Pain in Right side

Hi  all- Well now that I've finally posted (I started as dr d and changed my name) I can't seem to ask you guys enough questions! Of course it's hubby again- the poor man is making me a wreck (or perhaps I'm just naturally this way and use him as an excuse...?). Anyway, I'm not sure if this is even Hep C related but I figured someone here would know if this is a symptom of liver or related problems: He has a sharp, severe pain in his right side, not the front, more like a few inches above the waist where the rib cage begins. Whenever he coughs, burps or laughs the pain is excruciating. I've already rules out lung problems by taking him for chest xRays- his lungs/heart look normal, just a tiny bit of fluid in the bottom of right lung, suggestive of a cold. The pain started more in the back and has migrated to the side. No fever or cough, all bodily functions normal. I'm thinking it's a muscle but don't want to ignore it if there's something serious goin on. Anyone have any ideas or similar pains that were diagnosed?

[mremeet]

Hi, I'm not a doctor but here's a few of my experiences - First off people who are infected with HCV usually have some form of liver inflammation. Occasionally the inflammation can have periods of flare up as well. The liver itself does not have any nerve endings and therefore feels no pain, but it is encapsulated with a sheath that does have nerve endings. When the liver inflames, as it often does with HCV, the liver swells beyond its normal size and stretches or distends this sheath. When this happens, sometimes patients can experience anything from a vague discomforting sensation, to outright pain (depending on the amount of inflammation and the sensitivity of that particular person). This pain is usually associated with the upper right quadrant (URQ) right under the right lower rib (pretty much right where the liver is), but can sometimes be felt elsewhere too. This is a very common experience for many people with HCV, although I believe most people do not have this sensation constantly all the time. It usually comes and goes, and can go in near permamanent "remission" in many (I have experienced very little liver pain in the last few years).

There is another source of pain that can cause URQ pain. People who have experienced a long term HCV infection are especially susceptible to gallstones. Gallstones form in the gallbladder and can interfere with its normal functioning. The gallstones can inhibit or outright obstruct the flow of bile through the cystic duct (called cholestatis). This can cause anything from a mild discomfort all the way up to severe pain - and technically it can be fatal in extreme cases where the cystic duct is flatly obstructed with a lodged stone (although deaths are very rare to my knowledge). The pain is usually associated with "liver pain" in the URQ, but can also manifest itself elsewhere in the body as well. Referred pain can be experienced in the lower back, sides, shoulders and elsewhere. Pain is associated with an obstruction, although from what I've heard it can also simply be caused by the sensation of the gallbladder "clamping down" on the stones within it. Also, if the gallbladder is either partially or wholly obstructed, bile can back up within the liver (the source of the bile). If this happens, the backed up bile can irritate the liver and also result in the liver to swell (again distending the encapsulative sheath, thereby causing pain). If this occurs over a prolonged period of time, as far as I know it can also contribute to the progression of fibrosis (especially if HCV and/or alcohol are present concurrently).

You can get a sense if it might be gallstones causing the pain if the pain usually occurs shortly after consuming a meal, especially one with a lot of fat in it. The primary purpose of the bile is to break down fats into a digestable form. Anytime you eat a fat rich food, the gallbladder will attempt to discharge bile in order to break down or saponify the incoming fats. So if your husband experiences this liver pain most frequently after eating, it may be associated with the gallstones. Also, if insufficient bile is available to break down/digest the fats within the gut, it can cause indigestion - possibly further adding to the sensation of pain.

I was diagnosed with several quite mature gallstones when I was 31. I had probably had them since I was in my mid 20's and maybe even earlier, and I have no family history of them whatsoever (that I'd ever heard of). But I have been infected with HCV since the age of 17, so as you can see if you've had HCV for awhile, gallstones can be present at a surprisingly young age.

Anyway, hope this helps some, take care.

