Abdominal pain - almost 2 yr post op - GB already removed -- possible causes?

I am a VSG patient, but my sister is an RNY post-op, almost 2 years, who is experiencing severe abdominal pain.  Her gall bladder was removed last month -- even at that time, they weren't sure that was the cause, but since it's pretty common, they thought it was the most likely cause -- but the pain is back.

Now my sister, bless her heart, as we say in the South, is not the most compliant chick in the world.  She has lost more than 100 pounds, and I'd say that if she isn't at goal, she's pretty close -- she's not sure.  Anyway, she is going to the doc tomorrow and it's expected that he'll order an upper GI (which he suggested when she had a colonoscopy, but she didn't do it.  No real reason -- yes I told her she should do it!)

Here's the best I can figure out from what she tells me (we live in different states and only see each other a couple of times a year, but talk a couple of times a week!):

1. After he gallbladder surgery, the doc told her that he thought she was getting ulcers.  

2. She drinks wine and beer, sometimes to excess.

3. She also has some issues with depression (for very good reasons) -- but is not seeing anyone.  I've sent her some names.

4. The pains are sharp and sometimes cause her to miss work. Then they ease up for a while.  They did ease up after the GB sugery, but only for a couple of weeks.

I'm just worried about her, and want to make sure that she (and her docs) are exploring all the possibilities.  She's  near Knoxville, and there are a lot of experienced bariatric practices there --and she's seeing her bariatric surgeon tomorrow.  But the fact that they removed her GB without being sure that was the real cause of her problem has me a little concerned.

Any advice, suggestions, etc?

May be too many.. Ulcers - in the pouch or blind stomach, hernia, adhesion, twisted guts, obstruction, constipation, gas, or all of them...
Some may be difficult to diagnose. I had some - all of them at some point. Some can be corrected with diet - some need surgical intervention and may not be detectable during very detail testing.

It could be a stone stuck in the bile duct even from the gallbladder removal.  Do you know if they told her the results of the path lab results of the gallbladder? 

Ulcers are a possibility, a kink in the bowel.......adhesions too.

Definitely make sure she sees her surgeon and an endoscope should be ordered to rule out ulcers in the pouch.  If she has ulcers in the remnant stomach those aren't viewable and additional exploratory surgery would be required if all results come clean.  Have request the upper GI be done with contrast with our new anatomy it's best.

You are a good brother.

Sounds like the upper sooner than later.

Good luck to you both.

All sorts of things can cause abdominal pain - hernias, ulcers, pancreatitis, adhesions or scar tissue from past surgery, kinks in the intestines, bowel obstructions... the list goes on and on.

My advice to her would be to follow her doctors' advice and get any tests they recommend.  If she refuses to do tests meant to diagnose the problem, then the pain is probably going to continue.

I would also suggest she stop drinking, since excessive alcohol consumption can increase your risk of things like ulcers and pancreatitis.  And if she is depressed but not getting treatment, well, depression can increase our perception of pain and make it harder to follow through with treatment recommendations, so I would suggest she get some treatment for that.