Upper Right Abdominal Pain: Causes and Solutions

Q: Upper Right Abdominal Pain: Causes and Solutions

Dear Mr. <br>Shi：<br>1. <br>Regarding your upper right abdominal pain, I believe it may be what is commonly referred to as side stitch, as mentioned in my response on June 27, 2016. <br>Therefore, I recommend that you consult a coach to learn proper breathing techniques while run

Regarding sharp pain in the right upper abdomen?

Hello, Dr.
Hsiao.
I have been experiencing a sudden feeling of hunger shortly after meals, which feels somewhat like an empty stomach sensation without the typical stomach growling.
If I eat too quickly, I might even feel hungry halfway through my meal.
Eating slowly seems to alleviate the sensation somewhat, but it’s difficult to distinguish between hunger and discomfort.
My food intake hasn’t changed significantly, just a few bites less, but I have a strong aversion to foods I don’t like.
It’s possible that my expectations contribute to my reluctance to eat more, and I haven’t experienced any nausea or vomiting.
I have tried to continue eating until full, but that results in a feeling of bloating while the hunger sensation persists, albeit to a lesser degree.
Burping has become less frequent.
This sensation peaks about one to two hours after eating and gradually subsides.
If I snack in between, I still feel some reaction, and drinking water also elicits a mild response.
However, the symptoms diminish the longer it is after eating.
Breakfast feels normal, but dinner is when these issues are more pronounced, leading me to hesitate or eat very little at dinner.
My meal times are consistent at 9 AM, 12 PM, and 6:30 PM.
In May, I had routine blood and urine tests, which showed a fasting blood glucose of 91 mg/dL, slightly elevated GPT at 37 U/L, triglycerides at 163 mg/dL, and creatinine at 1.3 mg/dL, with no other abnormal values.
The symptoms tend to worsen when I’m at rest but improve slightly when I walk around, and they significantly ease when I jog in the evening (returning to a normal hunger sensation).
Occasionally, I feel a slight weakness, but it is very mild.
Bowel movements appear normal without significant abnormalities, though the odor has changed slightly; it’s not more foul or putrid, perhaps due to other secretions? After noticing these symptoms, I changed my lifestyle, completely eliminating sweets (previously I would drink juice and occasionally bubble tea, but I have now fully abstained) and incorporating daily jogging, whereas I used to only play basketball on Saturdays.
Over the past month and a half, I have lost 5 kg (from 92 to 87) and reduced my waist circumference by 10 cm (from 107 to 97).
However, I don’t believe these changes caused my symptoms, as I only began altering my lifestyle after they appeared.
Currently, I am taking Amlodipine 300 mg, Norvasc 5 mg, and Allopurinol 50 mg to control my blood pressure and uric acid levels, which remain normal.
I sought medical attention at Taipei Mackay Hospital due to my hunger issues, and the initial diagnosis was possible bloating and gastroesophageal reflux (which I do not feel, as I have no symptoms of heartburn or regurgitation).
The doctor prescribed medications including Esomeprazole, Gas-X, and Domperidone, and arranged for an upright abdominal X-ray.
I stopped taking the medications after two days due to lack of change and side effects of dizziness.
Upon returning for a follow-up two weeks later, the doctor reviewed the X-ray and found no significant abnormalities, so no further medication was prescribed.
Regarding the pain in my upper right abdomen, I experience discomfort when bending forward while seated, but if I brace my abdomen with my hand during the pain, it feels somewhat relieved.
Bending while standing does not usually cause pain; it’s more common when sitting.
Additionally, as mentioned previously, while the pain occurs sporadically, it tends to be more frequent after exercise.
If I relax my abdomen and press down with my hand, I cannot pinpoint a specific area of pain, even when applying significant pressure.
I have had an abdominal X-ray and an upper abdominal ultrasound in February, so the only remaining test is an endoscopy.
I am curious whether this upper abdominal pain is related to gastrointestinal, organ, or muscular issues, and I would like to know which specialty I should consult for assistance.
My work involves long hours at a computer, but I don’t typically feel pain while at work; it’s more common after returning home, where I sit on a standard folding metal chair instead of a more comfortable sofa, which seems to exacerbate the pain.
Thank you, Doctor.

