Hepatitis C Management

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Question:

This patient has persistent right upper-quadrant pain. She had hergallbladder removed 18 months ago and still has the pain. Her liver enzymes are elevated. She has had CT scans and a magnetic resonance cholangiopancreatography (MRCP), which were normal. What would be a suggested course of action?

The character of the abdominal pain is important in determining the next step. Hepatitis from any etiology may cause dull right upper-quadrant pain. This is typically mild, but can be bothersome. If the pain is sharp, intermittent, or colicky in nature, then biliary disease should be considered, more specifically sphincter of Oddi dysfunction or, less likely, a retained stone. An endoscopic retrograde cholangiopancreatography (ERCP) with or without sphincter of Oddi manometry could be helpful in this case. Often such pain is musculoskeletal and may respond to nerve blocks.

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