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[MERGED] My Biliary Tree (Liver, Gallbladder, Pancreas)

Doc Ira,

I've been worried about the pain I've been feeling on my upper right abdomen, which has been off and on (the intensity is graver when my stomach is empty...which means, if I don't eat.)

I went to two doctors but they told me I'm fine and they told me what I feel are just muscle spasms/twitches.

The location is my upper right abdomen which is just below the tip of my right ribcage.

I had an exceutive check-up last December and the doctor told me I've got two small polyps in my gallbladder which shouldn't alarm me at all since they're not supposed to cause pain. Ever since I learned that, though the pain has been off and on. But the intensity is not so extreme...it does actually feel like a spasm.

Do you think I am just thinking too much about it? Or do you think it's but natural for me to feel pain on the upper right part of my abdomen when I'm hungry?

What kinds of further tests should I undergo to ensure I'm perfectly safe and okay (yet the doctors have assured me there's no need since I don't have any bad symptoms at all)?

Am I over-reacting?

Your advice will be greatly appreciated.


  • IraIra PEx Rookie ⭐
    I need a little more info than what you gave me:

    1. What kind of pain is it? (burning, colicky, dull, etc.)

    2. Where does the pain spread, from the right upper abdomen to..?

    3. How severe is the pain?

    4. Aside from during hunger, when does it act up? When you drink alcoholic drinks or eat fatty food, does it act up?

    5. What other symptoms do you feel when you start getting the pain?

    6. What relieves it? What worsens it?

    Possible causes of pain in that area would be due to liver, pancreas, gallbladder, musculoskeletal, and occassionally stomach problems. I can't really narrow it down yet, though, kulang kasi ang binigay mo sa aking data. :)
  • I need a little more info than what you gave me:

    1. What kind of pain is it? (burning, colicky, dull, etc.)

    The pain is stinging. But when I think about it, it becomes numbing. When I touch and press on it, I don't feel any extreme pain in contrast to my friend who had kidney stones before. She's in extreme pain when the doctor presses on that part.

    2. Where does the pain spread, from the right upper abdomen to..?

    The pain just stays there. But sometimes I feel the pain at my back. Though it just stays there. When it attacks, the pain never spreads. I just stays in one area. It's localized. It's just either at the front or at the back.

    3. How severe is the pain?

    The pain is tolerable. If I do other things, then I forget it. Sometimes it disappears. I never get fever.

    4. Aside from during hunger, when does it act up? When you drink alcoholic drinks or eat fatty food, does it act up?

    Well it's irregular. I haven't established the pattern. When I'm full it seldom acts up. But when I'm hungry it does. Sometimes, I would feel "rumblings" inside as if my stomach is "erupting" (sorry for the term, but that's the closest description I can think of as of now.) The "rumbling" is loud enough for me and sometimes other people to hear it.

    5. What other symptoms do you feel when you start getting the pain?

    I get scared to bits and pieces (is that a symptom?). And my hands turn cold. Sometimes I'd feel that I can't move my leg muscles. Or sometimes, a leg muscle would be affected.

    6. What relieves it? What worsens it?

    It just goes away. Again, the pattern is irregular. I've had an abdominal ultra-sound last Christmas. Is the abdominal scan similar to aan abdominal x-ray? Or is it different?

    Thanks for the diagnosis. :)
  • IraIra PEx Rookie ⭐
    If you have had a biliary tree (liver, gall bladder, pancreas) ultrasound and it showed normal results, it might be that you have an acid peptic disease, or maybe a GERD ("ulcer" in layman's terms). Buy a couple of Maalox chewable tablets in Mercury --they're inexpensive, over-the-counter meds--- and see if it relieves you of the pain. Are you consulting a gastroenterologist, by the way?

    If not, it may still be gallstones. In some instances, gallstones cannot be seen in the ultrasound. Anyway, try to request for another blood test right after your bout of pain-- ALT, AST, amylase, Alk PO4, Total bili, Indirect bili, and Direct bili, then show the results to your attending physician. Or consider undergoing a CT scan of the abdomen, to relieve you of your worries. If the CT scan shows a normal results, then it may just be that colonic spasms (which is nothing serious, although a little annoying at times because of the pain).

