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Possible over active gallbladder or diverticulitis?

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Posted 6/5/2017 8:42 PM (GMT 0)
Hello all. 34 year old male in good shape. For the past 6 months or so I have been battling repeat episodes of pain below my right rib (about the third rib up from the bottom) and also back pain below the shoulder blade. When this flares up it can last days to weeks and is often associated with bad belching after meals. I have been through a battery of tests, included bloods 3 times, 2 Ultrasounds, upper scope, HIDA, and a CT with contrast. Through all of this the only things that were found were slightly low rbc blood counts (just above low cut-off), a 95% ejection fraction (that caused burping and then pain for 3 days), and a single diverticulum of the transverse colon near the gallbladder region.

I was on the path to have the gallbladder removed when the surgeon asked for a CT and the diverticulum was found. There was some evidence of slight past inflammation (mild hyperemia of the omentum adjacent to the diverticulum), thus my GP thought I may be suffering from recurrent diverticulitis. I am a little uneasy with this diagnosis as it seems the pain is up under my rib (perhaps too high for transverse colon) and it almost always radiates or refers to my back under my right shoulder blade. I also seem to be set off by big greasy meals and in particular caffeine (coffee is the worst trigger). Belching can help relieve the pain when this happens. My new GI has me scheduled for a colonoscopy tomorrow to rule out more sinister causes such as cancer, although I'm not sure it would cause such symptoms? Thanks for the help!.... I'm running a little tired on Dr. suggestions and would like to hear from patient experiences. smile
Posted 6/5/2017 9:46 PM (GMT 0)
Jklue:
Colon cancer rates are fastest growing in the under 50 year of age group. This is leading physicians to pay more attention to persistent GI symptoms in those under 50 and to order an earlier baseline colonoscopy than is typically recommended. It is good that your gastroenterologist is suggesting the colonoscopy given the statistical upward trending in the under 50 age group.

Given that caffeine/coffee and "big greasy meals" are triggers for you, it is logical to ask if you have tried an elimination diet to see if dietary changes can quell your symptoms. Just thinking of a "big greasy meal" gives me heartburn. Food sensitivities certainly can play a role in GI Alain and distress.

Gallbladder dysfunction is more common in female than males and tends to have a heritary link. Do you have any members of your family that have had gallbladder dysfunction?

With a HIDA scan showing a 95% ejection fraction, "pure" gall bladder symptomatilogy from calcium oxalate stones or slug seems unlikely. There can be dysfunction if the valve to the gall bladder, The Sphincter of Odi. The valve can spasm, causing a backup of bike salts, and causing transient symptoms similar to a gall bladder atrack.

I recall my gall bladder attacks as extremely painful. The pain was more than a nuisance. I was unable to eat practically anything (although I am not a big eater or overly fond of food to begin with). All to say, the pain was significant to where I was losing weight week by week.

You mention gas and benching frequently. Bacterial Flora in the gut that is out of synch can be a prime contributor to gas and either diarrhea or constipation. A quality probiotic can be helpful as well as refraining from foods that are high in simple carbohydrates and high fructose corn syrup. Bacteria in the gut have their own metabolism and produce gas from their on metabolic byproducts. Bacteria in the gut enjoy dining on simple sugars and carbohydrates that you consume.

The neurology of the gut and intestines is primitively. Pain felt in one region may have no relation to where the pain is originating. This is one reason why diagnosing abdominal pain is so difficult. The site of pain is often not a good indicator of where the pain is originating.

I would encourage you to ease off if foods that you know to be triggers of your GI episodes.

I hope your colonoscopy tomorrow is all clear of any significant finding.

Let us know how your work-ups proceed. Your information may help someone else with the same or similar queary.
- K -
Posted 6/5/2017 10:39 PM (GMT 0)
Seashell,
Thanks for the detailed response. I had read that CRC was on the rise in younger groups, and I am still worried about this, however I have not seen any blood in my stool (also had an occult test 3 months ago) and the pain hasn't been constant or getting progressively worse. It just seems to come knocking every 3-4 weeks or so. My BMs have also been pretty consistent as well (no D, etc), except they are lighter then they used to be. My CT report also said no bowel-wall thickening and no lymph node enlargement, so I guess that's good for what it's worth... although this was during a period of no pain.

