Continuing Liver Pain ...please advise..

[momtotwinsplus1]

Hi and thank you for your time. I am a 36 yr old female with liver pain that has gone on for about 2 yrs now. In the begining I noticed I had pain when laying on my stomach at night,or when I would palpate that area. My GP ran a full blood profile in which all values were normal. (including liver enzymes). I was referred for a abnominal u/s which showed only a mildly enlarged liver everything else looked normal. GP then referred me to an internist who specializes in colonoscopy. He palpated the area and told me the pain was the cartiledge between the rib bones. He asked me if Ive ever had mononeucleosis (I did, in 1986) and said that my liver would always be enlarged due to that infection.

For the past 10 yrs I have consumed alcohol, what I would consider, moderately. Wine with dinner and cocktails on the weekends. There was no evidence of fatty liver on the u/s.

My only other health issues are obesity, and mild mitral valve regurg. without prolapse. I also have occasional pvc's, and pac's. My GP has put me on Zoloft to help with the anxiety associated with the irregular beats. I have cut way back on my alcohol consumption, but have noticed since starting the Zoloft the pain in my liver area has increased. I am now feeling it without palpating or laying on it. It is a constant dull ache, which hurts more if I press on it.

My bowels are slightly irritable..i.e. during extreme stress I have diharrea immediately, otherwise I have never noticed blood in my stools, and they range from loose to formed, depending on what I am eating.

Could this be colon related? And could it really be due to cartilidge...Could it be that I have pain just because my liver is enlarged from mono? ANY suggestions as to how I should proceed would be extremely helpful.

Thanks again for your time!

[Kevin Pho, MD]

The pain may be related to the cartilage between the ribs.  There is a condition known as costochondritis which is a fairly common cause if pain in the chest/rib area.  If the liver enzymes are normal, it is unlikely there is a serious liver disease present.

The colon can be another possibility.  A colonoscopy would be an advisable test if it hasn't been performed already.  You may also  want to consider a HIDA scan with CCK stimulation to evaluate the gallbladder function.  This can also present with pain the right upper quadrant.

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.

[surgeon]

It's nearly certain that the pain is NOT from your liver; those things that might cause a painful liver (which doesn't have a lot of pain sensation anyway) would virtually always be associated with abnormal liver tests. Enlargement as an isolated finding may mean nothing at all. There is a condition called costochondritis which is inflammation of the joint between the rib bone and rib cartilage which is presumably what that doctor was referrring to. It's possible to be from the colon, although things which cause steady (as opposed to intermittant or crampy) pain in the colon would usually have other things going on, such as fever (diverticulitis), or chronic symptoms (crohn's disease, colitis). You didn't say if you'd had a colonoscopy; if you haven't, it might be a good idea. If the person you saw is truly an internist who does colonoscopy as opposed to a gastroenterologist (an internist with additional training in gastrointestinal disease), you might consider seeing one for the procedure and for evaluation.

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