RUQ Pain, High Ferritin Levels

I am 37 yrs old, 125 lbs.      Lost 10 lbs in past 3 months.    I have been having an undiagnosed RUQ pain for 3 months, scale from 3 to 7.    Feels like a "tennis ball" is lodged in the lower right rib area (gallbladder/liver area) on a constant basis, with varying degrees of pain.    I have no vomiting or nausea, the pain does not extent to shoulder or to the back scapular region.

I have had all sorts of test which all came back normal (Colonoscopy, Upper GI Gastroscopy, Upper GI Barium Swallow, 3 Ultrasound, 1 CT w + w/o contrast, HIDA Scan ejection fraction 50%).  

I drink alcohol for the past 15 years socially (1 beer every few days), but heavier on weekends occassionally (4-5 beers or 0.75L wine).     For the past year, I drink 1-2 glass of wine with dinner.  On weekends may be 0.75 ~ 1 bottle, socially on a Friday night.  Stop drinking totally in past 3 months ever since this RUQ pain started.

Bloodwork indicates the following abnormalities:

July Blookwork:   Ferritin 630 (done with fasting), LFT within normal range
Aug Bloodwork:   Ferritin 629 (done with fasting), LFT within normal range

Sept Bloodwork:  Ferritin 1125 (done without fasting)
IRON 23
Transferrin Saturation 0.45
TIBC 51
HH Genetic test: Inconclusive
LFT within normal range.

The doctor here just gave me some pain medication and do not think there is anything serious.


My questions are:

1) What is the appropriate course of action, next step ?  besides taking pain killers (Amitriptylin)
2) Would a liver biopsy be required or reasonable ? (i hope i don't need one as I heard it is very painful)
3) What is the possibility of Liver damage ? or Cirrhosis
4) Would it be possible for the CT scan to have missed something such as cancer ?
5) What other causes can there be besides Hemochromatosis ?
6) Would the RUQ pain be related to the high ferritin level ?
7) Would an enlarged liver cause this RUQ pain ?

Thank you and I truly appreciate the response.

[Kevin Pho, MD]

You have had a comprehensive evaluation, which I agree with.

1) I would consider a liver biopsy as the next step to exclude hemochromatosis.
2) Yes, a liver biopsy would be reasonable at this point.
3) Cirrhosis is only diagnosed via the biopsy.  Sometimes it can be suggested in the imaging tests you have had.
4) It is unlikely that a CT scan would miss a cancer.  That said, an MRI would be a more sensitive test for this.
5) Ferritin levels can rise in periods of stress to your body or infection.  So, things like cancer elsewhere or an infection can be ruled out.
6) It may be possible, depending on what is increasing the ferritin level.
7) Yes, an enlarged liver is a possible cause of RUQ pain.

These questions should be discussed with your personal GI 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