ABDOMINAL PAIN UPER RIGHT ABDOMEN

[ginno]

I have had 3 frightening occurrances of this problem over the past 14 months.  Each incident has happened after a bowel movement or when straining my abdomen (like an abdominal crunch).  The best way I can describe this is that when my abdominal muscles are strained, I feel a tightness in the upper right part of my abdomen, about 2 inches under my right rib cage, after the initial tightness it feels like something internally, intestines? internal organ? burst through the upper part of my abdominal wall into my diaphram, almost like a balloon has inflated inside me?   The pain when this has happened had cripple me for approx 1-2 minutes in duration, but it felt like much longer.  With and intense concentrated effort and by contracting the muscles in my abdomen, I can retract the protrusion, but again this has required much effort, concentration and pain.  After each incident I feel sore in that area for weeks, can often feel a gurgling or fluttering sensation in the area a day or two afterwards, feel pain if direct pressure is applied to area or if I lay on my stomach I feel like there is a mass the size of a baseball in my right side, same spot.   I have been to my IM for a physical, and he performed a variety of tests, and is puzzled.   He ordered a abdominal ultrasound, finding nothing.   Outside of this problem, my bloodwork indicated that I had stage 2 diabetes and a fatty liver.   In addition to the diabetes, I have developed a horrible case of scalp psoriasis with no signs of relief.   Other than blood glucose, fatty liver and psoriasis, everything else was normal (lucky me!).   All of this has happened in 1 years time.  No one one either side of my have encountered any of these things and have been disease free for generations....  I don't know what to do next to identify what is wrong with me.   Other info;  female, 42 yrs old, overweight.  Please advise....

[saville140]

A related discussion, pain upper right side of chest was started.

[margarootoo]

Hello, Thanks for the help. I am a 43-year-old female. I have a similar problem, but there is no pain associated with a pressure sensation I have in the same spot (R side of upper abdomen). I cannot palpate a mass. Negative US for gall bladder and liver. Can a simple X-ray show something bad like a tumor? HIDA scan seems pretty expensive. I realize I cannot afford to have a serious illness go undetected, but I also would like to minimize health care costs ($3,500 deductible is all I can afford for private insurance). Any advice?

[Kevin Pho, MD]

I would consider further imaging the abdomen.  Symptoms in the upper right corner can be due to liver or gallbladder disease.   If the ultrasound is negative, you can consider a HIDA scan with CCK stimulation - which can evaluate the gallbladder ejection fraction.  A low EF may contribute to your symptoms.

If negative, you can consider a upper endoscopy, which can evaluate the upper digestive tract for inflammation or ulcers.  

These options can be discussed with your personal physician.

Followup with your personal physician is essential.

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

Kevin, M.D.
kevinmd_