Right Upper Quadrant Pain

[raffy67]

I have ulcerative colitis for over 14 years and when it is active I usually have pain on my lower left side.  Recently though I have been complaining of pain on my right side under the rib.  I went to see my gastroenterologist he claimed that it was my UC which sometimes affects the entire colon.  The pain is accompanied with burning on the right side and nausea as well shortness of breath.  I went to see my primary physician she requested a Abdominal and Pelvis ct scan this revealed a 3mm low-density lesion in the inferior aspect of the right lobe of the liver which is too small categorize.  My gastroenterologist claims that a 3mm-low density lesion in the right lobe of the liver is not to worry about.  My question is why do I have a burning pain on the right side?  Why does it get worse after I eat or drink?  They have also done a pelvic and abdominal sonogram which were normal.  What other tests can be done that can help me?  I cannot walk well because I am out of breath and in pain when I walk.  I would like to know what can be done?  By the way the ct scan also revealed bilateral ovarian cysts the largest in the right ovary measures 1.5 cm in diameter.  
The liver and spleen are normal in size.  The pancreas, kidneys and adrenal glands are normal.  There is no retroperitoneal adenopathy.  The lung bases are clear. I am 38 years old and blood and urine test that were done were normal.

[Kevin Pho, MD]

Pain on the right side can be diseases of the appendix, liver, or gallblader.  The CT scan can be done to evaluate for many of these diseases.  

It is not as good to image the gallbladder.  You can consider an ultrasound for further evaluation.  

Other possibilies can include the various causes of dyspepsia - either an ulcer or inflammation of the upper digestive tract.  An upper endoscopy or upper GI series can be ordered to evaluate for these possbilities.

More atypical studies like a HIDA scan with CCK stimulation can be considered to evaluate the gallbladder ejection fraction - if this value is low, it can lead to gallbladder pain.

You can discuss these options 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 patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
http://www.straightfromthedoc.com

[kimbacat]

Hi,

the pain on your right side is probably due to your UC, but I would suggest getting a colonoscopy to check things out just to make sure.  if you've had UC for 14 yrs, you should be getting regular scopes anyway due to the increased risk of colon cancer with long standing UC.  your colon runs up high across the upper part of your abdomen, takes a turn near your liver and goes down towards your hip where your small bowel joins it.  so pain on the upper right side can definitely be from your colon, even just from trapped air.  if your UC has spread, you might want to think about increasing or changing your meds to better control it, which I'm surprised your GI didn't do when you complained of new symptoms.

but I did want to point out that the shortness of breath should be investigated separately, preferably by a pulmonologist.  lung problems can be associated with IBD, especially large airway disease with UC (this area would not have been on your CT scan).  so, I would get it checked out just to make sure.  a simple pulmonary function test can tell a lot.  

take care

[Sarah Connors]

• Try ruling out the extra intestinal complications of Chronic UC, which do include the hepatobiliary system e.g. Sclerosing Cholangitis.
• Abdominal U/S wouldn’t do any harm.