Pain Under the Ribs: Liver or Gallbladder Issues? - Gastroenterology and Hepatology

Pain in the inner lower area of the left and right ribs?

Hello, due to work-related socializing, I occasionally drink alcohol.
Around the end of last year, I started to notice a soreness under the left and right ribs after drinking.
My medical history includes mild gastritis, specifically around the cardia.
I have undergone liver ultrasound during health check-ups, which diagnosed me with mild fatty liver (both GPT and GOT are normal, no signs of metabolic syndrome, and no hepatitis B or C, with normal alpha-fetoprotein levels).
I also paid for a liver elastography scan, which indicated moderate fatty liver.
If I do not consume alcohol, the symptoms typically resolve within three days.
If I have exercised that week, the likelihood of soreness is even lower.
The physician diagnosed it as a possible muscle strain, but the pain occurs only after drinking, lasting from that night until the next day.
(There was no exercise that week, so the chance of exercise-related injury is minimal).
Taking vitamin B complex or clam extract seems to slightly alleviate the pain.
Could this situation be related to liver issues or gallbladder disease? Thank you.

Xiong Da, 40~49 year old female. Ask Date: 2020/04/01

Dr. Lin Minghui reply Gastroenterology and Hepatology

Hello, a 40-year-old male is experiencing soreness in the inner area below the left and right ribs after drinking alcohol.
The pain slightly improves when taking B vitamins or clam extract.
An ultrasound shows fatty liver, with no significant gallstones or biliary issues.
Long-term alcohol consumption may lead to alcoholic liver disease, hepatosplenomegaly, gastrointestinal discomfort, pancreatitis, and malnutrition, which can result in muscle atrophy and deficiencies in folate and vitamin B12, potentially causing neuropathy.
Neuropathy is possible; it is advised to reduce alcohol intake.
If symptoms persist, follow-up in the outpatient clinic is recommended to check for other issues.
Wishing you peace and health! Sincerely, Dr.
Lin Ming-Hui, Attending Physician, Gastroenterology, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2020/04/01

More Info

Understanding pain under the ribs, particularly in the context of liver or gallbladder issues, can be complex, especially for individuals with a history of liver conditions such as fatty liver disease. Based on your description, it seems that your symptoms are closely linked to alcohol consumption, which can exacerbate underlying liver conditions.
Fatty liver disease, or hepatic steatosis, is characterized by an accumulation of fat in liver cells. It can be caused by various factors, including excessive alcohol intake, obesity, diabetes, and certain medications. In your case, since you have been diagnosed with mild to moderate fatty liver and have normal liver function tests (GPT and GOT), it suggests that while your liver is affected, it is not severely damaged at this point. However, the presence of discomfort after drinking alcohol indicates that your liver may be reacting to the stress of processing alcohol, which can lead to inflammation and discomfort.

The pain you experience under your ribs, particularly after drinking, could be attributed to several factors:
1. Alcohol-Induced Liver Stress: Alcohol is metabolized in the liver, and excessive consumption can lead to inflammation, which may manifest as pain or discomfort in the upper abdomen. This is especially true if you have underlying fatty liver disease, as the liver is already compromised.

2. Gallbladder Issues: While your symptoms seem to correlate with alcohol intake, gallbladder problems, such as gallstones or cholecystitis, can also cause pain in the upper right abdomen. However, gallbladder pain is typically more pronounced after consuming fatty foods rather than alcohol. Given your history of gastritis, it’s also possible that your symptoms could be related to gastrointestinal issues rather than liver or gallbladder pathology.

3. Muscle Strain: Since you mentioned that the pain occurs after drinking and is less frequent when you exercise, it could also be related to muscle strain, particularly if you are engaging in activities that involve the upper body. Alcohol can also lead to dehydration and muscle cramps, which may contribute to discomfort.

4. Gastritis or Gastroesophageal Reflux Disease (GERD): Given your history of gastric inflammation, it’s possible that your symptoms could be related to gastritis or GERD, which can cause referred pain to the upper abdomen and rib area.

To address your concerns, it is advisable to:
- Limit Alcohol Intake: Reducing or eliminating alcohol consumption can significantly improve liver health and reduce symptoms. Alcohol can exacerbate fatty liver disease and lead to further complications.

- Monitor Symptoms: Keep a diary of your symptoms in relation to your diet, alcohol consumption, and physical activity. This can help identify triggers and patterns.

- Consult a Specialist: Given your history of fatty liver and current symptoms, it would be prudent to consult a hepatologist or gastroenterologist for further evaluation. They may recommend imaging studies, such as an ultrasound or MRI, to assess liver and gallbladder health more thoroughly.

- Lifestyle Modifications: Incorporating regular exercise, a balanced diet low in saturated fats and sugars, and maintaining a healthy weight can help manage fatty liver disease and improve overall health.

In summary, while your symptoms may be related to liver issues, they could also stem from other gastrointestinal or musculoskeletal factors. A thorough evaluation by a healthcare professional is essential to determine the exact cause and appropriate management of your symptoms.

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