Right Upper Abdominal Pain: Causes and Recommended Tests

Liver, gallbladder, and gastrointestinal issues?

Hello, I have a mild stabbing sensation in my upper right abdomen.
Sometimes, when I move, it feels like I've pulled a muscle, but repeating the same movement doesn't cause any sensation.
There is no pain when I press on it, but there is a dull pain that radiates to my back.
Initially, I experienced a feeling of warmth, but after seeing a doctor who performed an ultrasound, I was diagnosed with gastroesophageal reflux disease (GERD).
After taking the prescribed medication, the warmth sensation disappeared, but the stabbing pain has not resolved and has not worsened in terms of GERD symptoms.
I only experience flatulence and gas.
I would like to ask if this stabbing pain could be due to chronic inflammation (primarily in the upper right abdomen), and if the pain is radiating from the back, what could be the possible causes? What examinations should I undergo? My symptoms are quite vague, feeling like pain but not quite pain, and since there are many patients, doctors tend to diagnose quickly.
I am relatively young, and I am worried that this minor pain could lead to a bigger issue if not investigated, especially since my budget is limited.
I just want to understand the origin of this pain and what tests I should consider.
Thank you for your guidance.

Xiao An, 20~29 year old female. Ask Date: 2017/12/17

Dr. Chen Qifeng reply Gastroenterology and Hepatology

Gastroesophageal reflux disease (GERD) requires diagnosis through endoscopy.

Reply Date: 2017/12/17

More Info

Understanding right upper abdominal pain can be complex, as it may arise from various underlying conditions. Your symptoms, including a mild stabbing sensation and a feeling of tightness that radiates to your back, warrant careful consideration. The fact that you experienced a sensation of heat initially, which subsided after treatment for gastroesophageal reflux disease (GERD), suggests that your symptoms may be multifactorial.

Possible Causes of Right Upper Abdominal Pain
1. Gastroesophageal Reflux Disease (GERD): As you mentioned, your doctor diagnosed you with GERD. This condition can cause discomfort in the upper abdomen and chest, often described as a burning sensation. While the heat sensation has resolved, the lingering stabbing pain may still be related to esophageal irritation or inflammation.

2. Musculoskeletal Issues: Given that you experience pain that feels like it is coming from the back, musculoskeletal problems such as muscle strain or rib dysfunction could be contributing to your discomfort. Activities that involve twisting or lifting can strain the muscles in the upper abdomen and back, leading to pain that may feel sharp or stabbing.

3. Chronic Inflammation: Chronic inflammation in the gastrointestinal tract, such as gastritis or duodenitis, could also be a possibility. These conditions can lead to discomfort in the upper abdomen, particularly if there is an underlying infection or irritation.

4. Gallbladder Issues: Conditions such as gallstones or cholecystitis can cause pain in the right upper quadrant. This pain is often sharp and may radiate to the back or shoulder. If you have a history of gallbladder issues, this could be a consideration.

5. Liver Conditions: Liver inflammation (hepatitis) or other liver diseases can also present with pain in the right upper abdomen. Symptoms may include fatigue, jaundice, or changes in appetite.

6. Pancreatitis: Although less common, inflammation of the pancreas can cause pain that radiates to the back and may be accompanied by nausea or vomiting.

Recommended Tests
Given your symptoms and the complexity of potential causes, the following tests may be beneficial:
1. Ultrasound: Since you have already had an ultrasound that indicated GERD, it may be useful to repeat this test or consider a focused ultrasound of the gallbladder and liver to rule out gallstones or liver issues.

2. CT Scan: A CT scan of the abdomen can provide a more comprehensive view of the organs in the abdominal cavity and help identify any structural abnormalities.

3. Endoscopy: If GERD is suspected to be the primary issue, an upper endoscopy may be warranted to assess for esophagitis or other abnormalities in the upper gastrointestinal tract.

4. Blood Tests: Liver function tests, pancreatic enzymes (amylase and lipase), and complete blood counts can help identify any underlying inflammation or infection.

5. H. pylori Testing: If gastritis is suspected, testing for Helicobacter pylori, a common cause of stomach inflammation, may be useful.

Conclusion
Your symptoms, while mild, should not be ignored, especially if they persist or worsen. It is essential to communicate your concerns with your healthcare provider, particularly regarding the chronic nature of your pain and the potential for underlying conditions. If your current physician is unable to provide a thorough evaluation due to time constraints, consider seeking a second opinion or consulting a specialist, such as a gastroenterologist or pain management specialist. Early diagnosis and treatment can prevent complications and improve your quality of life.

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