Right Side Abdominal Pain: Causes and Diagnostic Approaches

Sharp pain below the right rib cage. Abdominal bloating and pain?

Hello, Doctor.
I'm not sure if my previous message was sent, so I'm asking again.
I currently have two issues:
1.
I experience sharp pain in the right side of my abdomen (below the rib cage) after bowel movements.
I feel a burning pain even when I haven't eaten anything, as if acid has lingered in my intestines, leading to sudden and intense burning pain.
This pain can become unbearable but eventually subsides on its own.
Some doctors believe it may be irritable bowel syndrome (IBS), but my pain is always localized to the same spot.
Could there be any lesions in the right side of my intestines? What kind of examinations could be done to investigate this?
2.
After meals, I experience abdominal bloating and pain.
An X-ray showed the presence of fecal matter, gas in the colon, and gas in the small intestine.
I find that passing gas alleviates the discomfort.
I'm unsure if this is related to my first issue.
3.
Occasionally, I have a burning sensation in my upper right abdomen, which improves after passing gas.
Is it possible that being underweight (currently with a BMI of 17.9) is causing my intestines to be more palpable against my abdominal wall? I have been on a restrictive diet for two months, and these issues began afterward.
I'm concerned that I may have injured my gastrointestinal tract or developed adhesions, bile reflux, or other problems.
My symptoms fluctuate, especially after eating or when I haven't eaten.
I have undergone a general CT scan, which revealed only mild ascites, intestinal gas, and fecal matter.
Some doctors have suggested further imaging studies like a bowel imaging test, CT, or MRI.
Do you have any recommendations for me? Thank you.

Zhang Ke 0, 30~39 year old female. Ask Date: 2021/10/19

Dr. Chen Shidian reply Gastroenterology and Hepatology

A complete examination has been conducted.
Please follow the physician's medication and dietary recommendations, and continue to monitor your condition.

Reply Date: 2021/10/19

More Info

Understanding right-side abdominal pain can be quite complex, as it can stem from various underlying conditions. Based on your description, there are several potential causes and diagnostic approaches that can be considered.

1. Right-Side Abdominal Pain After Bowel Movements
The stabbing pain you experience in the right side of your abdomen after bowel movements could be indicative of several conditions. One possibility is Irritable Bowel Syndrome (IBS), which is characterized by abdominal pain and changes in bowel habits. However, since you mentioned that the pain is localized and consistent in its location, it may suggest a more specific issue, such as inflammatory bowel disease (IBD) or even diverticulitis.
To investigate this further, a colonoscopy could be beneficial. This procedure allows direct visualization of the colon and can help identify any inflammation, polyps, or other abnormalities. Additionally, stool tests can help rule out infections or other gastrointestinal issues.

2. Postprandial Abdominal Distension
The abdominal bloating and pain you experience after eating, along with the X-ray findings of retained stool and gas, suggest that there may be a functional gastrointestinal disorder at play. This could be related to gastric motility issues or food intolerances.
Given that you experience relief after passing gas, it may indicate that your symptoms are related to excess gas production or poor gas evacuation. A dietary review might be helpful, focusing on potential triggers such as lactose, gluten, or high-fiber foods that can exacerbate bloating.

3. Right Upper Quadrant Discomfort
The burning sensation in your right upper abdomen, especially after meals, could be related to several factors. It might be associated with gallbladder issues, such as biliary colic or cholecystitis, particularly if the pain is triggered by fatty meals. However, given your low BMI and recent weight loss, it’s also plausible that your abdominal organs are more prominent, leading to discomfort.

Your history of dieting and the potential for adhesions or gastroesophageal reflux disease (GERD) should also be considered. The fact that you have experienced these symptoms after a period of significant weight loss raises the possibility of gastrointestinal motility disorders or even functional dyspepsia.

Diagnostic Recommendations
1. Colonoscopy: This is crucial for evaluating the colon and ruling out conditions such as IBD or diverticulitis.

2. Upper Endoscopy (EGD): This can help assess the upper gastrointestinal tract for issues like GERD or gastritis.

3. Abdominal Ultrasound: This can evaluate the gallbladder and liver for any abnormalities.

4. CT or MRI: If the symptoms persist and other tests are inconclusive, these imaging modalities can provide a more detailed view of the abdominal organs.

5. Dietary Consultation: Working with a dietitian can help identify food intolerances or dietary habits that may be contributing to your symptoms.

6. Functional Tests: Tests to assess gastric emptying or motility may be warranted if functional disorders are suspected.

Conclusion
Given the complexity of your symptoms and their potential interrelatedness, it is essential to work closely with your healthcare provider to develop a comprehensive diagnostic and treatment plan. Keeping a symptom diary, noting when symptoms occur and their relation to food intake, can also provide valuable insights for your healthcare team. Early intervention and thorough investigation are key to managing your symptoms effectively.

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