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Dr Basu
Dr Basu, Experienced Specialist
Category: Medical
Satisfied Customers: 28194
Experience:  MD
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Symptoms are right sided chest pain under bone radiating

Customer Question

Symptoms are right sided chest pain under breast bone radiating up. Pain under right shoulder blade and right side of back, bad nausea with headache and fatigue. Generally feel bad. When symptoms are worse I have a tender point when pressing stomach between bottom of riibcage and belly button right side and sometimes centre. Symptoms often worse after food but no almost constant
2 x lfts showed only slightly raised alp at 130 and 140.
First ultrasound showed gallbladder sludge, liver kidneys pancreas spleen normal.
Second ultrasound normal.
Mri showed all organs normal
Please help, I know something is wrong because I shouldn't feel this way, often have bitter taste and dry mouth
Submitted: 2 years ago.
Category: Medical
Expert:  Dr Basu replied 2 years ago.

Dr Basu :

Hi there, This is Dr Basu, Experienced Specialist. I am here to address your concerns and provide great service.

Dr Basu :

The fact that you still have right sided pain worse with meals suggests something is still wrong there.

Sphincter of Oddi dysfunction or a blockage in the pancreatic duct can cause these changes.
Also gallbladder may not be functioning which will not be seen in MRI or ultrasound.
There is a possibility of a growth or obstruction at the opening of the sphincter of Oddi--this is where the pancreatic duct opens into the duodenum.
Sometimes bile stone can cause this blockage.

Also excess bile acid circulation through the intestine in the absence of gallbladder can precipitate similar symptoms.

To check the sphincter of Oddi dysfunction or biliary dyskinesia you will need a test specialized to look inside the duct.

MRCP is one such good test --a noninvasive test by MRI but specially focused to check the pancreatic duct and sphincter od Oddi.

Sphincter of Oddi manometry is another good option.

ERCP is another test which is invasive that can be considered as well.

These tests have not been done so far.

These tests can be ordered by a gastroenterologist.

Dr Basu :

You will also need a HIDA scan to check the gallbladder function well.

Dr Basu :

Best wishes,

Dr Basu :

It was my pleasure to help you today.
I am Dr Basu experienced in Gastrointestinal Diseases.
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Expert:  Dr Basu replied 2 years ago.
Dr Basu : Hi there, This is Dr Basu, Experienced Specialist. I am here to address your concerns and provide great service.
Dr Basu : The fact that you still have right sided pain worse with meals suggests something is still wrong there.

Sphincter of Oddi dysfunction or a blockage in the pancreatic duct can cause these changes.
Also gallbladder may not be functioning which will not be seen in MRI or ultrasound.
There is a possibility of a growth or obstruction at the opening of the sphincter of Oddi--this is where the pancreatic duct opens into the duodenum.
Sometimes bile stone can cause this blockage.


Also excess bile acid circulation through the intestine in the absence of gallbladder can precipitate similar symptoms.


To check the sphincter of Oddi dysfunction or biliary dyskinesia you will need a test specialized to look inside the duct.


MRCP is one such good test --a noninvasive test by MRI but specially focused to check the pancreatic duct and sphincter od Oddi.


Sphincter of Oddi manometry is another good option.


ERCP is another test which is invasive that can be considered as well.


These tests have not been done so far.


These tests can be ordered by a gastroenterologist.
Dr Basu : You will also need a HIDA scan to check the gallbladder function well.
Dr Basu : Best wishes,
Dr Basu : It was my pleasure to help you today.
I am Dr Basu experienced in Gastrointestinal Diseases.
If I have answered all your questions, Please rate my response Excellent (click on the smiley faces) under this chat box only.
Please bookmark my profile for asking further questions!
This is the link to my profile:
http://www.justanswer.com/medical/expert-mysticdoc/
Customer: replied 2 years ago.
Could any of this bar liver related? I used to drink a lot although not now.

Could gallbladder dysfunction cause a tender point in abdomen?
And could all my symptoms, nausea fatigue back,pain be related to gallbladder?
Expert:  Dr Basu replied 2 years ago.
Yes of course, any blockage in the bile or pancreatic duct will also elevate the liver enzymes.
Yes the tender point can be caused by either your gallbladder or pancreas problem.
Also worsening of symptoms with meals suggests gallbladder or pancreatic issue.
Yes all your symptoms are related to gallbladder or pancreatic problem.
That is why I recommended the above specialized tests for further evaluation and diagnosis.

Best wishes,

It was my pleasure to help you today.
I am Dr Basu experienced in Gastrointestinal Diseases.
If I have answered all your questions, Please rate my response Excellent (click on the smiley faces) under this chat box only.
Please bookmark my profile for asking further questions!
This is the link to my profile:
http://www.justanswer.com/medical/expert-mysticdoc/
Customer: replied 2 years ago.
Sorry I meant do you think there could be a problem with my liver?
Expert:  Dr Basu replied 2 years ago.
Liver problem should have shown up in MRI scan.
So it is unlikely you have any significant damage in the liver.
Still, I will suggest a viral hepatitis panel to rule out hepatitis B and C, ferritin level to rule out iron overload syndrome, antibodies ( ANCA, AMA, ASMA, anti Liver, kidney) to rule out autoimmune hepatitis.
But I feel your problem lies elsewhere as I discussed earlier, not in liver.

Best wishes,

It was my pleasure to help you today.
I am Dr Basu experienced in Gastrointestinal Diseases.
If I have answered all your questions, Please rate my response Excellent (click on the smiley faces) under this chat box only.
Please bookmark my profile for asking further questions!
This is the link to my profile:
http://www.justanswer.com/medical/expert-mysticdoc/
Customer: replied 2 years ago.
Would a pancreatic problem not show up on mri?

Expert:  Dr Basu replied 2 years ago.
MRI can miss pancreatic problem sometimes.
That is why I suggest MRCP which is also a MRI scan but with contrast specially injected inside the common bile duct and pancreatic duct to look for any blockages.
I also suggest a HIDA scan, a nuclear medicine study which assess the gallbladder function --how well it contracts to release bile in response to food.

Best wishes,

It was my pleasure to help you today.
I am Dr Basu experienced in Gastrointestinal Diseases.
If I have answered all your questions, Please rate my response Excellent (click on the smiley faces) under this chat box only.
Please bookmark my profile for asking further questions!
This is the link to my profile:
http://www.justanswer.com/medical/expert-mysticdoc/
Customer: replied 2 years ago.
But I had mri of liver pancreas and spleen and at that time the bile ducts were also,looked at

Is hida scan the only way to diagnose gallbladder dysfunction?

Would gallbladder dysfunction cause nause and fatigue
Expert:  Dr Basu replied 2 years ago.
Yes HIDA sca is the best way to look for gallbladder dysfunction.
Yes ofcourse, gallbladder problem will cause all these symptoms.

Best wishes,

It was my pleasure to help you today.
I am Dr Basu experienced in Gastrointestinal Diseases.
If I have answered all your questions, Please rate my response Excellent (click on the smiley faces) under this chat box only.
Please bookmark my profile for asking further questions!
This is the link to my profile:
http://www.justanswer.com/medical/expert-mysticdoc/
Customer: replied 2 years ago.
I have my mri results. It says I had an mrcp? Would this still look at the liver?
Expert:  Dr Basu replied 2 years ago.
yes it should have looked at your liver as well --that is why the problem is not in the liver.

Best wishes
Customer: replied 2 years ago.
Should have or does??
Expert:  Dr Basu replied 2 years ago.
it DOES.
You do not have any significant liver problem.
Please go for the Hida scan --and then you can update me.

Best wishes

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