URQ abdominal pain

[Nidorina]

Here's a poser--I've had a localized pain under my right ribs that came and went for about 2 months, and is now constant for about 2 weeks.  It increases or decreases in severity, but never dissipates, and if I don't treat it (with Tylenol) it spreads to my back, left ribs, and all up & down my right side.  I have a history of Crohn's Disease, and had a resection (terminal ileum, ileo-coecal valve, and appendix) about 6 years ago, but that has always been associated with lower RQ pain.  I also had my gall bladder removed 2 years ago.  I'm about 80 pounds overweight.  Here's the kick--I'm 24 weeks pregnant, so imaging and scope studies are out.  I had an ultrasound, and the only abnormality was a slightly enlarged liver.  All the bloodwork they've done (CBC, Chem 12, Liver Panel), seems normal, so it doesn't appear to be a Crohn's flare-up.  No abnormality in stool or urine.  This is my second pregnancy, and I did have a flare-up during my first, but with no unusual presentation.  In addition to the pain, I have diarrhea and low-grade fevers (neither of which is particularly unusual for me) nausea, heartburn, and some vomiting (none of which is particularly unusual in pregnancy).  My doctor dismissed it as a muscle pain, but two weeks of constant treatment with heat and Flexeril have made no improvement.  Likewise my GI specialist says it's too hard to tell what's going on from the info they have, and I'll have to wait until I have the baby to treat it.  Should I be concerned that this is something more serious than what they're seeing?

[COOKIEB]

A related discussion, ruq pain swelling was started.

[Xraysiren]

I have the same pain. Mine usually starts in my back above my kidney, but just below, my shoulder blade. It feels like someone is stabbing me with a screwdriver.  Then the pain radiates around my ribcage and I have a fiery burning pain in my rt upper abdomen just below my ribs. It isn't very deep though. I have had it during two pregnancies, but ALSO when I am NOT pregant. Sometimes I can't sit, stand, or walk, just curl up in a ball on the couch and try not to cry. Muscle relaxers/pain killers don't work. An OB doc blamed it on a 7mm kidney stone in my lower Rt pole, but a Nephrologist who saw me while I wasn't pregnant said that the stone wasn't causing my pain. I saw a chiropractor who said that it was a displaced rib joint and that there was no treatment. My diet doesn't seem to have anything to do with the timing of my bouts of pain so I don't think it is my gallbladder. All of my liver labs are normal except my Alk Phos which is only a little above normal.

[SandiD]

I have similar symptoms to yours, have had them for 4 months now... started as mild pain under both ribs, but has since gotten worse on my right side.  Still have the pains on left side too, just not constantly like the right side.  I have all kinds of tests run - Upper GI, ab ultrasound, HIDA Scan, CT Scan, colonoscopy, all were normal.  My GP now has me on prednisone hoping that it's just musculoskeletal... but the way it sometimes the way the pain intensifies on some days just makes me wonder if there isn't something really going on in there (tumor, etc.)  But I guess that would have shown on the tests.  Have you had any luck with the muscle treatments they've had you on?  I am scheduled to try Phys. therapy too, but don't start that til June 2nd.  Any advice you can pass along would be much appreciated.  Going undiagnosed with this constant pain is driving me crazy with worry.  Especially with future travel plans abroad.  
Good luck.

[showtruck]

I have very similar symptoms. I first notice symptoms during a long distace car drive (Oct. 2005). It started with back pain directly behind the gallbladder, which felt like muscle strain. Within two weeks, I had a sunburn sensation below my right ribcage that has never ended. The sensation is always there with varying intensity. Two weeks after the sunburn sensation began (about 1 month after the original back pain), a physical, knotting pain in the gallbladder area of my abdomen. It felt as if I had a bloated organ, so I went to an ER. There, they did a complete blood count, urine test, multiple x-rays, and a CT scan only to say that nothing was wrong, other than a small amount of white blood cells in my urine (ie, kidney or bladder infection). Since then, the pain has intensified (knotting internal pain, sunburn sensation, and back pain) and I have went to a second ER. This time at the University of Tennessee Medical Center. They too, took a blood and urine sample and confirmed that all counts were within normal limits. This doctor did however palpate the abdomen and pressed on the exact spot that hurts internally, which caused elevated pain. He identified this spot as the area where the gallbladder and liver is located and said that I may have a growth/tumor on the gallbladder or possibly, gallstones. He suggested I go to a family practioner for ultrasound, since there was no emergency to be addressed at the ER.

I have not noticed an increase or decrease of intensity before or after eating. Also, when I sleep at night, it is more comfortable to sleep on the affected side.

Since Jan. 12, 2006, I have seen my family physician who sent me to a gastrointestinal doc for gallbladder testing and probably removal.  After a hidascan, colonoscopy, an endoscope, and many blood test, there are still no answers- everything was normal.  My GI specialist referred me back to the family doc for musculo-skeletal conditions.  Not sure what other test should be done, will take any recommendations and let you know what we find out!

[LvdByGod]

added note, the liver panel can also look fairly normal in very early disease too...

i'm just thinking your pregnacy could be putting added pressure to the enlarged liver too. you may just find out you have fatty liver aggrevated by the pregnancy... but, either way i would still insist on finding out why your liver is swelling...

[LvdByGod]

i have an enlarged liver and have urq pains as you describe... when the liver becomes enlarged it presses against the sack around it and causes pain there... but, the liver itself gets no pain only the sack around it...various things can cause this swelling to occure...look at this site for alot of info on liver problems.

http://www.liverfoundation.org/db-home/articles

be sure to ask the doc about fatty liver... it can be caused by several things encluding being overwieght... and there is also a disease called NASH, (non alchoholic steatosis). enlarged liver can also be caused by other assults to the liver...

have your alt and ast checked (that's a simple blood draw called a liver panel) and also check for the hepatitic a, b, and c.

i don't know if you can get a liver biopsy while pregnant or not but that is what you should get as soon as possible based on finding out you have and enlarged liver... this can tell the doc all sorts of things about why it is enlarged...

the biopsy really requires no meds to do and you are awake to get it done... most folks only get the area numbed for it...

basically, with an enlarged liver you have a risk of developing cirhosis and liver damage... you need to find out why your liver is enlarged... the only real way to tell is the biopsy ... the docs can tell you many things by the biopsy... see site i posted...

i have hepatitic c and fatty liver from being overweight...i get this urq pain... from how you described it it sounds just like the pains i get...i would check this out...or at least talk to my dr about it... i had a biopsy and it's quick and easy and fairly painless...

is your alt and ast on the blood test raised??? these are indicators of problems with the liver...but they can also show normal the very late stage of the disease...this is why they use the biopsy to really see what's going on in the liver...

hope all this helps and you find nothing...

[Kevin Pho, MD]

Difficult to say without evaluation.  

Being pregnant would limit the diagnostic options.  The ultrasound would rule out many of the major liver disorders.  With the gallbladder being removed, you can consider Sphincter of Oddi dysfunction as a possible cause.  An ERCP with Sphincter of Oddi manometry can be considered after pregnancy.

Other imaging studies to consider would be an MRI or an MRCP.  The latter test can evaluate the biliary ducts for the presence of any stones.  

Other causes of dyspepsia - such as an ulcer, GERD or inflammation of the upper GI tract - can be evaluated with an endoscopy.

These options can be discussed with your personal physician.

Followup with your personal physician is essential.

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, M.D.
kevinmd_b