[dlr2007]

Hi mremeet- Thanks for your reply. Sorry to hear about your experience w/ gallstones- but your post was helpful. My husband has had hep c for probably 20+ years, so gallstones are a possibility. I think we need to call up his PCP and push for more tests. Can an ultrsound show gallstones? Unfortunately hubby's PCP is a nice guy but not too proactive. He has watched his platelets slowly drop over the years and kept saying "not to worry, they're not too low". Also recently prescribed an asprin-type pain med for hubby, but I interjected that w/ the platelets it might cause problems- he agreed and prescribed something else.Hmmm. I'll ask my husband if the pain gets worse after meals- it's been going on for about a monbth now- he does NOT like to go to the dr. I think I'll at least call and see if I can get another appt. I just keep thinking it's weird, hubby is up and about during the day, gets out of breath easily though, then lays down and it seems to get worse- just taking a deep breath hurts- I try not to make him laugh cuz it causes him so much pain. I'll keep you posted! Thanks again for your help. -Dee

[mremeet]

To answer your question, yes an ultrasound can be used to diagnose and even measure the size of gallstones. It can also be used to measure the size of the spleen, which can also offer important diagnostic information to his doctor. Also, I'd really advise your husband see a smart and proactive hepatologist who has a lot of current experience with HCV. And have a complete lab workup with that doctor, certainly including a liver biopsy. We've seen our share of patients who come in here with misguided advice and misadventures stemming from experiences with doctors who know little of HCV. As common as HCV is, it still doesn't have a lot of visibility or understanding amongst much of the medical community (even amongst some GI's, if you can believe that). Plus HCV treatment is a rapidly evolving field, so it really pays to have a doctor who's up on the latest developments looking after you. If you just hang out on this forum for awhile, you'll see how things are changing, often month to month with new studies, theories, and treatment strategies.

If your husband is having a lot of pain with dropping platelets, I'd aggressively look into that ASAP. "Leaving lying dogs sleep" usually is not a good idea with HCV, especially if pain in involved. Take care...

[mremeet]

Oops, I misspelled "cholestatis" above - it should be "cholestasis", sorry about that (just in case you googled it and couldn't find any info).

[dlr2007]

Thanks for your replies- it's so comforting to go onto my computer and see responses to my posts. Well, I called hubby's PCP today and got nowhere fast- PCP says "muscles take a long time to heal, you know!". That's fine if it is a muscle, which I hope it is, but if it's not...? Reading your replies gave me the confidence to call his gastro and leave a message w/ hubby's symptoms. Whadeya know- the gastro calls back and orders an ultrasound done! Awesome!!! I really like my husbands gastro, as well as my own. They work in the same group/office. I just wish we could bypass the not-so-swift PCP's... oh well, at least now we'll get some answers. If the unltasound comes back normal, then I'll  relax and go w/ the strained muscle idea. I'll keep ya posted! Thanks again!  -Dee

[orleans]

Ditto on the gall stones. I just had mine removed 3 weeks ago and your story sounds the same as mine.

[wyntre9]

"He has a sharp, severe pain in his right side, not the front, more like a few inches above the waist where the rib cage begins. Whenever he coughs, burps or laughs the pain is excruciating"

Just putting in my 2 cents coz I've has exactly those symptpms before.  At the time I had severe asthma and was coughing constantly;  couldn't lie down, couldn't sleep.  It was miserable and the pain was excruciating.

The doctor diagnosed it as an inflamation (inflammation) in the membrane between the ribs and the lungs.

It's called costochondritis (at the time I thought it meant an alien dinasuar had invaded my body.)

here's more info.  

Costochondritis causes pain and tenderness in the places where your ribs attach to your breastbone (costosternal joints). Often the pain is sharp, though it can also feel like a dull, gnawing pain. Pain associated with costochondritis occurs most often on the left side of your breastbone, though it can occur on either side of your chest.
Other signs and symptoms of costochondritis may include:

[dlr2007]

Wow- sounds just like what my husband has! I'm gathering it is not a progressive or life-threatening condition, which is good. Sounds like you had an awful time of it and I'm sorry to hear that, but the info helped out- really makes sense. I got hubby booked for an ultrasound on March 7th (that's the earliest appt they had) so I really hope it's nothing that is getting worse and worse. Thanks for your reply! -Dee

[wyntre9]

Of course that explanation isn't necessarily hep-C related, but it sounds exactly like what I had.

That was a long time ago but I remember going nuts until the Dr. explained it to me.

Whenever I laughed, coughed, even breathed, (the burping I never was too adept at)
I had shooting pain.

If it is costocondritis, it should go away as the inflamation (inflammation) clears up but he may have to take short term meds until the pain is more manageable.  

At least, that's what happened with me.

Good luck.