Pain in left upper quadrant

I am 28 yr old female. I gained 70lbs when I was pregnant. When my daughter was 1yr old, I started having pain in left lower quad, dull and aching. This pain then moved to left upper quad. Would radiate and had no other associated symptoms. I was referred to numerous doctors, including a renal doctor. I had my gallbladder removed along with exp lap in Aug 2006. I also had negative EGD and colonoscopy just prior to my surgery. Only 1 benign polyp was removed. The pain continued to worsen and remained undiagnosed. In March 2007, I was told that I had an elevated ALP (135). Then in June 2007, I felt a small soft lump under my left breast and another small lump on my ribs just below the end of my sternum. Both lumps were painful and moveable. My family doctor sent me for CT scan with contrast, which showed 3 small areas on liver that had remained unchanged since prior CT scan which was done in May 2006, and an accessory spleen, which was not mentioned when I had the exploratory lap. My doctor then sent me for an ultrasound to evaluate the accessory spleen. That test was negative. I now have pain in my left upper quadrant and right upper quadrant. This pain is worse when I am lying down. I have the same 2 lumps on my left ribs that are moveable, soft and extremely painful to touch. I also have a soft lump that is moveable and nontender immediately below my left short ribs in area of spleen and pancreas. My right rib cage is also extremely painful to touch, no lumps palpated. When I am lying on either side, it feels as if I am lying on something, when nothing is there. I feel "fullness" there when I am lying down. This pain makes me short of breath at times and radiates on the right side to my back. It can be sharp as if it is going straight through me. Other than my weight gain, I have hoshimotos hypothyroid. I am very concerned about this pain and am desperate to find a cause. I have seen so many doctors and no one has a diagnosis. I am going to a new internal medicine doctor on Monday Dec. 3. I also need to tell you that I have had numerous negative Chest xrays, pelvic ultrasound, and even a bone scan of my entire body, and a negative CA125 ordered by my family GNP. I also have been treated for h. pylori during the time since the pain started. This pain makes me nauseaous at times when it gets really bad. I am just looking for some help and direction. Thank you very much.

[Kevin Pho, MD]

You have been through a comprehensive workup, with many of the major GI disorders already evaluated for.  

More specialized tests can be considered to evaluate for LUQ pain.  This can include a gastric emptying scan looking for gastroparesis, a 24-hr pH study to exclude GERD or a motility study to look for esophageal dysmotility.

The soft lump can be evaluated by a surgeon.  If the diagnosis is elusive, it can be biopsied for a more definitive answer.

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 patients education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
www.kevinmd.com