Upper Right Quadrant Pain

[skyjumper]

I'm a 36 year old male who eats well, exercises regularly, and lives a reasonably healthy lifestyle.  Four month ago I started having pangs of pain in my right upper quadrant, just under my ribcage.  I couldn't indentify any obvious pattern (e.g. pain after eating a fatty meal), but I did notice I felt it often at night.  Concerned, I saw my primary care physician who suggested it might be a gall bladder problem.  I had a blood test done for liver function, it came back normal.  Next he referred me for an ultrasound.  The ultrasound found nothing unusual so my physician prescribed Nexium and said I was likely flirting with an ulcer or some persistant gastritis.  

Three months passed and I continued to have periodic pain, slowly becoming more persistant.  I checked in with my physician again and he set me up for an upper GI endoscopy.  Fortunately, that came back negative as well. I'm certainly happy that nothing was found, but am left with worsening (almost ever-present now) symptoms and no answers. The pain is typically under the lower right side of my ribcage, but sometimes radiates higher in my chest.  If I curl my fingers under my ribs it is usually quite tender, all the way down the length of my liver.

Two weeks ago my stools had an orange hue to them (I assume this is what is refered to as "clay colored"?).  This lasted for about ten days, but my stool color seems to have returned to normal.

My question is what conditions could be causing this pain if it didn't show up on an ultrasound or an upper GI endoscopy?  Since the ultrasound was performed very early on when I just started feeling the symptoms, is it possible that it could have missed something serious(i.e. small tumor that has since grown)?  I don't think my primary physician intends to do any more tests, so am wondering if I should insist on any others or whether I should see a specialist?  I'm trying not to be neurotic about it, but am growing increasingly concerned.  Any thoughts or advice would be much appreciated.  Thank you.

[medically annoyed]

OUCH IN THE SIDE: It does seem to be that there is a connection between you, me and tired of feeling sick and the mono. I will tell you that my right quandrant pain comes and goes but never completely gone.  It is subsided now but I am starting to increase in head pain (not sinus like) and sinus pressure.

[ouchintheside]

Looks like I am the latest in a long list of RUQ pain sufferers. I had my first attack when I was 23. A terrible, sudden pain that lasted for about 15-20 minutes and sent me to the ER. They said I had a stomach virus. I am now 38 and have had several attacks every year. One doc prescribed Dicyclomine HCL (Bentyl) at 10mgs a dose as needed for pain. It worked great for a few years. About 2 years ago, I was in a very stressful time of my life, and had alot of attacks, and then the sensation that there was a large, swollen mass in my R side just beneath my ribs became a constant. I Have been to several doctors and had blood tests, ultra sounds, HIDA scans, etc. all normal. I have been asked if I am depressed, and told it is in my head... I have been to the ER more times than I can count. I have tried treatment for H. Pylori, that seemed to make me feel better for about 6 mo. I take ranitidine and that takes care of the acute pain, but not the pressure and swollen feeling. I also had Mono when I was 10 and have had problems with fatigue, weight, and general feeling of unwellness since I was a kid. I live in fear for whenever I start feeling a tingling in my side.. the pain is unbearable. I have gotten to the point where I dont want to go to the doctor anymore because they make me feel like I am crazy.

[medically annoyed]

Tired of feeling sick:  I forgot to mention that several people are leaning me towards gluten intolerace.  One of the names for that is celiac disease.

[medically annoyed]

Tired of being sick: To answer the liver question.... If you ask any Dr. does mono affect the liver, I would suspect that they would say generally no.  However having a severe infection in the body if not completely handled properly can lead to difficulties with the liver and or other organs.  I don't know if you have had a liver blood test yet, but I have and they say it is fine. As far as the lymph nodes, they say it is normal when you run any kind of infection in your body to have this occur.  (Bronchitis, etc) I believe my lymph nodes were swollen repetively after the mono and I don't think I ever really had them to swell before.  With that said, before they do a biopsy you should have an extensive line of blood test before they start cutting into you.  Your basic CBC's should show off if you are thinking cancer  (so I am encouraged to believe).  I do have recurring allergies that were definitely worse in the last two years and wonder how much that they play a role.

In addition, back to mono... my friend was informed that once you have mono, that not only do you test positive for (if not from Cytomyalgia) the Epstien Barrs Virus forever but you also always have elevated levels.  Even more, she was told there is  such a thing as chronic mono and because you have elevated levels, I don't think that Drs. easily detect you as having it again.

But since I went to the leading infectious disease Dr in my area.  I tend to believe him when he says that it is not mono related and that I do not have any type of infection in my body.  Regardless of all my symptoms.

Now, some interesting facts that I don't know may be related to you are the following:
My blood pressure tends to be between 88 and 90 over 50, so even when it is elevated it only goes as high as 120/70 but on average at high 100/70.  I consider that high for me and a sign of something wrong.  The Drs consider that in perfect health.  My temp works the same way.  I am usually 97.6 and if I am at 98 my head is pounding and at 99 I feel absolutely horrible.  Yet Drs. say healthy.  I guess that is why they put me in the Fibromyalgia/Chronic Fatigue syndrome category for aches and pains.

Do you have any additional details to offer?

[Tired of feeling sick!]

I hav been having the same symptoms that you are medically annoyed. I too was diagnosed with mono, but it was when I was 12, (I'm now 28). I'm wondering if there is a connection between the two problems. Could mono damage your liver? I have been having a general unwell feeling for years, really lethargic, headaches, swollen lymph nodes, achiness, and intermittent upper right quadrant pain. I have seem many drs. and am losing faith in the medical community! Have you had a biopsy of your lymph nodes? My dr is worried about it and wants to do that test.I have been diagnosed with IBS, ulcer, gastritis, etc. The pain is sometimes really noticable in the shower when the water hits that spot and it is really tender. I have also had reoccuring bronchitis and strep throat for years since the mono at age 12. Also I have frequent stomach problems, I never know how my stomach is going to act. I am getting so frustrated with feeling like this!!!!!

[Tired of feeling sick!]

I hav been having the same symptoms that you are medically annoyed. I too was diagnosed with mono, but it was when I was 12, (I'm now 28). I'm wondering if there is a connection between the two problems. Could mono damage your liver? I have been having a general unwell feeling for years, really lethargic, headaches, swollen lymph nodes, achiness, and intermittent upper right quadrant pain. I have seem many drs. and am losing faith in the medical community! Have you had a biopsy of your lymph nodes? My dr is worried about it and wants to do that test.I have been diagnosed with IBS, ulcer, gastritis, etc. The pain is sometimes really noticable in the shower when the water hits that spot and it is really tender. I have also had reoccuring bronchitis and strep throat for years since the mono at age 12. Also I have frequent stomach problems, I never know how my stomach is going to act. I am getting so frustrated with feeling like this!!!!!