Right Upper Abdominal Discomfort: Causes and Insights

Dull pain in the right upper abdomen?

Hello doctor, for the past week, I've been feeling a dull discomfort in my upper right abdomen, approximately in the area just below the sternum and slightly to the right, about two fingers above the navel.
It's not exactly painful, just somewhat uncomfortable, and the sensation comes and goes rather than being constant.
I can't pinpoint exactly where the discomfort is, and pressing on my upper right abdomen doesn't cause any pain.
I've also been experiencing pain in my lower back on both sides, but that should be related to my ankylosing spondylitis.
Currently, my appetite is good, and I have regular bowel movements, usually first thing in the morning, and then again after breakfast.
However, sometimes right after dinner, I suddenly experience abdominal pain, and my stool is often unformed and floats on the surface of the water.
Typically, I feel much better after a bowel movement, but the discomfort in my upper right abdomen persists.
What could be the issue?

Mr. Lin, 30~39 year old female. Ask Date: 2018/02/08

Dr. Chen Shidian reply Gastroenterology and Hepatology

Hello, sir.
You have liver, gallbladder, and gastrointestinal structures in the upper right abdomen.
If you still feel unwell, you may visit the gastroenterology clinic for an ultrasound examination.
Changhua Hospital cares about your health.
Chen Shidian.

Reply Date: 2018/02/08

More Info

Understanding discomfort in the right upper abdomen can be complex, as it may stem from various underlying conditions. Based on your description, the discomfort you are experiencing—located just below the sternum and slightly to the right—could be attributed to several factors, including gastrointestinal issues, musculoskeletal problems, or even referred pain from other areas.

Possible Causes of Right Upper Abdominal Discomfort
1. Gastrointestinal Issues:
- Gallbladder Problems: Conditions such as gallstones or cholecystitis can cause discomfort in the right upper abdomen. Gallstones can block bile ducts, leading to pain, especially after meals.

- Liver Conditions: Liver enlargement or inflammation (hepatitis) can also present as discomfort in the right upper quadrant. Given your history of chronic hepatitis B, it is essential to monitor liver health closely.

- Gastritis or Peptic Ulcers: Inflammation of the stomach lining or ulcers can cause intermittent discomfort, often exacerbated by eating.

2. Musculoskeletal Issues:
- Given your mention of ankylosing spondylitis, it is possible that the discomfort could be related to muscle strain or inflammation in the back or abdominal wall. This can manifest as referred pain, where discomfort is felt in one area due to issues in another.

3. Referred Pain:
- Pain from other organs, such as the kidneys or pancreas, can sometimes be felt in the upper abdomen. For instance, kidney stones or infections can cause pain that radiates to the upper abdomen.

Symptoms to Monitor
- Pain Characteristics: Since you mentioned that the discomfort is not constant and does not worsen with pressure, it may lean more towards a functional or muscular issue rather than an acute abdominal condition.

- Bowel Movements: The fact that you have regular bowel movements is a positive sign, but the description of your stools being poorly formed and floating could indicate malabsorption issues, possibly related to dietary factors or gallbladder function.

- Associated Symptoms: Keep an eye on other symptoms such as nausea, vomiting, changes in appetite, or any significant changes in your bowel habits.

Recommendations
1. Dietary Adjustments: Consider keeping a food diary to identify any potential triggers for your discomfort. Fatty or greasy foods can exacerbate gallbladder issues, while certain foods may irritate gastritis or ulcers.

2. Hydration: Ensure you are adequately hydrated, as dehydration can lead to digestive issues and affect stool consistency.

3. Medical Evaluation: Given your history of chronic hepatitis B and the presence of discomfort, it would be prudent to consult a healthcare provider. They may recommend imaging studies, such as an abdominal ultrasound, to evaluate the liver, gallbladder, and other abdominal organs. Blood tests to assess liver function and check for any signs of infection or inflammation may also be warranted.

4. Physical Therapy: If musculoskeletal issues are suspected, physical therapy may help alleviate discomfort related to muscle tension or spinal alignment.

5. Follow-Up: If symptoms persist or worsen, seek medical attention promptly. It is crucial to rule out any serious conditions, especially given your medical history.

In conclusion, while your symptoms may not indicate an immediate emergency, they warrant further evaluation to ensure that any underlying issues are addressed. Regular monitoring and communication with your healthcare provider will be key in managing your health effectively.

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