Shiti, 30~39 year old female. Ask Date: 2016/06/27

Dr. Xiao Yongxun reply Internal Medicine

Dear Mr.
Shi:
1.
Regarding your upper right abdominal pain, I believe it may be what is commonly referred to as side stitch, as mentioned in my response on June 27, 2016.
Therefore, I recommend that you consult a coach to learn proper breathing techniques while running to avoid hypoxia and cramping of the diaphragm and respiratory muscles.
In early military training, it was generally taught to coordinate breathing with footsteps: inhale through the nose for two counts and then exhale through the mouth for a longer count.
This method allows for longer and more sustained running.
Additionally, it is important to gradually increase your exercise intensity rather than making sudden increases to prevent potential risks.
This diagnosis is commonly seen in rehabilitation clinics, so you may consider visiting a rehabilitation specialist.
2.
If the pain persists without improvement, you should consult a gastroenterologist, pulmonologist, or cardiologist to investigate any potential internal organ issues.
If necessary, an upper gastrointestinal endoscopy, commonly known as a gastroscopy, may be considered.
3.
As for feeling particularly hungry during or after meals, this is indeed possible.
Especially for those who eat quickly, blood sugar levels can rise rapidly, leading to increased secretion of incretin, followed by a significant release of insulin, which causes blood sugar levels to drop quickly, resulting in a feeling of hunger.
If one continues to eat large amounts at this time, it can lead to gastric distension until a feeling of fullness is achieved.
However, this often results in discomfort, including bloating and even nausea; this condition can improve significantly with a proper walk after meals.
It is important to note that this eating habit can lead to excessive caloric intake, resulting in obesity and increased fatigue or drowsiness.
The best approach is to chew slowly and savor each bite, aiming to eat until you are about 80% full or not hungry.
4.
The theoretical basis for the above is supported by physiological experiments showing that the same amount of glucose administered orally leads to significantly greater insulin secretion compared to intravenous administration.
5.
A weight loss plan through diet and exercise typically aims for a weight loss rate of about 0.5 kg per week.
Rapid weight loss can lead to the body being unable to adapt, potentially causing hormonal imbalances, and may also result in a quick rebound effect.
Therefore, you are clearly performing exceptionally well.

Reply Date: 2016/06/27

More Info

Understanding upper right abdominal pain can be quite complex, as it can stem from various causes, ranging from gastrointestinal issues to musculoskeletal problems. Based on the symptoms you've described, let's delve into potential causes and solutions.

Possible Causes of Upper Right Abdominal Pain
1. Gastrointestinal Issues:
- Gastritis or Peptic Ulcers: Inflammation of the stomach lining or ulcers can cause pain, especially after eating. Symptoms may include a burning sensation or discomfort in the upper abdomen.

- Gallbladder Problems: Given your history of gallbladder surgery, it's essential to consider post-cholecystectomy syndrome, which can lead to pain due to bile duct issues or changes in digestion.

- Gastroesophageal Reflux Disease (GERD): Even if you do not experience classic symptoms like heartburn, GERD can manifest as upper abdominal discomfort, especially after meals.

2. Musculoskeletal Issues:
- Muscle Strain: Prolonged sitting, especially in a non-ergonomic position, can lead to muscle strain in the abdominal or back muscles, causing pain that may worsen with certain movements or postures.

- Intercostal Neuralgia: Irritation of the nerves between the ribs can lead to sharp or aching pain in the upper abdomen, particularly when bending or twisting.

3. Other Considerations:
- Stress and Anxiety: Psychological factors can manifest as physical symptoms, including abdominal pain. Stress can lead to muscle tension and gastrointestinal disturbances.

- Dietary Factors: Changes in diet, such as increased fiber or reduced sugar intake, can alter bowel habits and lead to discomfort, especially if your body is adjusting to these changes.

Diagnostic Approach
Given the complexity of abdominal pain, a thorough diagnostic approach is essential. Since you've already undergone several tests, including X-rays and ultrasounds, the next steps could include:
- Endoscopy: If not already performed, an upper gastrointestinal endoscopy can help visualize the esophagus, stomach, and duodenum to check for ulcers or inflammation.

- CT Scan: A more comprehensive imaging study can help identify any structural abnormalities in the abdominal organs.

- Consultation with Specialists: Depending on the findings, you may benefit from seeing a gastroenterologist for gastrointestinal concerns or a musculoskeletal specialist for pain related to muscle or nerve issues.

Treatment Options
1. Lifestyle Modifications:
- Dietary Adjustments: Keeping a food diary can help identify any specific triggers. Eating smaller, more frequent meals and avoiding known irritants (like spicy or fatty foods) may alleviate symptoms.

- Posture and Ergonomics: Improving your workspace ergonomics can reduce strain on your back and abdominal muscles. Consider using a chair that provides better support.

2. Medications:
- Antacids or Proton Pump Inhibitors: If GERD or gastritis is suspected, these medications can help reduce stomach acid and alleviate pain.

- Muscle Relaxants or Pain Relievers: If muscle strain is a concern, over-the-counter pain relievers or muscle relaxants may provide relief.

3. Physical Therapy: If musculoskeletal issues are suspected, physical therapy can help strengthen the abdominal and back muscles, improve posture, and reduce pain.

4. Stress Management: Techniques such as mindfulness, yoga, or counseling can help manage stress, which may be contributing to your symptoms.

Conclusion
In summary, upper right abdominal pain can arise from various causes, and a comprehensive approach is necessary to identify the underlying issue. Given your symptoms and history, it would be prudent to consult a gastroenterologist for further evaluation, especially if the pain persists or worsens. Additionally, addressing lifestyle factors, including diet and ergonomics, can significantly impact your overall well-being and symptom management.

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