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Dr. Thomas, MD
Dr. Thomas, MD, Board Certified MD
Category: Medical
Satisfied Customers: 63757
Experience:  Board certified Internal medicine and Integrative medicine. Many years of experience all areas.
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The worst of my pain is in and under my right shoulder blade.

Customer Question

The worst of my pain is in and under my right shoulder blade. I don't have any real abdominal pain apart from abdomen being a bitter tender when I press below my rib cage.

Can gallbladder sludge cause more back pain than front pain?
Submitted: 3 years ago.
Category: Medical
Expert:  Dr. Chip replied 3 years ago.
Does it hurt to raise that arm above your head or to try to scratch your back with your right hand? Have you had an MRI of the right shoulder?
Customer: replied 3 years ago.
No I already advised I have had an ultrasound that showed sludge in gallbladder sludge, liver spleen and pancreas normal, had an MRI which was normal, lfts normal apart from slightly raised ALP.

I just want to know if gallbladder sludge can cause the most if the pain in the back/shoulder blade as this is where most of my pain is along with right sided chest pain
Expert:  Dr. Chip replied 3 years ago.
Yes, Nicola, the referred pain from the gall bladder can be anywhere along the right chest--either in front or in back--all the way up to the right shoulder. Sludge can cause this but so can gall bladder dysfunction like poor emptying so I would still get the HIDA scan to check for that and I would strongly consider removing your gall bladder since I think it's the cause of all your pain
Customer: replied 3 years ago.
I am worried about the possible side affects of gallbladder removal.

Would having it removed cause me to have problems such as weight gain? I have also heard that people can still have pain after removal?

Some people seem to have excruciating pain in the abdomen which I don't have, is this normal?

Also would drinking alcohol make gallbladder sludge symptoms worse?
Expert:  Dr. Chip replied 3 years ago.
Usually there's right upper quadrant abdominal pain but not always. Alcohol could worsen the symptoms. As for side effects of gall bladder removal, most often there are none, and weight gain is not one of them. The so-called post cholecystectomy syndrome is not common and it's usually from a retained gall stone in the common bile duct, but since you don't have stones that wouldn't be a risk factor after removal of your gall bladder
Customer: replied 3 years ago.
I also have a constant bitter taste in my mouth, can gallbladder troubles cause this?

Also I sometimes experience very slight itchyness
Expert:  Dr. Chip replied 3 years ago.
No, the mouth bitterness would not be from the gall bladder but it could be due to gastric acid reflux. Since your bilirubin levels are normal, the itching wouldn't be from a gall bladder or liver problem
Customer: replied 3 years ago.
At the moment the pain is bad in my upper back right side in shoulder blade area, sometimes pain is middle if back right side. At the front the pain is quite high up, under and just slightly to the right of the breast bone with nausea.

Do these symptoms sound in any way like they could be liver related?
Expert:  Dr. Chip replied 3 years ago.
No--not at all related to the live4
Customer: replied 3 years ago.
Do they sound like typical gallbladder symptoms or something else?

Could it be biliary dyskinesia
Expert:  Dr. Chip replied 3 years ago.
Biliary dyskinesia is what I've been talking about with the possible poor gall bladder emptying and yes it sounds like typical gall bladder symptoms
Customer: replied 3 years ago.
I am also finding that I have increased flatulence after eating, is this significant atall?
Expert:  Dr. Chip replied 3 years ago.
Does it happen more with fatty or fried foods?
Customer: replied 3 years ago.
Yes more so with fatty foods and dairy
Expert:  Dr. Chip replied 3 years ago.
It could be related to gall bladder dyskinesia but it also could be something like irritable bowel syncrome
Customer: replied 3 years ago.
I am still worried about liver. Would liver cirrhosis 100% show on mri? What are the chances of it being missed.
Customer: replied 3 years ago.
Relist: Answer came too late.
I had an ultrasound and mri of liver. Both came back normal with debris found in gallbladder. My symptoms are right shoulder blade and back pain sometime underneath right armpit and also pain on right side if chest a nausea.

Would liver cirrhosis 100% show up on these tests? What are the chances of it being missed?
Customer: replied 3 years ago.


You replied
19 November 2013 04:29 EST
I am still worried about liver. Would liver cirrhosis 100% show on mri? What are the chances of it being missed.


Customer: replied 3 years ago.
Relist: Other.
No answer from doctor
Expert:  Dr. D. Love replied 3 years ago.
I notice that you have relisted the question.

No, an MRI is not 100% (very few tests are). An MRI, by itself is quite good, but has about 90% accuracy. In the setting that the liver blood tests of AST and ALT also are normal, then the likelihood that there is any cirrhosis would be much less, probably less than 1%.

