need to). What would you do?

Thanks in advance.
posted by Pieprz to Health & Fitness (9 answers total)
My gastro(s) didn't even test my gallbladder or suggest it. My ultrasounds were normal. My HIDA scan was "normal" (thanks, crappy doc I saw while my regular GP was out of the office. My results were 51% function and they send you to surgery at 38%. I checked the results myself.)

I had mine out almost 3 years ago and I WISH I would have know about it during the 1+ year of horrible pain. I'm so glad to be rid of that thing.

I had all the symptoms of a gallbladder issue. Bouts of pain, horrific digestive problems, acid stomach pain that didn't respond to treatment (I also have GERD), ER visits, shoulder pain, back pain, the list goes on.

A) Your gastro sounds crap if they didn't fully listen to you.
B) Did you end up doing a consult with a surgeon? I would do that next if you haven't.
C) If I were you, I'd have surgery or at least a HIDA scan and GET THE RESULTS. I am not your doctor. It's not medical advice.

As my surgeon said, it's another "test" when they don't have a clear gallbladder issue. I'm so extremely glad it's gone. Again, I wish I would have known when everything started to get totally unbearable.

(Also, my gallbladder looked "beautiful" even when they took it out. But microscopic pathology revealed chronic inflammation and I got relief from the severe symptoms after surgery.)
posted by Crystalinne at 10:21 PM on August 25, 2017 [1 favorite]

Have you had an endoscopy? My gastro insisted I have one because, even though I do have gallstones, I also have GERD which he said isn't caused by gallstones. It turns out I also have Barrett's esophagus and also hiatal hernia. Go me!
posted by hazyjane at 11:13 PM on August 25, 2017

I'm right there with you, I'm 37/F and for the last year, my gall bladder flareups are in the form of occasional fever, burning pain in my stomach with the bloating, the diarrhea (sometimes) and the discomfort that leans toward outright pain when I am in the "wrong" position which is improved by adjusting. My mother and sister both were in agony prior to their surgeries and I watched them suffer during their diagnosis period and then both were significantly relieved by the lack of gall bladder pain afterwards.

I, too, have other gastro issues (ulcerative colitis) so I thought maybe it was something associated with that. The difference between you and I is that I found a surgeon who did an ultrasound and found the few small stones that appear to be giving me these infrequent bouts of pain and other issues. FWIW, my surgeon says that I should stick it out until I "can't handle it anymore" and then he'll go in and fix my minor hernia at the same time, two-for-one style.
posted by Merinda at 11:16 PM on August 25, 2017

All of those symptoms sound like gall bladder pain. I am so intensely glad to be rid of my gall bladder, that it was absolutely worth the surgery. The pain is just likely to get worse and worse until you are writhing on the floor during an attack and swearing like a pirate when a stone blocks the bile duct. Also, stones can move into the pancreas, and that's just a big recipe for bad stuff!

What an ass of a gastro, not to have even looked at your information and to expect the patient to have a medical report memorized! :grrr: Trust your GP!
posted by happyturtle at 11:49 PM on August 25, 2017

I presented with gallbladder symptoms on and off for many years -- along with other digestive ailments. But the gallbladder symptoms were enough to land me in the ER once or twice. They finally removed it about four years ago despite not finding much of anything (post surgery revealed some small stones).

After the surgery, which I mentioned was many years ago, I've still had the same pains, and they've gotten increasingly worse and more persistent to the point that they are now constant. The only inconsistency is the level of pain, sometimes it's a dull pain, sometimes it'll drop me to the ground. I've been to many doctors and specialists, and had all kinds of tests and procedures done -- everything comes out "normal". Right now, I'm on ulcer meds and they help...

So yeah, get a second opinion, and a third if you think you should, because if you're not comfortable with your treatment, then you should find a doctor who listens.
posted by patheral at 8:46 AM on August 26, 2017

Your description sounds exactly like my gallbladder before I had it removed. I think the second doctor wrote you off as having anxiety. She should of taken the time to get all your results and review them herself.
posted by SyraCarol at 11:32 AM on August 26, 2017

One other poster mentioned a HIDA scan, and I want to make sure you don't gloss over that, OP. A HIDA scan is a definitive test for gallbladder function. If I were you I would call up that gastro, or your regular doc, and ask for one.

I had atypical gallbladder symptoms, or at least my internist said I did. When I wouldn't stop nagging her because the attacks were so extreme, she ordered a HIDA scan--something she hadn't even told me existed. The scan showed 1% function and a couple of 1cm stones. I was immediately scheduled for surgery and felt relief right away afterward.

Good luck.
posted by ImproviseOrDie at 12:15 AM on August 27, 2017

Can you get a 3rd opinion? Or at least ask your internist to review the notes the gastro sent. I'd want to be very cautious before starting a new medication. You can also keep your gall bladder healthier by reducing fat in your diet.
posted by theora55 at 12:39 PM on August 27, 2017

I'd encourage you to get a third opinion and a scan. My gall bladder appears "perfect" on tests although I had the same symptoms as you. Docs assured me that there was no way my insurance would pay for surgery without test results being worse than they were. I tried acupuncture, and after three sessions had total relief from symptoms, and now have to go back for one or two sessions a year. For some reason, mine usually acts up in the summer. I wouldn't have gone the alternative route if there had been any chance of getting insurance to pay for surgery. I'm sure my gall bladder will need to come out eventually.
posted by Former Congressional Representative Lenny Lemming at 6:35 PM on August 27, 2017

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