Pressure in upper right abdomen / Dry mouth

[Dingo199]

I am an otherwise healthy, active 39 year old man.  I am thin and I do not smoke or drink.

Approximately one month ago I began to experience an uncomfortable pressure in my upper right abdomen under my bottom rib.  It is not painful and pushing on it doesn't hurt.  The pressure increases after a meal and slowly goes down within 2 to 3 hours.  If I eat a fatty meal or dessert the pressure is worse.  In the morning after I wake up the pressure in my abdomen is at it's lowest.

At around the same time (a month ago) my mouth and lips became chronically dry.  In addition I get small fissures/sores on my tongue that come and go.  I should also note that at the same time I became allergic to what seems like every nut and many foods make my tounge "tingle" like a mild allergic reaction.

Over the last month my mouth and lips have become slightly more moist but the pressure in my abdomen and tongue fissures have remained.  I drink plenty of fluids including gatorade.  I do not have diarrhea, nausea, jaundice, itchy skin or general weakness and I'm not running a fever.

Thanks for any help or advice in advance.

[Kevin Pho, MD]

Upper right abdominal pain, especially in association with eating, can be due to liver or gallbladder disease.  Gallstones, for instance, would be a common possibility.

I would start with imaging the upper right quadrant, either with an ultrasound or CT scan.  Obtaining liver enzymes via blood tests can help determine if there is any blockage in the biliary tree that may be leading to the pain.

These options should be discussed with your personal physician.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin Pho, M.D.

KevinMD.com
Twitter.com/kevinmd

[Kevin Pho, MD]

One last comment regarding the dry mouth.  You can consider rheumatologic diseases like Sjogren's syndrome, which would lead to that symptom.

Blood tests to look for possible auto-antibodies should be done if this is suspected.

Thanks,
Kevin

[Dingo199]

Hi Reruho,

Very interesting.  Did you have dry mouth as well?  In addition to the pressure I feel in the upper right abdomen my mouth and lips are dry, especially my lips.

Thanks for responding!  8-)

[Reruho]

I suffer from  the same symptoms as you and for years thought it was a gall bladder attack and was told it was IBS 22 years ago. Everytime I had an attack and I went to the doctor, all the tests would come back normal. I was once treated for back strain.  I recently got a GI to run some other tests since I know I do not have IBS. (I have no bowel dysfunction, never have.) My doctor ran a Hida scan with CCK. I have an injection fraction between 14 to 20%, which means my gall bladder does not empty properly and it swells and aches. I have reached a point where the attacks are daily, so it might be time to remove the gall bladder.
Reta

[Dingo199]

Hi Kevin,

One comment on Sjogren's.  You are 100% correct that dry mouth could be caused by that or some other autoimmune disease.  But fortunately for me the odds are slim.  I looked up Sjogren's and like most autoimmune disease it usually begins and progresses very slowly over many years.

From this link
http://books.google.com/books?id=WRW3QDBszroC&pg=PA62&lpg=PA62&dq=sjogren's+sudden+onset&source=bl&ots=453T3UktV9&sig=kw614MD90lMKKkTkGrLeEUGNkHc&hl=en&ei=2Jt9SruiD4LcNbCihPMC&sa=X&oi=book_result&ct=result&resnum=2#v=onepage&q=sjogren's%20sudden%20onset&f=false

"The feeling of intraoral dryness associated with Sjogren's often develops over a period of months or years.  Sudden onset of oral dryness is rare in Sjogren's.  Occasionally, an individual is not aware of being dry until asked if he or she can swallow a cracker without water."

My mouth went from normal to paper dry within a week.  Although anything is possible at least the odds are in my favor as far as autoimmune disease.  

Once again thanks for your help and insights!

[Dingo199]

Thanks for the response Kevin

One last question.  Is there an obvious reason why some sort of blockage or allergic response in the liver/gall bladder area would lead to sudden dry mouth?

I know that Hepatitis can lead to dry mouth but I'm not sure why.

[Dingo199]

I have one other piece of data about myself that may or may not be useful.

I have been taking a variety of supplements over the past several years.  Psyllium, Fish Oil, Acidophilus, green tea, calcium, and Multi B.  I happen to be very disciplined and I've been taking some of those for almost 10 years straight.  In addition I have a habit of eating the same breakfast and lunch every day.  I know to some people that sounds crazy but it's easier for me.  I have eaten the same exact breakfast for many years, I've lost count how long.  My lunches have been the same for almost as long except when I occasionally go out.  

I have no idea if this is relevant to a sudden onset of food allergies, dry mouth and stomach pressure but I thought I should mention it.