I have tried the elimination diet, and have even been put on the FODMAP. This did seem to help, although if I slip up and eat meals out (that have more fat in them), or drink caffeine, I seem to relapse. Alcohol doesn't seem to bother me. I did some extensive searching on hyperkinetic gallbladders and found a number of recent medical papers (e.g. Afaneh et al., 2016) that seem to be considering this a condition doctors should take into account. From what I read >80% seems to be considered high, with >90% very high. The surgeon I met with said he had heard of this, but it wasn't a sure thing to relieve pain removing it.

When it does flare up it can last a few days to weeks and I typically loose 5-7 pounds, but then gain it back. This is mainly because I don't eat because of the pain, which I would put at an 8 or so. The worst episode was 3 months ago and I felt pain all the way up my right shoulder, almost to my neck. I wasn't able to sleep at night. It felt like I pulled a muscle. I guess with the "referred" pain I was trying to convince myself that right shoulder pain couldn't come from the colon, but I really have no clue. I had read that the nerve receptors from the biliary tree enter the spine at the same spot as the upper right back/shoulder.

Thanks again for the response. Also, my mother just found out she has a distended gallbladder and also Addison's. My sister has microscopic colitis.
Posted 6/7/2017 12:53 AM (GMT 0)
Update: Just got out of colonoscopy and feel much less out out if than the upper GI. Doc found a flat (sessile) polyp 2-4 mm in the hepatic flexure. Also found out I have diverticulosis (which I knew) and internal hemorrhoids (which I suspected). Unless the polyp comes back cancerous I think the focus shifts back to the gallbladder. More fiber is coming to my diet.

Worst part of this whole thing was the prep, and then overhearing something getting diagnosed with Lynch syndrome right before I went into the procedure room sad I feel really bad for this person.

I'll post more results when I get them
Posted 6/7/2017 3:43 AM (GMT 0)
Jklue:
Three cheers for making it through with the colonoscopy. People often cringe at having a colonoscopy and avoid or delay having the procedure. Now you can be an advocate for your friends as they approach the need for a baseline scope.

Thank You for taking the time to update your thread. Once someone posts with a concern, the members here genuinely care and take a vested interest in hoping that a positive resolution to the presenting concern is actualized. People that you may never meet in person care about you and want the best for you.

Now you know what the inside of your colon looks like. Scattered diverticuli and scattered internal hemorrhoids. That's good that he was able to remove the polyp. Flat polyps can be difficult to resect. You'll be in good steed as you age having this baseline colonoscopy at age 34.

You're correct to feel a twinge of emotions for the individual identified with Lynch Syndrome. Understanding that other people are enduring their own health challenges does help place one's own miseries in perspective.

Since you may be recirculating to the gall bladder as a source of your symptoms and woes, do talk with your gastroenterologist about Sphincter of Ode dysfunction. Here the valve to the gall bladder spasms intermittently - resulting in gall bladder occlusion type symptoms.

You may also want to explore clarification of the superior mesenteric artery (SMA). This is a fairly rare disorder and requires an astute physician to make the diagnosis. Intermittent blockage of the SMA causes pain radiation similar in distribution to your narrative. People affected are fairly miserable with transient episodes of pain and limited ability to eat. The condition is successfully treated by surgery to respect the segment of SMA affected.

I am sorry to hear that your mother has been diagnosed with Addison's. I have Addison's myself. It can be a challenge to find the optimal dosing and timing for replacement hydrocortisone and Florinef. MDJunction has a fairly active online support forum.

I hope that you and your gastroenterologist are able to narrow the focus of possible conditions. In the meantime, "go easy" on greasy meals and coffee which have aggravated symptoms in the past.
- K -
Posted 6/7/2017 8:22 PM (GMT 0)
Seashell:

Thanks again for following up. I agree with you-- I have read many post in which the original poster never follows up.

I will be waiting on the biopsy results from the polyp, but the doctor didn't seem to concerned when he came in after the procedure. My memory is a bit fuzzy, but I remember him saying he removed a small flat polyp and to eat more fiber. I blame the diverticulosis and hemorrhoids on my fast-food midwest diet growing up. Since I met my wife 5 years ago it has been fresh fruit and veggies-- going to stick with this.

One thing that was strange is that I starting running a low fever just before the procedure. I still feel it today and wonder if it was from the prep/dehydration, or simply my immune system getting run down from dehydration/no food. If it continues I plan to call the doc.