    An abdominal scan is different from an abdominal xray. Abdominal scans are more detailed and shows your abdominal contents better.
  • Thanks Doc Ira for the advice. Send bill na lang. ;)

    Yeah I went to a gastroenterologist.

    I guess may pagka-hightech ka Doctora. Dito ka na nag-"Free Clinic."

    Dumami pa sana ang katulad mo. :)

    Actually, marami pa akong questions about medical conditions.

    Is it true that 80% of the men have MVP (Mitral Valve Prolapse)? That's what my cardiologist told me (I have it!). Is it deadly? Is it a predisposing factor in acquiring a cardiovascular disease? (My cardio doctor, whom I consulted about 5 years ago, told me it's not. Just wanna know what your experience tells you about this. Maybe there are new findings.).
  • IraIra PEx Rookie ⭐
    Naku, cardiologist ang nagsabi sa iyo--so trust him over me! That's his field! :) Well, I'm not very sure about the frequency of mitral valve prolapse (although I think it's less than 80%), but I know it is fairly common, and usually does not present with symptoms. Its significance is in dispute because of the frequency with which it is diagnosed in healthy people. Meaning, hayaan mo siya. If your cardio gives you a clean bill of health, then go on with your life. :)

  • great bedside manners, doc.

  • Hi docs Ira and BU!!

    This is really super urgent. My friends 2 month old daughter was recently diagnosed with Biliary Atresia. The parents need more information on this, do you think you can help me out?

  • IraIra PEx Rookie ⭐
    That's a really difficult medical problem to have to go through. My sympathies to your friends and to their baby.

    Biliary atresia is a congenital anomaly in the liver's intra- and extrahepatic bile ducts. The duct is either very small, or almost nonexistent. The ducts are fibrosed, making the duct non-passable, so the chemicals coming from the liver do not get transported out of it, and they get dammed, and backflow to your blood. The longer the atresia exists, the more poisoned the baby gets.

    There are three types of biliary atresia: Type I, where the biliary channels are greater than 150 microns, Type II, where the channels are less than 150 microns but still reconizable microscopically, and Type III, where no channels are recognizable at all. Patients with type I would have the best prognosis, while patients with type II, dismal prognosis. Unfortunately, surgically correctable forms account for only around 15% of the cases.

    It is very, very important to have the baby treated surgically within the first 2-3 months of life, if her case is surgically correctable. If done early enough, this would allow prolonged survival in over 1/3 of the patients with biliary atresia, even in some with the so-called uncorrectable form. Many pediatric surgeons do either a Kasai operation, or a procedure called Roux-en-Y portojejunostomy on these patients. Another treatment would be to have a liver transplant (in selected patients with severe forms of atresia).

    Tell your friends to consult an excellent pediatric surgeon ASAP. If they still don't have one, I would advise them to consult Dra. Josefina Almonte. She holds clinics at Medical City and Manila Doctors' Hospital, among other places.
  • Hi Doc Ira!

    thanks so much for the prompt reply. My friend's baby has already been operated on, I think she's closer to the type III, as my friend said that her baby had no ducts at all.

    My friend told me, however, that the doctors have said that if her baby were to survive then she would eventually need a liver transplant, and knowing how hard it is to get a donor or a compatible one at that, the baby's future seems dismal.

    How hard is it exactly to treat a baby with Biliary Atresia? Will she have to be in hospital forever, can she live normally? How hard is it for the parents?

    Thanks for recommending a doctor, I'll tell my friend.

    [This message has been edited by katzmeeow (edited 06-16-2000).]
  • IraIra PEx Rookie ⭐
    Prognosis for children who have biliary atresia even after surgery is guarded. There is a 70% survival rate 1 year after surgery, and the child will have a fair chance of growing up. She won't have to be bedridden. However, even if surgery was done early, bile duct decompression does not mean the child is cured. She will be frequently plagued with liver and gallbladder problems. Some common problems include hepatic fibrosis progressing to cirrhosis, gallbladder infections, portal vein hypertension, and gastrointestinal hemorrhage. There is also a good chance that she will require further reoperation once she has grown up, due to these complications. Liver transplantation is the only hope for "cure".

