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HCV, Triple Therapy and Gallbladder symptoms/disease
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HCV, Triple Therapy and Gallbladder symptoms/disease

I'm nearing the end of triple therapy... 2 weeks and 2 days till I take my last ribavirin pill!  Every so often, I get a sharp, almost knife like stabbing feeling under my right ribs.  I've speculated it's some gallbladder issue.  Anyone out there with HCV have similar issues? symptoms?  Anyone have insights into the risk of some form of cancer (bile duct, etc.) in association with HCV?  My doc said he will arrange for a gallbladder scan once I'm done with treatment.  That should help figure this out, but he doesn't think it's a blocked duct or anything as that would cause more severe and lasting pain, but isn't it possible for small stones to temporarily block a duct causing the types of symptoms I've had?  Thanks.

Mark
13 Comments Post a Comment
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I had gallstones about 30 years ago, and had my gallbladder removed at that time. I remember pretty clearly how it felt when I had an attack, and your description doesn't sound very much like my own symptoms. For me the pain was hard but not as sharp as a knife - it filled a larger area than that would imply. It also lasted a really long time. Each attack would build up in pain over the course of an hour or so, then hurt really bad for something like 8-12 hours, then subside slowly over the course of another 24-36 hours. How long do your pains last? When was your last ultrasound? That ought to show any problems with the ducts.
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I remember others on treatment saying they had pain in the upper right side during treatment.  Is not unusual for people with hepatitis C to also have gallstones.  If you have a gallstone attack you will know it.  It's much more than a sharp pain.  Your almost done with treatment and you have been taking some very strong treatment drugs.  Everyone has a risk of cancer but I sure by now this treatment is getting really old.  Get though this and go get screened for gallstones.  Don't let your mind start thinking you  could have cancer or something.....It will make you nuts.   I have had my gallbladder removed and did have a few sharp pains that sent my mind thinking it could be something serious.  Take a deep breath....your almost done.
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Thanks for those responses.  DB, my wife always says I "pre-worry".  C, you pretty much said what my doc said.    Last ultrasounds said the ducts and gallbladder looked good.  It is a bit of a mystery... perhaps an ulcer or something.  I'll try to keep a level head.   Just wish I knew what level of damage the HCV caused.  It's a bit unclear ... biopsy was 0-1 fibrosis, fibrosure indicated cirrhosis, but that could be skewed by gallbladder disease.  Well, I'll get this figured out.  Thanks to both of you.

Mark
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Avatar_m_tn
Sorry to hear of the issues Mark, but I am pulling for you.

willy
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Thanks Willy.  Anytime one has mysterious medical issues in the context of a known disease, it's a bit scary.  I'm trying to maintain a positive attitude and am really excited about nearing the end of tx!

Mark
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Do the pains happen when you move or when you are resting in a certain position? If so, then I'd suspect they might be caused by a bit of adhesive scar tissue resulting from your liver biopsy – which would in turn mean there's no need to worry. I had occasional sharp pains (that were extremely short in duration) for over a year after my first biopsy. I got used to them and they gradually faded to a mild discomfort. Then I had major surgery to remove a choledochal cyst and reconstruct new ducts out of part of my small intestine, and those sharp pains returned at a whole new level of intensity for several years. They are distinctly related to certain movements and positions, and although the surgery was now 8 or 9 years ago, they still return pretty often if I lie on my left side. I'm sure it is scar tissue tugging on things as they fall into a different position from movement. Yours might be totally different, but try to analyze what you are doing when they occur, just in case this might be relevant to you. Good luck, and congratulations on being very nearly finished with tx!
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Thanks Ceanothus for your thoughts.  One fairly recent episode was while I was watching TV with my son.  A very sharp, unexpected pain for about 2 seconds shortly followed by kind of a spasmotic sensation nearby the pain.  And then it went away.  I've wondered if it could have been a small gallstone passing through a duct.  My doc thinks passing a stone would be more severe and prolonged, but seems like stones could very in size from microscopic to several millimeters in diameter ... so ...?

