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CT shows gas in biliary tree
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multitasker posted:
Have you had this, and what does it imply?

Could my post Whipple surgery reconfiguration be a cause or could there be an issue with that? The report said everything looked as it should look for a person who has had that surgery.

I keep having bouts of intense pain that comes out of the blue, either suddenly (after taking a daily medication) or gradually. It can be disabling and has caused me to miss work, so I decided to see if I could get some help with it. I have been diagnosed with reflux, but this feels like something more or something different. The pain is epigastric, mid-abdomen, and especially right below/beneath the right ribs. The pain can go through to the center of my back and wraps around my side from the right rib area.

I had an upper GI and colonoscopy Dec 5th. Lesions were noted, and on a severity scale of 1-10 (I asked) they are a 1 or 2. 2 weeks ago I had another bout of this intense pain, was immediately fatigued, became dehydrated quickly, my stool was yellow from the 3rd day to the 12th and I had diarrhea for about 2 days. The epigastric pain was constant this time and while I had no appetite, I was drinking water to try to get hydrated again. Even water caused the epigastric and rib area pain to worsen. I had labs done on the 4th day and amylase and lipase were normal as were the other labs. I had a CT a week ago that shows gas in the biliary tree, or Pneumobilia and it isn't something a normal healthy person has, according the research I've done.

I'm seeing a new GI doc at the end of March and I wonder what to expect or what more I can offer about my experience. I don't want to be written off as anxious, as my anxiety is completely under control, or as 'just' GERD/reflux because it isn't heartburn pain and I can't relate it to something I eat or drink.

I don't smoke, drink, eat salty or sweet junk food, fried foods, or drink coffee or soda.

I really want to know what's going on and particularly I want to be able to manage it, and to stop having it affect my work and my work attendance.

Any comments/suggestions/feedback is greatly welcome! Thank you in advance.
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calgal37 responded:
Hey Tasker! Long time, no hear. I had hoped you were 'all fixed.'
 
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multitasker replied to calgal37's response:
Hi CalGal! I looked around to see if you were still here but I didn't see you, so I'm glad you replied. I hope all is well with you!

Finally have better insurance this year, so I can pursue my long standing digestive issues. Maybe I just need Creon, maybe there is scarring, idk. Can't tell what starts the cycle.

CalGal, is air in the billiary tree significant?
 
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calgal37 replied to multitasker's response:
Tasker, it's possible it could be signaling that your doc should do a follow-up. In some cases the air could be 'reflux' from whatever anastomoses was done between the end of the common bile duct and the duodenum, which may be no biggie. But in other cases it could suggest there's some kind of leak possibly due to formation of an fistula of some sort.


What does your doc suggest?
 
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multitasker replied to calgal37's response:
CalGal, the US and CT were ordered by my primary. I have an appointment with a GI doc next week. In the meantime, my protonix dosage was doubled and that seems to be helping a lot. So now I'm conflicted about following up at this time with the GI doc and the expenses that could include. Still contemplating.... Somehow I always think these things are my fault....
 
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calgal37 replied to multitasker's response:
Tasker, ask your primary, but I don't think air in the biliary tree is a normal finding. The liver/bile duct system is a fairly 'closed' system that typically doesn't have air in it. The digestive system itself can have 'air' possibly due to swallowing it or maybe due to bacterial 'digestion' products.


If you have some form of air/gas in the biliary system, it would suggest it's moving/refluxing/passing from the digestive system into the biliary system. That would suggest a non-normal process. And if air/gas can move, by extension (in my mind) it could also suggest that bacteria or small particulate matter could also move. The outcome of that might not be a good one.


I don't know how in the heck something like that could in any way be your fault. You're doing everything you can to stay well, correct? So...............your fault? Nope.
 
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multitasker replied to calgal37's response:
Thanks! I did email my primary and he suggests establishing with the GI doc due to my complicated GI configuration. I think that's how he put it.. lol. He is enthusiastic about the GI doc and she sounds great, so I will be going.

I'm also curious about what she thinks about the air being there. I can't imagine that air introduced during the Whipple would still be there after all this time - almost 8 years. I asked the primary "Doesn't it ever resolve??!" and he said it sometimes takes time. Okay, but that is a long time!

I am overweight again, and working successfully on that. Being overweight easily can make me blame myself in some way.


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