upper right quad abdominal pain...at base of rib cage

[MOguy]

I'm a 34 year old male, 180 pounds, athletic, workout moderately several times a week with a history of minor bowel problems (IBS) on and off for the past 10 years or so.  About a year ago I experienced a significant feeling of pressure on the right side of my abdomin (abdomen) and along the base of my ribcage.  It lasted for several days and was accompanied by constipation.  This had never happend to me before.  After several days, the constipation ended and the pain subsided...so I figured they were related.  Well, on and off since then, I have had the "filling" sensation under at the base of my right ribcage.  It just feels like there is a balloon in there.  Its not really pain...it's not even sharp.  Its just like there is a huge air bubble stuck in there.  Unfortunately, I know its not gas, because I continue to have BM's without much relief.  I've been tested for Hepatitis a couple of times since this all started and nothing has shown up.  Then, about 3 months ago, while working out, in this very same region, I felt something give way...it felt like a air bubbles being released.  Again, it's not so much pain as it is a sensation.  Could it be a liver issue or could my intestine been somehow pinched off? Hernia? I just don't know and it's driving me nuts.  I don't want to go to see a doctor, but now Im getting nervous.  I'm starting to get more upset stomachs and my wife tells me my breath smells like mothballs at times.  Any help you can give would be greatly appreciated.

[Kevin Pho, MD]

Typically gallbladder or liver diseases can present with right upper quadrant pain.  Liver function tests as well as an abdominal ultrasound would be a reasonable approach to investigate this.

If negative, you can further your investigation with tests to evaluate the upper digestive tract - namely an upper GI series or upper endoscopy.  These tests can evaluate for ulcers, inflammation of the upper GI tract, hiatal hernia, or GERD.

You may want to discuss these options with your personal physician or ask for a GI referral.  

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.
Medical Weblog:
kevinmd_b

[SMSIRL]

What was the symptoms of your minor bowel problems (IBS)?
Are symptoms on the front/back or both?
How far below the ribcage?
How far in from your right side?
Any diarrhea?
Any blood in stools?
Any fat/oil in stools?
What do you mean by constipation?
When you say upset stomach what do you mean?
Do you eat foods/drinks with volatile components such as Garlic/Onion/Alcohol etc.
Any dietary changes that you can associate with this new symptom?


This information would be useful to medics in determining the most likly causes.

All the best

[MOguy]

What was the symptoms of your minor bowel problems (IBS)?
-Alternating constipation vs. diarrhea for several months...that was about 10 years ago...then recuring once every couple of years after.

Are symptoms on the front/back or both?
Mostly in the front but sometimes radiating up my back and chest.

How far below the ribcage?
The pain has never really extended below the last rib

How far in from your right side?
anywhere from the left side in to about 1/4 or 1/3 of the way across

Any diarrhea?
Not recently...nothing regularly.

Any blood in stools?
No blood in stools...that has never been a symptom.

Any fat/oil in stools?
Yes...the stools have changed character some.  They are not as solid and tend to be more oily and with a hint of green film.

What do you mean by constipation?
I didn't have a BM for more than a week.  That was only the initial problem.  FYI, I was under tremendous stress at that time that may have contributed.

When you say upset stomach what do you mean?
I mean that I am functional, but with occassional waves of nausea.

Do you eat foods/drinks with volatile components such as Garlic/Onion/Alcohol etc.
I don't drink alcohol heavily at all.  Maybe 1 or 2 beers a week at most.  I do drink a lot of diet soft drinks and tea.

Any dietary changes that you can associate with this new symptom?  None that I can think of.

One last comment, I know my trigycerides (sp?) are considered high.  I also have high cholesterol.

Thanks for the advice on other information to provide.

[surgeon]

Certainly gallbladder disease is high on the list of possibilities. At some point, the way to find out is going to be to see your doctor.

[SMSIRL]

Appart from the high possibility of gasllbladder issue, two further things to be considered

Firstly, Fatty Liver can cause tenderness in the area discribed.

Secondly, Inflamation (inflammation) of the last part of the small bowel can lead to :
1. diarrhea
2. malabsorbtion of bile salts which can lead to gallstones.

The first would be apparent on the suggested ultrasound, the second would be worth an investigation in someone complaining of the right side problem, if diarrhea had been a reasonably persistant problem. Because some people who apparently have IBS have in fact Crohn's but without any large gut involvement. A person with Crohn's not infrequently gets a gallbladder disease [incl stones] and/or Fatty Liver.


yours

Shaun

[jmm706]

I've had the exact same symptoms minus the naseau.  I had an abdominal ultra-sound, nuclear gall bladder test, upper GI radiation scan, upper endoscopy, and colonoscopy.  The diagnosis given was GERD.  I was put on 40mg daily of Nexium about a year ago.  The pressure under right rib remains and sometimes reaches all the way around to my back.  Pressure is much less noticeable when standing.   Guess it's back to the Dr again as it doesn't seem to be improving.

[Pherra]

I have the same syptoms (symptoms) earlier expressed,but sometimes my stool is hard and rocky.I had a kidney infection in the past and sometimes have a feeling similar to menstrual cramps in my lower right abdomine.I feel tired most of the time.

[heatherjo811]

I've had similar symtpoms over the past few months.  I have to go in on Friday for an endoscopy and colonoscopy.  My doc thinks I have H pylori.  Has anyone said anything about this to you as a possibility?

[pcolyer]

Has the root cause of all of the symptom of the mothball odor been determined?

My interest is in understanding the odor of mothballs on the breath.  This appears to be a relatively widespread occurrence.  And, I would like to identify the cause so that a cure may be found.

The phrase from MOguy on 19-Jun-04 that prompted my question is "my wife tells me my breath smells like mothballs".  I have also noticed people with "mothball breath".  In making a search on google, there are others who have commented about people smelling of mothballs or having breath that smells like mothballs.

What is the root cause and chemistry of the mothball odor on a person's breath?

Could the be Candidiasis?  I plan to re-read "The Missing Diagnosis" by C. Orian Truss, M.D.  If my memory is correct, there is a reference to mothball odor in that book.

[thekit161]

I too suffer from the above pain mainly below the upper right abdomen just below the last bone in my right rib cage. I have a CT abdomen scan done 4 months ago (april 07). It ruled out any liver, kidneys or gallblader stones. I have hiatus hernia as confirmed by an endoscopy done in 2005. I had a colonoscopy  in Feb 06 so I don't think it's my colon. What else could be wrong? Is it time for another endoscopy? Do you think the primary problem is the hernia?

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