Mark
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just wanted to say there is many things that can cause the liver area pain,and remember even the meds itself can have toxic effects on the liver.I am hep c free now with cirrhosis 1.5 yrs svr I still get that upper quad. pain and for me diet plays a key role in it. If I get backed up and im not regular, I feel it, if I don't eat right and eat to much fat I feel it. If I take care and eat well it goes away. So each of us can be experience it differently. now on your gallbladder for me when I passed a stone or had gallbladder issue ,I did have that pain but it was always accompanied by severe stomach pains that were felt in my back along with nausea.read this below for a few more tips....I like the one on posture too,I do slump and put a lot of pressure on that area and feel it too.....





May 14, 2013 Hep C and Cirhossis, Stages of Cirrhosis fatty liver, hepatic steatosis, Hepatitis C, hepatitis c treatment, hurts, liver, Nash, stage 4 cirrhosis, yoga benefit
Can My Liver Feel Pain?

You know by now that if I have experienced it, I’m going to talk about it to my  friends. That would be YOU. I have heard a lot about liver pain from doctors, internet research, and on forums. That is where we all go for information, right? But it is easy to hear conflicting information about many topics, and liver pain is one of them. There are times when my liver hurts. The dull ache, or sharp piercing always grabs my attention. Fear is sure to follow, paralyzing fear.

fatty liver, Nash, cirrhosis

What can cause you to feel liver pain? Here is what I know:

Fatty liver is known as steatosis. I was not diagnosed with fatty liver. I have cirrhosis as a result of having Hepatitis C. Cirrhosis and Hepatic Steatosis nearly always go together. I think of it this way: My liver has a lot of fibrous bands growing on it. It chokes the blood supply and keeps my liver from acting as a filter to cleanse my blood. As a result, the foods that are consumed do not get used as well by my entire body. When I eat foods with excessive amounts of fat, my liver swells and presses against nearby organs and surrounding tissue. This includes pressing against nerves. The swelling itself can create a feeling of heaviness. The pressure can create a feeling of fullness and twinges of pain in the upper right quadrant near the ribcage.

The spleen feeds into the liver. When the liver is overloaded and cannot filter blood and metabolize food well, it gets all out of wack. It tries to pass the work to the spleen. The spleen swells, hoards platelets and white blood cells, and loses it’s ability to filter out toxins. Most people can live without a spleen. The liver takes over the job. With cirrhosis and especially portal hypertension, the liver is not able to lend a hand, so the spleen enlarges and can be painful.  The enlarged spleen is due to portal vein hypertension. The blood goes to the spleen when scarring fibrosis keeps it from flowing into the liver. It’s a bloody traffic jam and can cause a full or bloated feeling in your stomach. Even if you do not have liver disease, bloating can feel uncomfortable.

Gas and bloating can cause pain. This is almost too easy to figure out. It is also embarrassing to talk about. So I’ll make it quick. A friend of mine who has cirrhosis pointed this out to me when I was concerned about pain under my ribcage. For those who have fibrous banding on the liver, it makes sense that when the colon presses on it after a meal, it could create discomfort. Haha. I’m such a girl. I hate talking about that. But I love ya too much to NOT tell you what I know.

Poor posture can cause pain in the area of the liver. Sitting in a hunched over position at a desk, or even in bed can put pressure on the liver. It is good to be aware of the placement of that live giving organ that has kept us alive through the Hepatitis C Virus and cirrhosis.

marichana liver pose

I’m going to tell you the truth: I had daily pain in my liver area for a couple of months. Scary-awful-reading-everything-I-could get-my-hands-on-and-worrying-about-it-way-too-much-kind-of-pain. I had come too far to have my liver fail now. I needed to stop and listen to my body.

The first thing I noticed was how I hunched over my desk while grading papers during the day, and again at night while reading or writing at the computer. Then, I began to be more conscious of how erect I sat or stood. One particular yoga pose has always been a favorite to open up the liver area. Instead of staying in the pose for just a few minutes, I lingered twice as long and hugged my liver.

We all know what a nutritional ninja that I am. Yet, a closer analysis of my diet made me stop and think. After spring break, I was eating on the go a lot. Although my habit of eating a liver loving diet is firmly in place, some laziness had crept in. A few of the seniors had taken to bringing hot and fresh donut holes into my 1st hour class. Of course they bribed me with a little bag. (Okay, truth be told, I confiscated them) I was doing this every day for weeks. Then around lunch time, I began hitting the cafeteria when the cooks served up fresh hot rolls. Now you know my little secret – My weakness is bread!

donut holes ihelpc

If I had done this a few times a month, it could be easily balanced out through the day. I was doing this several times a month! I decided to make a few changes for 2 weeks and see if there was a difference. My experiment consisted of a different protein shake in the morning that had more raw organic food. I reasoned that the probiotic effect would be better if I had Greek Yogurt for lunch 3 days a week. I kicked it on the Forbidden Rice (black rice) at the same time. As this routine wore on I forgot about it. Literally, it never came to mind. A few weeks later, I logged on and remembered my painful liver post. That is when I realized that there was NO pain whatsoever.