My mother suffers from a long list of ailments, Addison's being one of them. She basically has no immune system left (CD4 count stays around 200), and she has been on steroids so long that her bones are starting to break (including the spine). Resting blood pressure around 210/110. Over the past 10 years doctors have been unable to find the cause, some saying carcinoid syndrom, others saying autoimmune. Her struggles has put my "small" issues into perspective....
Posted 6/8/2017 5:29 AM (GMT 0)
Jlklue:
A low grade fever presenting BEFORE the colonoscopy would likely be attributable to dehydration caused by the colon-cleansing prep.

Be certain to rehydrate your body with high quality clear liquids or the electrolyte packets available (ex. Emergen). Avoid high sugar sports drinks (Gatorade. sport drinks (Gatorade, Power Ade).

Experienced gastroenterologists have a good ability to visually identify a polyp as benign or malignant one. That your gastroenterologist is unconcerned should ease worries as you wait for final microscopic biopsy results.

Which leads you back to considering your gall bladder. Also discuss Sphincter of Odi and intermittent occlusion of the superior messenteric artery (SMA).

Addison's is a serious, life-altering condition. I am sorry that your mother has so many health complications stemming from corticosteroid use. I am in a similar predicament. The corticosteroids that keep me alive are also eroding my body and organs. It is a surreal experience.
Finding an endocrinologist with pituitary and HPA axis speciality has been key for me. I wish your mom well. It's a difficult course with Addison's.

We are here for you however you may need.
-k -
Posted 6/9/2017 12:46 PM (GMT 0)
Karen is right about getting hydrated well after a scope. I have crohns & UC & have had more than my fair share of scopes. I too am thinking you have a possible gall bladder issue that is rearing its head. Stick with your current diet.

Take care.
Posted 10/19/2017 10:39 PM (GMT 0)
Been a while, but wanted to update things. I am scheduled to have surgery to remove my gallbladder in early December. After all the tests, and after figuring out all the triggers, my GI and surgeon think the most likely cause is a hyperkinetic gallbladder. My GI doctor said this is something that the medical community is starting to recognize as an actual condition and I had one of the highest ejection fractions he had ever seen.

I have been able to stay relatively symptom free just based on controlling my diet, however I do have episodes of pain under my right shoulder blade and indigestion every now and then. This always follows me eating a fatty meal, or drinking caffeine.

So, I am hoping I am not one of the unlucky ones that develops SOID after the surgery. I probably could keep living they way I have been with a limited diet, but I don't think it's a good idea to keep a inflamed gallbladder in me for years-- seems like a way to cause other problems or gallbladder cancer. Also, I would like to be able to eat like a normal person again. I haven't had cheese in probably 3 months.

Also, in hindsight-- I was very fortunate to have the colonoscopy. The polyp they did find was precancerous (SSA type) and my doc said it had a 15-30% to turning into cancer. He said I may not have made it to age 50 (for the regularly scheduled procedure). Those are odds I don't want to play with. So, I will now have colonoscopies every 3 years. I'm so glad I ended up having that test done.
Posted 10/19/2017 10:47 PM (GMT 0)
I also wanted to mention (as it was a topic in the thread) that a month ago my mother lost the battle with her ailments. After a steep decline that included intense pain from multiple broken bones (from the steroid use), she suffered from a ruptured colon and passed soon after. In hindsight, I believe she was clearly suffering from Cushing's Syndrome due to the steroid use. It was an unfortunate scenario, as she needed them to survive. Rereading Seashell's post above, it seems there were some very close similarities.

She was the toughest person I have ever met and anytime I feel down and out I remind myself how tough she was and what she had to endure.
Posted 10/19/2017 11:23 PM (GMT 0)
Jklue, I am so sorry for your loss.
Posted 10/20/2017 7:12 PM (GMT 0)
Jukle:
I am genuinely sorry for the loss of your mother. You have my heartfelt condolensences.

Addison’s is a serious, life-altering illness. I never saw Addison’s in my life’s trajectory and, yet, the condition found me. I keep looking for the person that I was before Addison’s . . . but I can no longer find her/myself.