If you have any further questions, please let me know.

Customer: replied 3 years ago.
Thank you. I had lfts all normal apart from ALP slightly raised at 139 the first time and then 140 the second time. I also had an ultrasound which was normal apart from debris in gallbladder.

What would be your diagnosis? Is the ALP indicative of cirrhosis??
Expert:  Dr. D. Love replied 3 years ago.
No. The AST and ALT are indicative of liver cellular problems. The ALP is indicative of biliary problems. Any condition that interferes with or obstructs bile flow can cause an increase in ALP, including gallbladder problems, such as the sludge that is seen on the ultrasound.

It is impossible to make a diagnosis over the internet, but all of the symptoms and findings are consistent with gallbladder disease from the sludge.

Expert:  Dr. D. Love replied 3 years ago.
I notice that the question is still open, but have not received any further questions. If I can provide any further assistance, please let me know.

Customer: replied 3 years ago.
My pain is all mostly in the back right shoulder blade and mid back and right shoulder.

I also experience a burning pain/ache in right side if chest under breast bone and sometimes below right armpit.

I don't seem to have the excruciating pain in the right abdomen people seem to have.

Is it possible with gallbladder disease to have more pain in the back/chest than the abdomen?
Customer: replied 3 years ago.
Relist: Other.
Don't want to wait for dr
Expert:  Dr. Chip replied 3 years ago.
Hi--sorry but I was off when you last responded to me. Listen--cirrhosis doesn't cause pain--neither in the abdomen or in the chest or shoulder blade. I see absolutely no reason for you to be worried about cirrhosis, but is there any more information you need?
Customer: replied 3 years ago.
I wasn't asking about cirrhosis. I was saying that I have the pain most in the shoulder blade, right side of the back, right side of chest but I don't have the excruciating pain in the abdomen that most people report with gallbladder issues.

So what I was asking was, is it possible with gallbladder disease to have more pain in the back/shoulder blade/chest than in the abdomen?
Customer: replied 3 years ago.
Relist: Other.
Don't want to wait
Expert:  Dr. Thomas, MD replied 3 years ago.
Hello
I can help you.

The answer is yes.
It is possible.

The pain in some cases can show up only in the shoulder blade area.

You would need to get an ultrasound and exam to help sort this out, of course.

In rare cases a HIDA scan is needed.

Use reply to let me know if you have further questions.
Please do not forget a positive rating.

Customer: replied 3 years ago.
I have already had an ultrasound which showed debris in the gallbladder. My ALP has also been slightly rAised. All other liver functions normal.

I also have nausea and fatigue
Expert:  Dr. Thomas, MD replied 3 years ago.
OK
We are on to more details and I can stay with you till you have your answer[s], but please remember we are only paid by ja per positive rating.

OK
Yes
This can be gallbladder.

Debris can cause problems as well.

A HIDA scan would show if there is a gallbladder emptying problem, and thus could confirm this.

Use reply to let me know if you have further questions.
Please do not forget a positive rating.

Customer: replied 3 years ago.
Is debris like sludge? What problems can this cause?
Expert:  Dr. Thomas, MD replied 3 years ago.
Yes like sludge.
I just stated the possible problem of a decrease in gallbladder emptying, which can be confirmed by HIDA scan.
Which is what I would do next if you have no other explanation for the pain.
Use reply to let me know if you have further questions.
Please do not forget a positive rating.
Customer: replied 3 years ago.
My consultant does not think the hida scan is necessary and has proposed to remove the gallbladder based on my symptoms, the ultrasound and lfts.

Also I recently had a baby, not sure if this is a factor?

Do you agree
Expert:  Dr. Thomas, MD replied 3 years ago.
I can not second guess your consultant.
If exam reveals this to be gallbladder, then I agree with your consultant.

Recently having a baby is not a factor in getting the gallbladder removed.

Use reply to let me know if you have further questions.
Please do not forget a positive rating.
Customer: replied 3 years ago.
No but pregnancy is a risk factor for gallbladder problems. I was not asking you to second guess I was asking for your opinion.

Do you think the symptoms are from gallbladder or something else?
Expert:  Dr. Thomas, MD replied 3 years ago.
It sounds like gallbladder.
However, unless I had clear findings on exam and the debris was pronounced, I would do a hida scan.

This depends on the amount of debris...if this is pronounced, with exam findings, then I would proceed with surgery.

In fact, if you are caucasion, have lighter colored skin, fertile, female and are at all over weight these are also all risk factors.

Use reply to let me know if you have further questions.
Please do not forget a positive rating.




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