Tightness/pain beneath right rib radiating to mid and lower back

[revjr]

I'm a 37 year-old male. Approximately 6 weeks ago, I started feeling a tightness and pressure under my right rib. No fever or nausea accompanies it and it doesn't seem to worsen after meals. In the last few days, the tightness, which makes me visualize a golfball under my rib cage, seems combined with a pain in my mid and lower back. I also noticed that the area in my right rib is slightly tender to the touch now. It's most noticeable when I'm lying down. Really a ratcheting up or tightening sensation. My GP ordered a chest CT scan and RUQ ultrasound, both of which showed no "abnormalities." Now he wants to order a HIDA scan. I had a kidney stone in 2006 with radically different symptoms than those I'm experiencing now. My question - is it appropriate at this point for me to ask for a referral to an internist, gastroenterologist, or urologist? Each time my GP orders a test it takes about two weeks to get it performed, and I'm anxious about the length of time this is taking to narrow down and whether I might be in danger of a blockage or infection (if that's not what I'm already experiencing). I mean, what do I do next if the HIDA doesn't show anything wrong with my gallbladder other than wait for him to suggest yet another procedure?

[Kevin Pho, MD]

I agree with the CT scan and ultrasound.  The HIDA scan with CCK stimulation can evaluate the gallbladder ejection fraction.   A low number there can be an explanation for the symptoms.  

Another consideration would be an upper endoscopy, which can exclude GERD or inflammation of the upper digestive tract.

A referral to a GI physician would be appropriate in this case to discuss the aforementioned options.

This answer is not intended as and does not substitute for medical advice - the information presented is for patients education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
www.kevinmd.com

[Leslie44]

I am a 44 year old female and am experiencing seemingly the exact symptoms that revjr posted on May 6, 2008.Tightness/pain beneath right rib radiating to mid and lower back. I have been suffering for approximately 3-4 weeks and am going for an x-ray and pelvic/abdominal ultra sound.  I recall that I had a similar episode about 2-3 years ago, which eventually went away but did not seek medical attention for at the time.  Signed LR

[revjr]

Hi Leslie:

How long did the previous episode 2-3 years ago last if you don't mind me asking? This is a very disconcerting, curious sensation. I hope all goes with your x-ray and ultrasound.

revjr

[Leslie44]

I can't really remember but I think it was at least several weeks.  Now, the symptoms are still occurring and at times are not as severe or maybe its just I am used to now.  I will be having my ultra sound/x-ray on Tuesday and i will let you know the results.  For several days during this I could not wear underclothing as it was so uncomfortable.  The feeling is hard to describe, but has gone away since. It is very strange as I was feeling fine the day before and then woke up with the pain in the morning which seems to get worse as the day goes on.  It however does not seems to bother me while sleeping? I don't know if this is related but on a couple of occasions I had a feeling of overheating.  PS - I mentioned to my dr. the possibility of shingles as i understand that a rash is sometimes not apparent and is difficult to diagnose.  The dr. seems to think it's related to either gallbladder or liver.
Oh, one other thing, do you ever have an uncomfortable feeling of hollowness in the middle of your chest?

[revjr]

It does sound very similar to mine. Mine is more of a tightness as opposed to pain, but I have become worried since it's spread through to my back and side now. Just like you, this doesn't affect my sleep. It's very noticeable when I'm sitting up or lying in bed...the hollowness you mention in your chest - I have had a sensation like a warm liquid spilling over my chest on occasion (not like reflux or GERD, though). I had a stress test and echo a few months ago for some tightness then but supposedly the results were normal. Now, oddly enough, the chest tightness has vanished and been replaced by this mess.

[JimK3145]

I've been following your comments as well as those of Leslie44. I have had similar symptoms of pain under my right front rib cage and well as on my back right rib cage. This started about 6 months ago. At first, it was really intense, happened about 1-2 times a week. Then in January thru March of this year, it became more frequent. But starting in April, it turned into more of a stiffness similar to what revjr is reporting. This stiffness is now very low level, lets me sleep at night, but I always know that it's there. I've had an abodomen sonigram, HIDA scan and CT scan and all say that my gallbladder and liver are okay. I had blood work done and that says that my liver seems to be okay also. My current gastroenterologist is stumped as to what is causing this pain/stiffness so he wants me to see another gastro doc at a teaching/medical hospital which I'm scheduled to do in late May. My primary care doc thinks it might be related to IBS but my current gastro doc doesn't seem to be convinced. I'll keep you both posted as to what the new gastro doc says at the end of May in regards to diagnosis, further testing , etc, Hopefully, the three of us will get this figured out.

[Leslie44]

The tight uncomfortable feeling is constant for me except while asleep, but it makes it very difficult to get into a comfortable position at night.  Yesterday it seemed that this uncomfortableness was more moderate and is now not half as bad as it was in the beginning, but still there.  I also noticed that it feels like I have some muscle strain in my lower back right side, maybe due to the continuous clenching.  Hope we can all resolve this sooner than later! Regards

[JimK3145]

I also have experienced the muscle strain in my lower back on the right side. During the day, the stiffness is very low but when I wake up after sleeping, I often note that the stiffness is more pronounced. After I'm up for about an hour, the stiffness returns to the low level state. Like I mentioned in my earlier post, my primary care doc thinks it might be related to IBS, but I would think that if it was, the stiffness would come and go rather than be present all of the time. Lets keep our fingers crossed that one of us three gets some good explanation!

[mikcin]

I like you and Leslie44 went thru like symptoms for 5 years only after the GB removal.  It took this long for anything to surface.  I would definately go to another gastro who should consider an ERCP.  I just had to have 3 of them done to clear the CBD.  The first attempt to get the impacted stones failed, then on to another gastro who could get them, then had to go back 6 weeks later and have yet another to clear out sludge in the CBD and this sludge did not show up on the last CT scan either, but CBD was full of sludge.  Believe me I had been thru every test in the book before this was done.  Several hospitalizations and trips to the ER in pain.  Evidently this was built up for quite some time and my liver enzymes finally went very high when the stones were impacted.  So I would keep trying to get to the bottom of this before you have to go thru all the pain.  It really sounds like you are experiencing something disfunctioning in your GB.  I also had the knot just before the emergency GB removal.