Blessings to you, faith and healing in your loss,
Karen
Posted Yesterday 5:22 AM (GMT 0)
Jklue,

Please let us know how the gallbladder surgery went. I am having similar RUQ pain as well for the past two years. 39 y/o male. My HIDA was 88%, and ultrasound and contrast MRI only show a benign 5mm polyp on my gallbladder, everything else normal. My primary doc doesn't think it's the problem, and the GI doc doesn't either, but has no better idea. I've seen a few surgeons, one doesn't think I need it removed, the other said that it is likely causing the problem and would remove it. The pain comes and goes. Some days I don't notice it, some days its a dull ache that bothers me all day. It's never been bad enough to go to the ER or anything though. I think that caffeine makes it worse as well, and high fat foods do sometimes also, but not all the time. I can't decide whether to just try and live with it, or bite the bullet and get the GB removed. I know there can be long term complications with approx. 10% of people that get their GB removed, so I am hesitant to do it without knowing for sure that it's the problem. Hyperkinetic gallbladder seems to be slowly be realized as a possible problem, but a lot of docs don't believe in it yet.
Posted Today 9:15 PM (GMT 0)
Hello-- Yes I will post an update after my surgery. I am scheduled for next Tuesday, and honestly I can't wait. The past month or so has been almost constant pain under and beside my right shoulder blade. The past week I had a bad flare up, with pain in the gallbladder region, tons of gas, and back pain. I have started having more loose/urgent stools, with what appears to be a ton of bile seeping out (doesn't seem to be Fat, as it sinks down into the toilet bowl and is yellow/orange in color (the fluid), stool is not greasy and is brown).

I was worried for a while it was my liver all along, as I have had times in the past when I was probably drinking too much beer (periods of 3 a night or so, with month long breaks here and there), but I have had liver blood tests 4 times the past year (all normal, along with GGT and pancreas enzyme and CBC) and the ultrasound and CT scans where normal. I guess that pretty much rules out the liver, although they will get a look at it on Tuesday smile For some reason I think doomsday scenarios (bad anxiety) where I have cirrhosis from drinking beer over the past 6-7 years. I guess I tend to google everything and over-react. I have a hard time thinking that liver pain can come on so sudden and intense when eating certain things (my understanding is that is really only hurts when it is swollen or if there are issues with the bile ducts).

At this point I'm about 95% sure it's my gallbladder, as my pain/indigestion seems to be directly related to eating food, especially fatty/big meals and caffeine... I can't even drink decaf coffee now without pain shortly after.
Posted Today 9:36 PM (GMT 0)
What you have described symptoms wise is exactly how i was before having my gallbladder out. I never have looked forward to any surgery, but I did that one.

Good luck with your surgery.
Posted Today 11:36 PM (GMT 0)
I felt sooo much better after I had mine out.

Keep us posted.
Posted 11/30/2017 4:00 AM (GMT 0)
Jklue,

It's uncanny how much your situation sounds like mine. I even worried for a while it was my liver as well! The pain is right in that general area, and I've had my share of overdoing it with the beer, though that was more in my 20's. However, all my liver enzymes are normal as well, and the MRI showed no liver issue. I don't drink much anymore because that seems to cause pain sometimes as well. Coffee and peanut butter seem to as well. I really can't decide if I want to have it removed or not. I just don't want to end up with digestive problems from not having a gallbladder. Most people tolerate it just fine, but some do not. My primary care doc thinks I'm crazy for even considering it!
Posted 11/30/2017 5:36 PM (GMT 0)
Hey Bummedinsocal,

I feel you-- I thought for a while I could just deal with it, alter might diet, etc. I tried for about 8 months, and it seemed I kept getting more and more sensitive to my triggers (stress, high fat foods, caffeine, sometimes alcohol). I also found very high processed sugar foods caused pain as well.

My pain under my right rib almost always feels like a bruised feeling, and when it is at it's worst it causes me sooo much pressure and belching-- which helps relieve pain when it is happening (pressure on gallbladder?). This usually starts about an hour after eating a meal. I usually have morning nausea as well when this is happening. Also I can put 2 fingers on the location of the pain under my right rib-- right where the gallbladder is located. I have never felt widespread pain across my whole liver region, it has always been in that specific spot (3-4 inches down from the sternum, along and under right rib). When the pain is not too bad it seems to mainly be a chronic ache in my back by my shoulder blade, sometimes extended up to my neck even.

My suggestion would be to have a HIDA scan if you have not had one yet. That is the only test (4 blood tests, CT scan, 2 Ultrasounds, 6 doctor visits, 2 ER visits, upper endoscopy, colonoscopy) that found anything abnormal. It also caused pressure and me to start belching during the CCK injection (hormone that triggers gallbladder to squeeze), and within 2 hours of the procedure my pain came on strong (I had been ok before going in) and lasted for 3 days. My results came back at 95%, and although they initially said "normal", the GI and surgeon agreed this is not normal and it was one of the higher ones they have ever seen. There is a bunch on new (past 5-10 years) literature on overactive (hyperkinetic) gallbladder issues and it can cause the same symptoms as a underactive (<30%) gallbladder, which they typically suggest removal.

