Navigating Conflicting Information on Cholecystitis Diagnosis
Background Information: Age 29, Height 5'11", Weight 285 lbs, generally out of shape, occasional light alcohol consumption, non-smoker, currently taking 200 mg of Sertraline and Quetiapine daily. Symptoms: Over the last 12-18 months, I have experienced abdominal pain approximately 4-6 times. This pain is described as crampy and gnawing, akin to hunger pangs, at times feeling as though my abdomen might burst. The discomfort is mainly centered about an inch above my navel, accompanied by slight stomach distension. The episodes usually last around 6-8 hours, and I have had recent bouts of diarrhea. Absence of Symptoms: I would like to clarify that I have NOT experienced nausea, vomiting, fever, sweats, or pain radiating to my lower back. Incident Timeline: - **August 24:** - 6 PM: Consumed a Chipotle bowl with chips and guacamole. - 10 PM: Tried to sleep but discomfort prevented it. - **August 25:** - 4 AM: After a sleepless night, I decided to go to work early. - 4:30 AM: Found it difficult to remain still at work due to discomfort; drove myself to urgent care. There, I received hydration via an IV (2L saline, 1 bag of acetaminophen, and 1 bag of antibiotics over two hours). - 5 AM: Underwent blood testing, a urinalysis, and a CT scan. The results indicated an inflamed gallbladder, leading to a diagnosis of acute cholecystitis and an incarcerated umbilical hernia. A significantly elevated white blood cell count was prevalent. The doctor advised me to schedule a follow-up with a primary care physician (PCP) for further evaluations and a possible surgical referral. Prescriptions included Clindamycin (300 mg four times a day) and Tramadol (50 mg as needed). - **August 26:** - 7 PM: Ate a Salata wrap. - 10 PM: Experienced the same pain as previously, took Tramadol which provided relief, allowing me to sleep. - **August 27:** - 4 AM: Woke up due to pain; took Tramadol and fell back asleep. - Noticed very dark stool (not tarry) and bright orange urine on this day, wondering if it might be a side effect of the medication. - **August 29:** - Saw a PCP who agreed with the diagnosis of acute cholecystitis and confirmed the presence of a visible hernia, but disputed the incarceration classification. She suggested scheduling a visit with a surgeon, noting that I was protective during the abdominal examination. - **September 4:** - Consulted with a surgeon, who confirmed the symptoms matched the acute cholecystitis diagnosis. He stated the hernia was present but defined it as fat, not intestine. He recommended an ultrasound for thorough evaluation and planned a cholecystectomy for September 9. - **September 5:** - Underwent an ultrasound where the technician observed that the gallbladder appeared normal, with no gallstones present. There was also no inflammation or thickening of the walls. The technician seemed puzzled by my diagnosis since I reported pain in the mid-abdomen rather than the upper right quadrant and felt no discomfort during the gallbladder examination. Current Situation: I find myself uncertain about proceeding with surgery, especially given the absence of abnormalities in the ultrasound results. I am keen to avoid unnecessary surgery. I anticipated the ultrasound would reveal some issues, but the technician’s findings and confusion regarding my pain’s location have raised my doubts. Three professionals recommended the gallbladder removal, while one expressed caution. Asking for Insights: Do my symptoms align with the diagnosis of acute cholecystitis? I haven’t exhibited the typical signs associated with gallbladder issues, which leaves me perplexed. While the CT findings seemed conclusive, the ultrasound results have shaken my confidence. I have my medical documentation available if anyone requires further review. Thank you in advance for any insights you can provide.
Answers (1)
9/6/2025, 1:01:51 AM
OpenHealth AI
Your situation involves some complex medical considerations, especially with the conflicting information regarding your diagnosis of acute cholecystitis. It's understandable to feel uncertain about proceeding with surgery when ultrasound results appear normal, and that concern is valid.
Key Points:
- Symptoms vs. Diagnosis: Acute cholecystitis typically presents with right upper quadrant pain, fever, and often includes nausea or vomiting. Your symptoms of mid-abdominal pain and lack of classic signs may raise questions about this diagnosis.
- Diagnostic Conflicts: The CT scan indicated inflammation, while the ultrasound did not show gallstones or gallbladder wall thickening, which complicates the surgical decision-making.
- Surgical Necessity: Surgery may be recommended when there's clear evidence of disease, but conflicting findings can lead to hesitation.
Explanation:
Acute cholecystitis usually results from a blockage of the gallbladder (often by gallstones) leading to inflammation. Your earlier CT scan suggested inflammation, but the subsequent ultrasound may not support that diagnosis. The varying opinions from specialists must be carefully weighed, especially in your case where one physician questioned the diagnosis.
The darker stool and bright orange urine may potentially relate to the medications you’re taking (Clindamycin or Tramadol), but reporting this to your doctor is prudent to rule out any underlying issues related to liver function or bile flow.
Recommended Next Steps:
- Further Evaluation: Schedule further discussions with your surgeon to address your concerns about the conflicting diagnostic results. Ask for the rationale behind their surgical recommendation despite the ultrasound findings.
- Additional Imaging or Tests: Inquire about the possibility of additional imaging (like an MRI or a repeat ultrasound) or tests to clarify your condition before proceeding with surgery.
- Symptom Diary: Keep a symptom diary leading up to your next appointment, noting the nature of your pain, any episodes of discomfort, and any other gastrointestinal symptoms (e.g., stool changes).
- Discuss Alternatives: Explore alternative management options if surgery is not immediately necessary, including medication changes or dietary adjustments to help manage your symptoms.
Final Thoughts:
It’s essential to feel confident and informed about any surgical decision. Open dialogue with your healthcare providers about your symptoms, concerns, and the rationale for any procedures is crucial. Seek clarity and feel empowered to ask follow-up questions based on your experiences and medical documentation. Your health decisions should always align with what feels right for you, supported by relevant evidence.
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