By listening to my body I was able to take a mental inventory of my diet, posture, and exercise. Not only was the pain gone, but my mind was free of the fear that had been hanging over me like a black cloud.

Let me remind you that I am not a doctor. If the pain level had been constant, severe, or unending – You know my transplant and gastro would have gotten a call from me. They will certainly get to hear my story at the next appointment, or they may read this blog post. You should also contact your doctor with any chronic or acute pain in your liver area.

Can My Liver Feel Pain? I say yes. One of the reasons for this blog is to remind you that you may have some control. I will never know for sure what caused my liver pain. I do know that with some modifications, it is gone. If I get into a rut again, someone please remind me to change up my diet, posture, and exercise? It will sure save me a lot of worry. I hope this helps you if you’ve been worried about liver pain.
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It's true that the size of a gallstone varies and some could be very tiny, but I still don't think they would cause a short-lived pain. My impression is that they are really tiny then they would pass without pain, but if they are large enough that they don't just move right along with the flow of bile, then they are going to move really slowly. I'm not an expert of course, but that's how I visualize it. Posture or gas seem far more likely causes.
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1840891_tn?1383280315
That that was a really helpful post, and insightful in linking both diet and posture to the pain. Another great example of the benefits of good diet! My only issue was that I wish you had identified it as "liver-area" pain rather than liver pain. I've read repeatedly that the liver itself doesn't have the right kind of nerve endings to sense pain, and they say that what we feel as liver pain is really coming from surrounding tissues or nearby organs. My own experience has been of pain that does seem more "in the area" than actually in the liver, but I've also felt a sense of poorly defined discomfort that really does seem centered in the liver itself. I don't know if that is allowed by the available nerve endings or if that too is an illusion and really is coming from nearby tissue. We are constantly getting new people who say their liver hurts and therefore they believe they have HCV, so I think we should to try to be consistent with medical facts in the discussion of liver pain and, whenever possible, differentiate between what it feels like and what it probably really is.
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Avatar_m_tn
Well I agree theres no nerves in the liver, but there is also a medical definition for liver pain its called " hep·a·tal·gia (hp-tlj)
n.
Pain in the liver. Also called hepatodynia.  its a medical term and I didn't make it up, but thanks for the compliment I was just pasting someones article that I felt was helpful


liver pain, medically known as hepatalgia is the pain that is felt in the upper right quadrant of the abdomen, just beneath the rib cage. The pain is often perceived as vague and dull; but however can turn sharp and severe and may occur with back ache. Pain in the liver occurs when pressure is exerted on the liver’s pain receptors that lie on the capsule that covers the organ. The pain can often be confused with generalized abdominal pain, back ache or kidney pain unless the pain specifically occurs in the right abdomen.

Pain in the upper right quadrant may also occur due to formation of gall stones, abdominal disorders, and pancreatitis or may also be intestinal pain. In many instances, liver pain may be perceived as pain in the right shoulder. It is therefore necessary to always seek medical help for diagnosing the actual cause of the pain.

Ca
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Hey, thanks for that post --- really helpful and worth thinking about.  I'm calming down about that ... I guess the underlying anxiety is the uncertain condition of my liver ... either it's cirrhotic or its not....  I've had different assessments ---biopsy, fibrosure and they are inconsistent.  My doc says we'll get a fibroscan hopefully when it becomes available within the next year or so.  That will be the most definitive.

Anther 13 days of tx ... last interferon injection in 6 days (not that I'm counting!  :))

Thanks all.

Mark
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I had at times sharp pain, after having a few days in a row rich foods. I do not have any gallbladder stones but there are some other gallbladder motility issues which can cause pain. Check on gallbladder dyskinesia. A specific muscle relaxant (also good for colon/intestine cramps) helped my gallbladder channel to relax and drain properly an the pain disappeared. Usually a few days diet or even fasting make me feel a lot better.
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