    As for how hard it is for the child's parents--well, I think you know the answer to that as well as I do. :)
  • zimdudezimdude PEx Veteran ⭐⭐
    My inaanak had it and went under the kasai.
    She's normal except that she's small for her age.
  • Thanks Doc Ira!

    Zimdude: My friend's daughter is also my inaanak. How old is your inaanak now? Is there a support group here in the Phils for parent's with children suffering from Biliary Atresia?

    Thanks, will appreciate all your help.

    [This message has been edited by katzmeeow (edited 06-30-2000).]
  • Hi Doc Ira and BU!

    The baby I mentioned in this Thread also has Colydocal cyst, what is that?

  • IraIra PEx Rookie ⭐
    Choledochal cysts are dilatations of the bile ducts outside the liver. They are actually common findings among patients with abnormalities in the pancreatic-biliary-hepatic system, which your friends' child is suffering from. I would assume that since the child has undergone surgery, they would have already excised the cyst.
  • First time kong magpost dito a! :)

    Yung Uncle ko may ginagawa siya para matanggal yung gall stones. May iinumin kaya lang hindi gamot. Normal stuffs like apple juice, etc. Natural means ba. Effective siya kasi marami siyang natanggal na gall stones by means of poo poo. :glee:

    You guys interested? Post ko yung procedure kung gusto ninyo.
  • Abominable : Related kayo ni MEM? :?:

    By the way, my Uncle calls that process flushing. :D
  • yes, please. im very interested! and if meron, a list of the recommended food and food to avoid also. thanks! :)
  • **Removing gallstones naturally
    by Dr Lai Chiu-Nan

    (It has worked for many. If it works for you please pass on the good news. Chiu Nan is not charging for it, so we should make it free for everyone. Your reward - if someone, through your word of mouth, benefited from the regime)

    Gallstones may not be everyone's concern. But they should be. Because we all have them. Moreover, gallstones may lead to cancer.

    "Cancer is never the first illness," Chiu Nan points out. "Usually, there are a lot of other problems leading to cancer. In my research in China, I came across some material which says that people with cancer usually have stones.

    We all have gallstones. It's a matter of big or small, many or few. One of the symptoms of gallstones is a feeling of bloated-ness after a heavy meal. You feel like you can't digest the food. If it gets more serious, you feel pain in the liver area."

    So if you think you have gallstones, Chiu Nan offers the following method to remove them naturally. The treatment is also good for those with a weak liver, because the liver and gallbladder are closely linked.


    *For the first five days, take four glasses of apple juice every day. Or eat four or five apples, whichever you prefer. Apple juice softens the gallstones. During the five days, eat normally.

    *On the sixth day, take no dinner.

    -At 6 pm, take a teaspoon of Epsom salt (magnesium sulphate) with a glass of warm water.

    -At 8 pm, repeat the same. Magnesium sulphate opens the gallbladder ducts.

    -At 10 pm, take half cup olive oil (or sesame oil) with half cup fresh lemon juice. Mix it well and drink it. The oil lubricates the stones to ease their passage.

    The next morning, you will find green stones in your stools. "Usually they float," Chiu Nan notes. " You might want to count them. I have had people who passes 40, 50 or up to 100 stones. Very many."

    "Even if you don't have any symptoms of gallstones, you still might have some. It's always good to give your gall bladder a clean-up now and then. You'll find that your digestion is much better afterwards."

    This was the article my uncle read and followed. It worked on him, my aunt, and their employees.

    According to him, there were cases that some people were not successful for the first time, but succeeded in the third try.

    Good luck in flushing! :)
  • art727art727 PEx Influencer ⭐⭐⭐
    Originally posted by the-man
    hi uli Doc I. i would have PMd you regarding my questions below, but i cannot. my 35 yr old distant relative just underwent a gallbladder operation, his gallbladder removed by using the laparoscopic cholecystectomy method, which i'm not familiar with. hehehe. we're wondering how can the gallblader pass through a small cut on the stomach area. out of curiosity, can you answer the questions below:

    1. how big is the gallbladder?
    2. how is laparoscopic cholecystectomy being done?
    3. can the gallbladder be removed with that procedure? how?
    4. what is the difference between lap chole and open cholecystectomy?

    thanks in advance.

