Can Gallstones and Fatty Liver Cause Upper Abdominal Pain and Discomfort?

Can gallstones and fatty liver cause pain in the epigastric region or upper abdomen, right shoulder pain, and back discomfort?

Hello Dr.
Chen, I apologize for interrupting you during your busy schedule.
I am 36 years old, have never smoked or consumed alcohol, and my blood tests show no signs of metabolic syndrome (blood pressure around 125 or lower, normal high/low-density lipoprotein cholesterol, normal cardiac enzymes, and glycated hemoglobin = 5).
I would like to ask you if gallstones and fatty liver can cause upper abdominal pain.

Two years ago (in 2014), during a health check-up, an abdominal ultrasound revealed two gallstones (one measuring 1.1 cm and the other 1.3 cm; I am unsure if these sizes are considered large or small), and I was diagnosed with moderate to severe fatty liver (without hepatitis, and liver function tests were normal).
My total bilirubin was slightly elevated but returned to normal upon retesting two weeks later.
Additionally, during an endoscopy and colonoscopy, gastroesophageal reflux was not found, but there was mild superficial gastritis.
Over the past year, I have experienced discomfort in the "chest area" (around the xiphoid process; I am unsure if this is classified as "chest" or "upper abdomen").
The discomfort feels like "sharp pain, dull pain, and cramping," and it seems to be visceral pain rather than muscular pain.
I also have associated "right shoulder pain" (localized pain that I can pinpoint, with a sharp sensation resembling nerve pain, not muscular pain) and "right upper back pain" (a dull ache that feels like a nagging pain).
However, the pain in these areas rarely lasts more than one minute before subsiding, only to reoccur later.
I have not yet identified any patterns for these occurrences, but these symptoms are uncomfortable and concerning.
I have visited a cardiologist (exercise electrocardiogram + myocardial perfusion, with no signs of hypoxia) and a pulmonologist (self-paid 256-slice CT, with no abnormalities).
Therefore, I would like to ask if "gallstones" and "fatty liver" could lead to the various physical discomfort symptoms I am experiencing (including "sharp pain and dull sensation at the xiphoid process," "localized sharp pain in the right shoulder," and "dull, nagging pain in the right upper back").
I would greatly appreciate your clarification on this matter.
Thank you very much.
Sincerely, Mr.
Chen.

Mr. Chen, 30~39 year old female. Ask Date: 2016/10/19

Dr. Chen Qifeng reply Gastroenterology and Hepatology

In general, fatty liver is less likely to present with pain symptoms.
As for gallstones, treatment should be pursued whenever there are symptoms, regardless of their size or quantity.
In terms of location, the pain may be due to the gallstones, but based on your description of the pain, it does not seem typical of gallstone disease.
Classic gallstone symptoms usually occur after consuming a rich, fatty meal, presenting as pain in the right upper abdomen or upper abdomen, which may radiate to the back and shoulder.
The intensity of the pain can range from severe, sharp pain to a dull ache.

Reply Date: 2016/10/19

More Info

Gallstones and fatty liver disease can indeed contribute to upper abdominal pain and discomfort, although the nature and mechanism of the pain may vary.
Gallstones, particularly when they obstruct the bile ducts, can lead to a condition known as biliary colic. This typically manifests as sharp, severe pain in the upper right abdomen, often radiating to the back and right shoulder. The pain is usually triggered by the consumption of fatty or heavy meals, as the gallbladder contracts to release bile, which may be obstructed by the stones. In your case, the presence of two gallstones measuring 1.1 cm and 1.3 cm could potentially cause symptoms, especially if they are located in a position that leads to intermittent blockage of the bile duct. However, if your pain does not correlate with meals or is not severe, it may not be directly related to the gallstones.

Fatty liver disease, on the other hand, is less commonly associated with pain. It is often asymptomatic, but some individuals may experience discomfort or a vague sense of fullness in the upper abdomen. This discomfort is generally not sharp or severe and is more likely to be a dull ache. In your case, the symptoms you describe, such as the sensation of "pulling" or "cramping" in the epigastric area (the region just below the sternum), may not be directly attributable to fatty liver but could be related to other gastrointestinal issues, such as gastritis or functional dyspepsia.

The right shoulder pain you mentioned could be referred pain from the gallbladder or liver, as irritation in these organs can sometimes manifest as pain in the shoulder area. This is known as Kehr's sign, where pain is referred to the shoulder due to shared nerve pathways. The intermittent nature of your pain, lasting less than a minute, suggests that it may not be due to a chronic condition but could be related to muscle spasms or transient gastrointestinal disturbances.

Given your history of gallstones and fatty liver, it is essential to monitor your symptoms closely. If you experience more frequent or severe pain, or if you develop additional symptoms such as jaundice, fever, or persistent nausea, it would be prudent to seek further evaluation.
In summary, while gallstones can cause significant upper abdominal pain, fatty liver is less likely to be the direct cause of sharp pain. Your symptoms may be multifactorial, involving both gallbladder-related issues and possibly other gastrointestinal conditions. A thorough evaluation by a gastroenterologist may provide more insight into your symptoms and help determine the best course of action, whether it be observation or intervention. Regular follow-ups and imaging studies may also be warranted to monitor the status of your gallstones and liver condition.

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