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4 months dull ache under right rib
Hi Dear Doctor,
4 months ago I started to have a dull ache under my right rib.
I went to a gastroenterologist and they did a blood test and ultrasound.
From ultrasound they said i have an inflamed liver and from my blood results
the liver enzyme levels were as follows:

-Bilirubine direkt: 0.50 mg/dL (range: 0.2 - 1.3)
-Bilirubine totaal: 0.7 mg/dL
-SGOT: 97 U/L (range: 17-59)
-SGPT: 186 U/L (range: 21-72)
-Alkalische Fosfatase: 92 U/L  (range: 38-126)
-Gamma-GT: 81 U/L (range: 15-73)
-LDH: 641 U/L (range: 313-618)

Doctor suggested me to loose
some weigt. After first test, I followed a diet and exercised regulary.
One month later, I did a second blood test with the following results:

-Bilirubine direkt: 0.43 mg/dL (range: 0.2 - 1.3)
-Bilirubine totaal: 1.1 mg/dL
-SGOT: 61 U/L (range:17-59)
-SGPT: 115 U/L (range: 21-72)
-Alkalische Fosfatase: 85 U/L  (range: 38-126)
-Gamma-GT: 45 U/L (range: 15-73)
-LDH: 512 U/L (range: 313-618)

I continued diet and exercise became 68 kg from 74 kg. After two months from the second blood test, I had the following results:


-Bilirubine direkt: 0.24 mg/dL (range: 0.2 - 1.3)
-Bilirubine totaal: 0.7 mg/dL
-SGOT: 34 U/L (range: 17-59)
-SGPT: 53 U/L (range: 21-72)
-Alkalische Fosfatase: 81 U/L  (range: 38-126)
-Gamma-GT: 28 U/L (range: 15-73)
-LDH: 480 U/L (range: 313-618)

As you see there is an improvement in my enzyme levels and the levels are in the normal range in the last test.
However. the dull ache pain below liver continues: it is very irregular: it comes and goes during the day.
Recently, I have developed some other symptoms: there is bloating, constipation and a lot of wind after meals.
Also, bowel movement and rumbling. When I go to toilet, I feel a relief. Also, sometimes the dull ache region gets itching a little bit and the dull ache region
is a little bit hot. No vomiting, no blood in stool and no appetite loss.
A few days ago, my gastroenterologist ordered a CT scan for the right hand side and it was normal: normal liver, pancreas,  gall bladder, kidney and abdominal wall.
She said that she does not know the reason for dull ache pain below the liver.
What can be the reasons for the dull ache under liver and what should I do?
Thanks in advance,
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Avatar universal
Hello and hope you are doing well.

Hope hepatitis has been ruled out. Besides liver and gallbladder, the other causes for the pain could be gastritis, peptic ulcer disease and GERD. Disorders of the colon could also cause pain. Kidney disorders too produce colicky and sharp pain. Sometimes anxiety with flatulence can cause this pain. Please discuss these issues with your primary care physician when you happen to meet him.

In the meantime you could follow certain precautions. Avoid smoking and alcohol. Avoid
drugs like paracetamol and sedatives. Get vaccinated for hepatitis A and B.
Take a good protein diet. Try to include yogurt in your diet as it is a probiotic which replaces lactobacillus acidophillus (good bacteria) that helps with digestion.

Hope this helped and do keep us posted.
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thanks for your comments.  from the blood test all the all hepatits (A,B, C) were clear.  I  do not think my problem is GERD because I think GERD does not cause bowel movement, rumbling etc. Right? Moreover,  it should be something which elevates liver enzymes and at the same time causing
pain in the right  quadrant below liver. at the beginning doctor told it is due to liver inflammation but after my liver enzymes became normal (and from CT scan doctor told that no liver inflammation also) the pain continued: it comes and goes during the day and it existed during the 4 months.
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