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Upper right quadrant pressure w/ chronic diarrhea
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Upper right quadrant pressure w/ chronic diarrhea

I'm currently suffering through my fourth episode of chronic diarrhea accompanied by *pressure* (not pain, more like a pushing) in the URQ of my abdomen.  The pressure feels like someone is firmly pushing two fingers against my abdomen, but from the inside.  There is no pain, but the pressure is quite annoying and only subsides if I press against it with my hand.

The first time this happened, in Sep. 2002, I had been taking Vicodin ES for a traumatic back injury.  I was taking 3 pills/day when the abdominal pressure began.  I was concerned that the Vicodin was causing it, so I immediately stopped taking the pills.  After I stopped, I was stricken with acute diarrhea (as opposed to the slight constipation from the pills) which was bright yellow and seemed very acidic, i.e. caused a burning sensation.  I went to my GP and had an abdominal x-ray which revealed nothing but a slight thickening of the main bile duct.  No treatment was offered and the condition spontaneously resolved within a few weeks.

Thrice since this first episode, I have had repeat episodes.  The only mitigating factor seems to be alcohol consumption -- I never have more than one glass of white wine, but even this small amount seems to exacerbate the pressure and diarrhea.  Going on about four weeks now, I have had chronic diarrhea, ranging from complete liquid (usually bright yellow) to dark and almost gritty-looking.  The diarrhea is notably acidic in that it causes painful rectal burning.  The diarrhea and upper-right-quadrant pressure definitely seem related -- whenever I feel that now-familiar pressure, it is followed by diarrhea.  I seem to be having bowel movements fairly quickly after eating, and sometimes pass undigested food.  Occassionally, I will have a BM that consists solely of what looks like mucous or fat globules, either white or yellowish.

These episodes so far have resolved on their own, without medication or further testing, but I am beginning to be concerned that something serious is amiss.

I have no other symptoms, no noticeable weight loss, jaundice, pain, or intestinal symptoms.  I am a 33 year old female, 5'7", of normal weight, light smoker, social/light drinker.  I take no medication on a daily basis and have no diseases or allergies.  I have had normal liver function tests in the last four months.

My main concern is that I have a dysfunction of the gallbladder or pancreas.  Do the symptoms I describe (mainly chronic acidic liquid diarrhea and URQ pressure) sound like anything specific and/or recognizable?  Are there specific tests I should request from a gastroenterologist or my GP?  I do not have health insurance so would like to avoid unneccessary, costly tests, but would also like to nip this in the bud, should it be something serious.

Thank you for taking the time to read and respond to my query.

Pixie*
Related Discussions
233190_tn?1278553401
Hello - thanks for asking your question.

As you can imagine, there are many causes for chronic diarrhea and RUQ pain.  It is possible that they could be connected.  RUQ pain can be caused (as you surmised) by pancreatitis, gallbladder pathology (cholecystitis, gallsrones), liver dysfunction, dyspepsia (either ulcers or gastritis), and cancer.

Chronic diarrhea can be caused by irritable bowel syndrome (IBS), inflammatory bowel disease, malabsorption syndromes (such as lactose intolerance and celiac disease), and chronic infections (particularly in patients who are immunocompromised).

I would suggest the following initial tests to evaluate your symptoms:
- abdominal ultrasound (to evaluate for gallbladder pathology)
- flexible sigmoidoscopy or colonoscopy (to evaluate for inflammatory bowel disease or colorectal mass)
- stool tests for chronic infections or malabsorption syndromes

If those tests come up negative, further evaluation may be considered in the form of an abdominal CT, specific testing for neuroendocrine tumors (i.e. VIPoma, gastrinoma), tests for gallbladder ejection fraction and upper endoscopy to evaluate for dyspepsia.

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.

Thanks,
Kevin, M.D.
4 Comments
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Avatar_n_tn
I had the pressure in the upper abdomen with back pain. I had these "attacks" when I ate something particularly fatty. I wound up in the ER twice from blockage in the bile ducts from stones. After I had the surgery to remove my GB, I had the SAME sympthoms. It's been 2 months already, and I still feel the constant back pain and pressure in the upper abdomen. I heard some people it never really goes away. Lucky me.
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Avatar_n_tn
I had a series of terrible attacks 18 months ago (which turned out to be my gall bladder).  Doubling over pain in the middle of the night, diarrhea after heavier fat meals, etc.

I did the various procedures - ultrasound, barium fluoroscope, etc.  The esophagus looked fine, no signs of a ulcer.  The ultrasound tech looked astonished when she moved over my gall bladder - turns out it was filled with stones.  I had it taken out and since then it's been better (I've also been eating better).  

However, I do get the symtpoms described above periodically - diarrhea soon after a meal, sometimes almost completely liquid & yellowish, and I do get lower back pain (lumbar area) - which hasn't been tied to any disc issue.

Anyone have any help towards this? or is it just life-without-a-gall-bladder?

Thanks,
Joe
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Avatar_n_tn
I too feel intense pressure in the upper abdomen, just below the ribs -- its extremely intense when I'm sitting down (driving has become an ordeal) and my throat begins to get a burning sensation (indicating that the stomach is being pushed up too). However I dont get chest or heart burn at all.

I get relief when standing up and wearing clothes that are extremely loose or unbuttonning my trousers. My waist is 33-34 but I have been wearing 36 or elastic trousers.

I've already gone thru the following tests ...

   - barium swallow that ruled out reflux & hiatal hernia
   - a stomach endoscopy
   - CT scan that revealed that my gallbladder did not
     have stones and that my liver was okay
   - blood tests that show that the liver is fine

.. But my pressure in the abdomen is so intense that it makes me feel that my diaphram is going to be ripped out by it. The doctor has put me on ACIPHEX but that has not helped at all.

I am going in for a colonoscopy since I have had blood (fresh blood - not mixed in my stools) probably because of haemorroids.

Must mention that I am 30, dont smoke, drink rarely am not over weight (165 lbs and about 5-10 in height).

Getting desperate to even get diagnosed!!!!
Blank
Avatar_n_tn
I too feel intense pressure in the upper abdomen, just below the ribs -- its extremely intense when I'm sitting down (driving has become an ordeal) and my throat begins to get a burning sensation (indicating that the stomach is being pushed up too). However I dont get chest or heart burn at all.

I get relief when standing up and wearing clothes that are extremely loose or unbuttonning my trousers. My waist is 33-34 but I have been wearing 36 or elastic trousers.

I've already gone thru the following tests ...

   - barium swallow that ruled out reflux & hiatal hernia
   - a stomach endoscopy
   - CT scan that revealed that my gallbladder did not
     have stones and that my liver was okay
   - blood tests that show that the liver is fine

.. But my pressure in the abdomen is so intense that it makes me feel that my diaphram is going to be ripped out by it. The doctor has put me on ACIPHEX but that has not helped at all.

I am going in for a colonoscopy since I have had blood (fresh blood - not mixed in my stools) probably because of haemorroids.

Must mention that I am 30, dont smoke, drink rarely am not over weight (165 lbs and about 5-10 in height).

Getting desperate to even get diagnosed!!!!
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Avatar_n_tn
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