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Persistent Right Upper Abdominal Pain
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Persistent Right Upper Abdominal Pain

Hi I have been experiencing right upper abdominal pain for about 2 months now, which is progressively becoming worse and now is accompanied by nausea and sometimes muscle pain. Additionally, I have felt very very tired recently. I had similar symptoms about 6-7 years ago and had a workup then, but liver enzymes were high-normal (ALT was 30 I think), Ultrasound/CTs showed nothing and was negative for Hepatitis A, B and C (with immunity to B).

However the pain has returned and is even worse than before. I went to my doctor and he drew labwork and did an ultrasound again. The liver labs were normal:
ALT 18, AST 8, Total bilirubin 0.8, Direct Bilirubin 0.2 Alk Phos 84, Protein and albumin were both a little high actually at 8.2 and 5.4 respectively.
And the ultrasound was unremarkable, including gallbladder.

However I continue to feel awful and this dull pain is getting much worse. My physician seems unconcerned since the labs and everything came back normal, but I've read that many people with cirrhosis or liver disease can have normal labs/ultrasound even though there is damage being done to their liver. I don't know where to go from here, since my physician doesn't seem keen on the idea of working it up anymore.  Could this still be liver disease? What should I do now?
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Avatar_f_tn
If the pain comes and goes, and is increasingly worse as time goes by, it sounds like gallstones. My stones never showed up on ultrasound. Can't tell you how many "normal" ultrasounds I had until I had my gall bladder removed.

In the early stages, pain would come on slowly, and the whole area you are talking about would seem to contract. The pain is often described as feeling like a sword that goes all the way through to the back.
When the pain would subside, it was immediate, like a balloon bursting.
Eventually, it would not go away completely, and the stones wouldn't pass. Nausea and jaundice can accompany this.  

Just for further comparison, for me, the pain was also somewhat of a burning sensation. The only way to alleviate it in the moment is to lie down and try to relax all my muscles through the pain.

An ERCP (Endoscopic Retrograde Cholangiopancreatography) can look into the liver to see what's there. I was reading at http://digestive.niddk.nih.gov/ddiseases/pubs/ercp/ that there is another, less invasive test that can be performed now called a magnetic resonance cholangiography. Don't know if this might be an option to help diagnose the cause of your pain, but it is worth asking about.

Starting as far back as Junior High I had "attacks" of severe upper right abdominal pain, and each time I either went to the emergency room or was referred by my GP for ultrasound, etc., results were always normal. No explanation. Well, pain does not occur for no reason.

When I was in my twenties I had my gall bladder removed. In my experience, the pain has to be unbearable and constant before anything will be done. That's the sad truth. I just don't believe enough is understood about the condition. Unless they actually see stones or "sandy material" in the common duct or gall bladder, doctors seem to be clueless. Or they have to get a high liver enzyme result, and act while it is happening.  It can be very frustrating. When I started having this type of pain, I was repeatedly told that this is not a hereditary issue, but now it is commonly known to be hereditary. It is important to mention if anyone in your family has had a similar problem. That can help with your diagnosis.

Many people have no issues at all once their body adjusts to having no gallbladder. It usually takes about a year to level out. But I've had digestive issues ever since. In my opinion, for what it's worth, I think the gall bladder removal procedure will no longer be used in the future. It just doesn't address the underlying issue for everyone, and unfortunately for me, I still experience the same type of pain even without my gallbladder because my body has a tendency to produce stones. I'm 37 now. I have an attack every now and then, but not usually more than once a year.

Even though there is no gall bladder, pain occurs when the stones, or the thick material that produces stones, blocks the common duct. During one of the ERCP procedures I received, my gastroenterologist was able to widen the common duct, and this was helpful for me. Most of my family have had similar issues. Eventually, it can lead to liver problems, causing the liver to fail, but this takes a long time. My father passed from this exact thing. He was not diagnosed as needing a transplant early enough. His liver failed due to constant blockage, even though he had no gall bladder. He had gotten to a point where he did not feel pain from it because of scar tissue. He ultimately was diagnosed with primary sclerosing cholangitis (PSC), but this is only one of many variations of liver disease. Cirrhosis is one of the end stages of liver disease, not the beginning.

There is medication you can take to prevent stones, but my experience is that diet is your absolute best approach to prevention. Lower your cholesterol. Don't eat a lot of red meat or fried foods. (These are some of my pain triggers.)

I hope this helps.
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Avatar_f_tn
Thanks for your advice! How did you eventually get your doctor to take you serious enough to discuss gallbladder surgery? Every time I go to a doctor and its normal, they blow off any discussion of further tests, but I'm miserable, and I really would like some answers now.  Right now I'm seeing an internist, should I try and make an appointment with a gastroenterologist?
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