    Can I take this one doc Ira? first of all "the- man" I don't want to be mistaken as you because of that hehehe!..I frequently used that, and I told to many of my friends my reason why I often used "HEHEHE! is to let them know that it was me.....its not a form of criticizing somebody...okey? now let me get back to the topic..

    "the man"..for the layman's view, I would like to explain how the gallstone get there...here we go!

    There are three additional organs of the digestive sytem..the LIVER, GALLBLADDER, and PANCREAS. Although food does not pass through these organs, each plays a crucial role in the proper digestion and absorption of NUTRIENTS.
    First is the LIVER, located in the right upper quadrant(RUQ) of our abdomen which manufactures a thick, yellowish brown, sometimes greenish fluid called BILE. It contains CHOLESTEROL(a fatty substance), BILE ACIDS, and several BILE PIGMENTS. okey? these PIGMENTS is called BILIRUBIN, a waste product of HEMOGLOBIN destruction (which occurs in the LIVER as red blood cells are destroyed). The LIVER combines BILIRUBIN with BILE and both are excreted into DOUDENUM(parts of intestines) finally leaving the body in FECES (tae).
    BILE is continuously released from the liver and travels down the HEPATIC DUCT to the CYSTIC DUCT (all branches of the LIVER), the cystic duct leads to GALLBLADDER (a pear shaped sac under the liver), which stores and CONCENTRATE the biles for later use. After meals (ALTANGHAP), in response to the presence of foods in the STOMACH and DUODENOM, the gallbladder CONTRACTS, forcing the BILE out of the cystic duct into COMMON BILE DUCT, which joins the PANCREATIC DUCT just before the entrance to the doudenom. The DUODENOM receives a mixture of BILE and PANCREATIC DUCTS.....(to be continued) ...next!
  • art727art727 PEx Influencer ⭐⭐⭐
    Originally posted by the-man
    doc I, tnx for the info.

    is it true that a person who had his gallbladder removed should avoid eating foods high in cholesterol because one of the gallbladder's function is to digest 'cholesterol' or 'fats' (?)?

    also doc, if one of the purposes of the gallbladder is to store the bile which the liver produces, after it's gone, the gallbladder that is, where would the bile be stored?

    again, tnx.

    :cool: PART II

    Again "the-man" for the layman's view...

    BILE has a detergent-like effect on fats in DOUDENOM(First part of intestine DUO=2, DEN=10; doudenom measures 12 inches in lenght) It breaks a LARGE fats globules so that ENZYMES(a chemical that speeds up reaction between substances) from the PANCREAS(organ under the stomach that produses INSULIN) can digest the FATS. This action is called EMULSIFICATION(breaking of large fat molecules). Without BILE, most of the FATS( from Litson) would remain un-DIGESTED (di-MATUTUNAW).

    It is a hard collections of BILE that form in GALLBLADDER and BILE DUCTS.
    CALCULI(gallstone) can become lodged in the neck of the gallbladder or in the ducts leading to the doudenum. PRESSURES build up in the gallbladder, PAIN will experienced and INFECTIONS will follow..This is what you came up with..okey? "the-man"?

    to your first question...what is the SIZE of the GALLBLADDER..this is like you are asking the size of the SKULL(ulo) which really differ in sizes...so it was described as a"PEAR SHAPED"(peras ba yun?) so there's no configuration or exact measurement... .
    to your second question.. what is Laparoscopic cholecystectomy being done?....Okey! first let us define cholecystectomy..a CHOLE/E/CYST is a medical name for gallbladder and ECTOMY- means EXCISION or removal of the organ. so the surgical procedures is to open the abdominal part of the body.. yes! gallbladder can be remove through this kind of procedures. while LAPAROSCOPIC CHOLECYSTECTOMY--you can't and that is the difference between the two procedures..it uses ENDOSCOPES to SNARE stones and remove them..most of the time there are three surgeons involved in this procedure...three or more small incisions are needed to do it.......OKEY?
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