Right Upper Abdomen Discomfort: When to Seek Medical Advice

Pressure sensation under the right rib cage in the upper right abdomen?

First, I would like to mention the symptoms I have experienced in the past.
I am a college freshman, 164 cm tall and weigh around 45 kg.
I used to have frequent diarrhea and constipation, which started around the second year of junior high school.
At that time, I went to a clinic for an ultrasound examination, and everything was normal; I was diagnosed with gastroenteritis.
Later, I experienced issues with gastric bloating and underwent an upper gastrointestinal endoscopy in 2015, which also showed no problems.

In June and July, I worked part-time at a job, and during that time, I had a slight scoliosis of the thoracic spine leaning to the right, but everything else was fine.
Due to my work schedule, my sleep pattern was disrupted; I would return home around midnight and sleep from 4 AM to 10 AM before going back to work.
In June, I started experiencing discomfort in my stomach again, including bloating, loss of appetite, diarrhea, and constipation.
The doctor suggested that my symptoms might be due to irritable bowel syndrome.
I underwent a stool test and another upper endoscopy, where the doctor noted mild bile reflux and prescribed medication for my stomach.
Recently, my appetite has been okay, but I have noticed a feeling of pressure under my right rib cage, which is more pronounced when I slouch.
When I followed up with my doctor, he mentioned that at my age, the likelihood of liver or gallbladder issues is low and initially assessed that it was just intestinal contractions causing this sensation.
Since I will be moving to southern Taiwan for school, it will be inconvenient for me to return for follow-up visits.
I tend to be quite anxious and am worried about serious conditions like pancreatic cancer, liver cancer, or gallstones, which I have heard can present with similar symptoms.
Should I monitor my condition or seek a doctor's evaluation soon? Thank you.

Kai, 20~29 year old female. Ask Date: 2016/08/26

Dr. Zhang Hongwei reply Family Medicine

Hello, your gastrointestinal symptoms do indeed sound quite similar to irritable bowel syndrome.
If the endoscopy shows no issues, you might consider using medications for symptom relief, and also try to establish a regular routine and slow down your pace of life, which may help as well.
Regarding the pressure sensation under your right rib cage, since you have scoliosis, it is possible that the pain is musculoskeletal in nature.
If you are concerned about liver, gallbladder, or pancreatic issues, an abdominal ultrasound can provide an initial assessment.
It is advisable to consult a gastroenterologist for further evaluation.
Thank you for your inquiry.

Reply Date: 2016/08/26

More Info

When it comes to discomfort in the right upper abdomen, especially in a young individual like yourself, it's essential to approach the situation with a balanced perspective. Your history of gastrointestinal issues, including episodes of diarrhea and constipation, suggests that you may have a sensitive digestive system. The symptoms you've described, such as the recent pressure sensation under the right rib cage, could be attributed to a variety of benign causes, but it's also wise to remain vigilant.

Understanding Your Symptoms
1. Previous Gastrointestinal History: You mentioned a history of gastrointestinal issues, including gastritis and bile reflux. These conditions can lead to discomfort in the upper abdomen, particularly if there are dietary changes or stressors affecting your digestive health.

2. Current Symptoms: The pressure sensation you feel under your right rib cage could be related to several factors:
- Musculoskeletal Issues: Given your mention of a slight scoliosis, it’s possible that muscle tension or postural issues could contribute to discomfort in that area.

- Digestive Issues: Conditions like irritable bowel syndrome (IBS) can cause referred pain or discomfort in the abdomen, particularly if there are changes in bowel habits.

- Gallbladder or Liver Concerns: While it's less common for someone your age to have significant liver or gallbladder issues, conditions like gallstones or liver inflammation can present as discomfort in the right upper quadrant.

When to Seek Medical Advice
Given your symptoms and medical history, here are some guidelines on when to seek medical attention:
1. Persistent or Worsening Symptoms: If the pressure sensation becomes more painful, persistent, or is accompanied by other symptoms such as nausea, vomiting, fever, or jaundice (yellowing of the skin or eyes), you should seek medical attention promptly.

2. Changes in Bowel Habits: If you experience significant changes in your bowel habits, such as prolonged diarrhea or constipation, or if you notice blood in your stool, these warrant further evaluation.

3. Weight Loss or Appetite Changes: Unexplained weight loss or a significant decrease in appetite should be discussed with a healthcare provider, as these can be signs of underlying issues.

4. Anxiety About Symptoms: If your concerns about serious conditions like pancreatic cancer or liver disease are causing significant anxiety, it may be beneficial to consult a healthcare provider for reassurance and possibly further investigation.

Recommended Actions
- Observation: If your symptoms are mild and not worsening, you might consider monitoring them for a short period. Keeping a symptom diary can help you track any changes or patterns.

- Dietary Adjustments: Pay attention to your diet. Avoiding fatty, spicy, or overly rich foods may help alleviate some discomfort. Staying hydrated and maintaining a regular eating schedule can also be beneficial.

- Consultation: If you remain concerned or if symptoms persist, it would be wise to schedule an appointment with a healthcare provider. A thorough evaluation, including a physical examination and possibly imaging studies (like an ultrasound or CT scan), can help rule out any serious conditions.

Conclusion
In summary, while your symptoms may not indicate a severe condition, it's essential to listen to your body. If you feel that something is not right, seeking medical advice is always a prudent choice. Early intervention can often lead to better outcomes, and addressing your concerns with a healthcare professional can provide peace of mind. Remember, your health is paramount, and it's always better to err on the side of caution.

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