Right Rib Pain: Symptoms and Necessary Tests - Gastroenterology and Hepatology

There is a feeling of fullness on the inner side of the lower right rib cage?

Dr.
Chen, I have a question: Six years ago, I experienced frequent abdominal bloating and discomfort, so I consulted a gastroenterologist.
The hospital diagnosed me with excessive stomach acid, mild gastritis, and fatty liver.
The doctor advised me to pay attention to my diet, exercise regularly, and have annual check-ups.
Two and a half years ago, due to abdominal discomfort, frequent bloating, and changes in bowel habits, I visited the gastroenterologist again.
The doctor recommended a colonoscopy, which showed no abnormalities.
The doctor advised me to have a check-up every two years.
It has now been two and a half years since my last check-up.
About six months ago, I noticed a slight bloating sensation in the lower right side of my rib cage, which felt like gas, but I didn't pay much attention to it.
Three months ago, while sleeping on my right side, I felt a bloated and pressure sensation, but it was not painful, just uncomfortable.
Recently, for the past three weeks, my stool has been brown, and I have been feeling fatigued every day, but I do not have any jaundice.
Given this situation, what conditions could arise, and what specific tests should I undergo?

Shi Dawei, 50~59 year old female. Ask Date: 2020/08/08

Dr. Chen Shidian reply Gastroenterology and Hepatology

It may still be a gastrointestinal motility or digestion issue.
An ultrasound can be performed to rule out extrinsic gastrointestinal lesions.
A fecal occult blood test can be conducted for the colon.

Reply Date: 2020/08/08

More Info

Based on your description, it appears that you are experiencing discomfort in the right side of your rib cage, along with symptoms such as bloating, fatigue, and changes in bowel habits. Given your medical history of gastritis and fatty liver, it is important to consider several potential causes for your current symptoms.

1. Gallbladder Issues: Given the location of your discomfort, one possibility is a problem with your gallbladder, such as gallstones or cholecystitis. Symptoms of gallbladder issues can include pain in the right upper quadrant, especially after eating fatty meals, as well as bloating and nausea.

2. Liver Conditions: Since you have a history of fatty liver, it is crucial to monitor liver health. Conditions such as non-alcoholic steatohepatitis (NASH) or liver inflammation could contribute to your symptoms. While you do not report jaundice, fatigue is a common symptom of liver dysfunction.

3. Gastrointestinal Disorders: Your history of bloating and gastrointestinal discomfort could indicate conditions such as irritable bowel syndrome (IBS) or functional dyspepsia. These conditions can cause bloating and discomfort without any structural abnormalities.

4. Musculoskeletal Issues: Sometimes, rib pain can be musculoskeletal in nature, resulting from muscle strain or inflammation of the costal cartilage. This could explain the discomfort when lying on your side.

5. Pancreatic Issues: Although less common, pancreatic conditions can also cause pain in the upper abdomen and may be associated with bloating and changes in bowel habits.

Given these possibilities, it is advisable to undergo a thorough evaluation. Here are some recommended tests and examinations:
- Ultrasound of the Abdomen: This non-invasive test can help visualize the liver, gallbladder, and pancreas to check for any abnormalities such as gallstones, liver enlargement, or other structural issues.

- Liver Function Tests: Blood tests that assess liver enzymes can provide insight into liver health and function.

- Complete Blood Count (CBC): This test can help identify any signs of infection or anemia, which could explain your fatigue.

- Stool Tests: If there are concerns about changes in bowel habits, stool tests can help identify any infections or malabsorption issues.

- Endoscopy: If gastrointestinal symptoms persist, an upper endoscopy may be warranted to evaluate the esophagus, stomach, and duodenum for any abnormalities.

- Follow-up with a Gastroenterologist: Given your history and current symptoms, it would be beneficial to consult with a gastroenterologist who can provide a comprehensive evaluation and guide you on the necessary tests.

In summary, your symptoms warrant further investigation to rule out any serious conditions, especially given your medical history. It is advisable to schedule an appointment with your healthcare provider to discuss your symptoms and the appropriate tests to ensure your health and well-being. Regular monitoring and proactive management of your gastrointestinal and liver health are essential, especially considering your previous diagnoses.

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