Right Upper Abdominal Pain: When to Seek Further Medical Help

Right upper quadrant pain (has seen a doctor)?

Hello, Doctor.
On the morning of December 25th, I suddenly experienced mild pain in my upper right abdomen along with shoulder discomfort.
By December 26th, the shoulder pain had subsided, but the upper right abdominal pain worsened.
It hurts whenever I take a deep breath, laugh, or make large movements that stretch my abdomen.
The pain occurs regardless of whether I have eaten or not.
I visited a branch of a major hospital and underwent an abdominal ultrasound, but the doctors couldn't provide a clear diagnosis, only suggesting it might be nerve pain.
I followed the doctor's instructions and took the prescribed medication on December 27th, but my condition has not improved or eased.
Should I consider going to a larger hospital, such as Veterans General Hospital, for further examination?

Wu Tongxue, 20~29 year old female. Ask Date: 2016/12/27

Dr. Hong Yuanbin reply Internal Medicine

Hello, based on your description, it is possible that you may be experiencing a muscle strain or pleuritis.
Have you recently engaged in intense physical activity or lifted heavy objects? If so, a muscle strain is more likely.
Alternatively, have you had a recent cold or experienced severe coughing? If yes, it could be pleuritis.
However, if your symptoms do not improve, I recommend visiting a hospital for further evaluation.
Thank you for your inquiry.

Reply Date: 2016/12/27

More Info

When experiencing right upper abdominal pain, especially when it is persistent and worsening, it is crucial to seek further medical evaluation. The symptoms you describe—pain that intensifies with deep breathing, laughing, or certain movements—can indicate several underlying issues that may require more thorough investigation.

Given your history of gallbladder surgery, it is essential to consider that complications related to previous surgeries, such as adhesions or changes in the anatomy, could be contributing to your current symptoms. Additionally, conditions such as biliary colic, pancreatitis, or even referred pain from the diaphragm or shoulder can manifest as right upper abdominal pain.
The fact that you have already undergone an abdominal ultrasound is a good first step, but if the results were inconclusive and your symptoms persist or worsen, further imaging studies may be warranted. A CT scan or MRI can provide more detailed information about the abdominal organs and help identify any potential issues that an ultrasound might miss.
It is also worth considering the possibility of nerve-related pain, as suggested by the initial physician. Conditions such as intercostal neuralgia, which involves irritation or injury to the nerves that run between the ribs, can cause sharp, localized pain that may be exacerbated by movement or deep breathing. However, it is essential to rule out more serious conditions first.

In your case, since the pain has not improved with medication and continues to affect your daily activities, it would be advisable to seek a second opinion or further evaluation at a larger medical center, such as a university hospital or a specialized facility like Veterans General Hospital (榮總). These institutions often have access to more advanced diagnostic tools and specialists who can provide a comprehensive assessment of your condition.

In summary, while some abdominal pain can be benign and self-limiting, persistent or worsening pain, especially in the context of a previous surgical history, should not be ignored. Seeking further medical evaluation is a prudent step to ensure that any serious underlying conditions are identified and treated promptly. Always communicate openly with your healthcare provider about your symptoms and any concerns you may have, as this will help guide the appropriate diagnostic and therapeutic approach.

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