So, my suggestion would be to have a HIDA scan. If you come out <30% or >80% (especially over 90%) you probably have something going on with the gallbladder. Although I am not a medical doctor (I am actually a doctor (PhD) in geophysics), this is the best suggestion I have and good luck! smile

Post Edited (Jklue) : 11/30/2017 11:00:19 AM (GMT-7)

Posted 11/30/2017 5:51 PM (GMT 0)
bummedinsocal,

Sorry, I just reread your earlier post and realize you have an 88% ejection fraction. From what I have read that makes it hyperkinetic... I guess it comes down to how you can manage it with diet and drugs vs taking the risk on removal. Personally, I am tired trying to eat such a limited diet (my wife is also), only to have it flare up on something as simple as decaf coffee. Then I am in misery for a week or two. There are risks with surgery, but at this point it's not getting better so I am ready to try it.
Posted 12/1/2017 5:00 AM (GMT 0)
Jklue,

Yes, I've read that 88% is hyperkinetic as well. Actually, my HIDA report even said "hyperkinetic gallbladder", but my doctors said that doesn't mean anything and only a very low number is bad. It does take a long time for the medical community to change their mind on things (low fat diet helps lose weight??), so I realize that someday this may be a known issue. But I guess not yet. I don't get the belching and gas. Just a localized constant dull ache at the bottom right of my rib cage, and even just below that into the upper stomach area sometimes. I've had it for maybe a year and a half now. It's definitely gotten worse in the past 3-4 months, though its still intermittent. I just don't know how much pain I need to be in before its worth the risk of surgery. I will be very interested to hear how gallbladder removal works for you, since we have such similar symptoms. Good luck!

Post Edited (bummedinsocal) : 11/30/2017 10:06:01 PM (GMT-7)

Posted 12/7/2017 9:41 PM (GMT 0)
So, surgery went well I am am now day 2 out. I don't do so well on pain killers (backs me up), so I have been trying to do it without any. First few days were rough, but am feeling better now. Main pain is around belly button where the biggest incision was-- feels like my muscles are torn there, although I think it's just the abdominal wall.

Started eating more food last night. The first day I had pain up my right back/shoulder similar to where I had pain before (surgery folks said I would have gas pains). However, I no longer have any pain there, and I don't feel any under my right rib (other than incisions). So, as of now don't feel the "gallbladder pain", although I am having some indigestion. I have heard it takes a while for your system to adapt with gallbladder, so hopefully things come around in the next few weeks.

For now I am glad I did it and fingers crossed it worked smile
Posted 12/8/2017 12:23 AM (GMT 0)
Glad to hear the surgery went well. Careful with food, it is going to take some time for your body to adjust to the gall bladder being gone. I had the post op gas & walked & walked some more. That was the only way to get rid of it. The nurse was right, lol. If you eat something & it bothers you, give it more time before trying to eat it again.

Keep us posted.
Posted 12/8/2017 3:23 AM (GMT 0)
Jklue,

Good to hear you are doing well. Keep us updated! Hopefully over the next couple of weeks you will be back to normal. How long are you taking off of work?
Posted 12/8/2017 10:17 PM (GMT 0)
Day 3. Pain is very manageable at this point. I'm not taking anything and have even been able to walk the dogs up my steep road and do some stuff around the house. I think I did a bit too much though as I started to bleed on one of the incisions, so I backed down.

I plan on going back to work on Monday. My job mostly is behind a computer and I can for sure do that. I tried a bit of decaf coffee yesterday and it made me feel sort of weird (not pain, but sort of like it was triggering the area that is healing), so I stopped that. Decaf tea has been fine. My appetite is back to normal and I am eating mostly low fat foods/cereal/rice. The worst part so far was the pain from intestinal gas from being backed up from anesthesia, pain killers, and zofran they gave me at the hospital. I had to drink a bunch on MOM and then had terrible gas/pain for the past few days. A lot better today and I think my guts are getting back to normal. I hate those pain killers!

Looks like a I have a buddha belly, although I heard this will go away after a few weeks smile
Posted 12/9/2017 3:54 AM (GMT 0)
Day 2, I was at the horse track with my sister & niece that were visiting. It was during the summer & hot. They were putting wet paper towels on my neck, I do not recommend the horse track on day 2, lol. We still laugh about that experience.
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