Abdominal Discomfort: Insights from Gastroenterology

Q: Abdominal Discomfort: Insights from Gastroenterology

Hello： Your symptoms are more indicative of neuropathic pain. <br>Adequate sleep, moderate exercise, and stress relief should gradually improve your condition. <br>Try not to focus on whether any organ has a significant pathological change! Best wishes!

Abdominal discomfort and pain issues?

Hello, doctor.
About four months ago, I experienced pain in the liver area and unusual anxiety.
Prior to that, I was hospitalized for acute gastroenteritis about six months ago, and during blood tests, the doctor found elevated liver enzymes.
After an ultrasound, I was informed that I have fatty liver; I was diagnosed with fatty liver at around 18 years old but didn't pay much attention to it.
Later, I had liver area pain (which does not hurt when pressed).
I went to National Taiwan University Hospital (Gastroenterology and Hepatology) for an ultrasound and blood tests, and nothing significant was found (though fatty liver was still present).
After that, my bowel habits changed for a month, and I went to Cheng Kung University Hospital (Gastroenterology and Hepatology) for stool tests and blood tests, which all came back normal.
Recently, I also donated blood, and all the indices were normal, as well as my blood pressure (I am 178 cm tall, weigh 77 kg, and have a slightly high BMI).

Although all the indices are normal, I have recently been experiencing intermittent dull pain in my right abdomen, usually under the right rib cage and some tenderness below the navel on the right side.
Sometimes, I also feel sharp pain a bit further away from the navel (around the area above my belt), but these symptoms usually do not occur simultaneously.
I suspect it may be related to my sitting posture (I spend almost all day sitting on a chair, and at home, I like to either lie down or sit in a Japanese-style wooden room with my laptop on my stomach).
Sometimes, I feel better when I stretch my body and try to sit up straight, and there have been a few instances where the pain was more intense (for example, tenderness in the lower right corner of the navel), but after stretching, I can no longer find the tender spot.

Additionally, I have been waking up with pain, which I think is related to my habit of sleeping on my side in a curled position (I tend to wake up in this position).
Therefore, I recently consulted an orthopedic doctor, but X-rays showed no issues with my bones (spine, cervical spine, thoracic spine, etc.—though I occasionally feel tenderness in the thoracic spine, which made me think it might be related).
I have also seen a traditional Chinese medicine practitioner and took some herbal medicine for tonifying qi, but it did not help...
(I have been experiencing this pain for about three months, usually in one area at a time, and it is not constant; I feel it most upon waking).
Although it is not uncomfortable enough to affect my daily life, I am still worried about my health...
it has been affecting my mood.

To maintain my health, I have been consistently running and hiking; my general lifestyle and exercise do not seem to affect my condition, but there has been no improvement.
I originally planned to see a skilled massage therapist, but since the orthopedic doctor told me there is no issue with my bones, I am now unsure which specialist I should see to identify the cause of my recent discomfort (the orthopedic doctor kept saying that this could not be a bone issue...).
Thank you for your patience in reading this.
(By the way, I am asking in the pulmonary medicine department because the orthopedic doctor suggested I see this specialty...
this was about a week ago, but since the doctor's attitude was somewhat unfriendly, I left the hospital directly.
If you also recommend this, I will find time to visit another hospital.)

Lan, 20~29 year old female. Ask Date: 2019/04/11

Dr. Yang Wenda reply Pulmonology

Hello: Your symptoms are more indicative of neuropathic pain.
Adequate sleep, moderate exercise, and stress relief should gradually improve your condition.
Try not to focus on whether any organ has a significant pathological change! Best wishes!

Reply Date: 2019/04/11

More Info

Understanding abdominal discomfort can be quite complex, especially when multiple factors are at play. Based on your description, it seems that you have been experiencing a variety of symptoms, including pain in the liver area, changes in bowel habits, and discomfort in the right side of your abdomen. Given your medical history, including a diagnosis of fatty liver and a previous episode of acute gastroenteritis, it's essential to consider both gastrointestinal and musculoskeletal factors in your case.

Firstly, the pain you are experiencing in the liver area could be related to your fatty liver condition. Fatty liver disease can sometimes lead to discomfort or pain, particularly if there is inflammation or if the liver is enlarged. However, since your recent ultrasound and blood tests did not show any significant abnormalities, it may be that your fatty liver is stable at this time. It's important to maintain a healthy lifestyle, including a balanced diet and regular exercise, to manage this condition effectively.

The changes in your bowel habits, along with the abdominal pain, could suggest a functional gastrointestinal disorder, such as irritable bowel syndrome (IBS). IBS can cause symptoms like abdominal pain, bloating, and changes in bowel habits without any identifiable structural abnormalities. Stress and lifestyle factors, such as prolonged sitting and poor posture, can exacerbate these symptoms. Your observation that stretching and changing your posture seem to alleviate some discomfort supports this idea.

Additionally, the pain you describe in the right lower quadrant, particularly near the area of the appendix, could be concerning. While your previous evaluations have ruled out significant issues, it might be worthwhile to consider a follow-up with a gastroenterologist to explore this further. They may recommend additional imaging studies or tests to rule out conditions such as appendicitis, diverticulitis, or other gastrointestinal issues.

Regarding your concerns about posture and its impact on your symptoms, it is indeed possible that prolonged sitting and certain sleeping positions could contribute to discomfort. Poor posture can lead to muscle tension and strain, particularly in the back and abdominal areas. Engaging in regular physical activity, maintaining good posture while sitting, and using ergonomic furniture can help alleviate some of these issues.

Since you mentioned that you have seen an orthopedic specialist and had X-rays that showed no bone issues, it may be beneficial to explore other avenues, such as physical therapy. A physical therapist can provide exercises and strategies to improve your posture, strengthen your core muscles, and reduce discomfort.

Lastly, if you feel that your symptoms are affecting your mental health, it may be helpful to speak with a mental health professional. Chronic pain and discomfort can lead to anxiety and stress, which can further exacerbate physical symptoms. A holistic approach that addresses both physical and mental health may provide you with the best outcomes.

In summary, while your symptoms may not indicate a severe underlying condition, it is essential to continue monitoring them and seek further evaluation if they persist or worsen. A multidisciplinary approach involving gastroenterology, physical therapy, and possibly mental health support may be the most effective way to address your abdominal discomfort and improve your overall well-being.

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