Upper Right Abdominal Discomfort: When to See a Neurologist

Q: Upper Right Abdominal Discomfort: When to See a Neurologist

Hello： If there are no structural abnormalities and the ultrasound shows no issues, and there is no significant impact on daily activities, it is generally recommended to observe temporarily to see if the symptoms change, which could provide more clues regarding potential causes.

Sensation of stabbing heat in the right upper abdomen?

Recently, I have been experiencing a tight sensation in the upper right abdomen (approximately from just above the navel to just below the lower edge of the ribs).
Sometimes, it feels warm, and this has persisted for about a month and a half.
At the end of last month, I had an abdominal ultrasound which showed no abnormalities (only mild fatty liver).
Subsequently, I underwent gastroscopy and colonoscopy, and the reports indicated only gastroesophageal reflux disease (GERD) and gastritis, along with the removal of two benign polyps.
The doctor prescribed gastric medication, which I have been taking for about two weeks.
The occasional nausea I previously experienced has disappeared, but I still have intermittent tightness and a prickly heat sensation in the upper right abdomen.

I have noticed a pattern: when I lie flat to rest at night, I almost never feel this discomfort, but during the day while I am active, I frequently experience these sensations.
They come and go, sometimes present and sometimes absent, but they never reach the level of pain; it just feels tight and warm.
"It’s like this every day." After resting, the symptoms tend to lessen, which is quite bothersome.
The hepatobiliary and gastroenterology specialist mentioned that my ultrasound, gastroscopy, and colonoscopy showed no significant issues and suggested that I might consider consulting a neurologist.
I am unsure if it is appropriate to see a neurologist for symptoms like mine.
Thank you.

Liu, 30~39 year old female. Ask Date: 2021/12/24

Dr. Hong Weibin reply Neurology

Hello: If there are no structural abnormalities and the ultrasound shows no issues, and there is no significant impact on daily activities, it is generally recommended to observe temporarily to see if the symptoms change, which could provide more clues regarding potential causes.

Reply Date: 2021/12/24

More Info

When experiencing persistent discomfort in the upper right abdomen, especially after undergoing various diagnostic tests such as ultrasound, gastroscopy, and colonoscopy, it is understandable to feel concerned about the underlying causes. Your symptoms, which include a sensation of tightness and warmth in the upper right abdomen, warrant a thorough evaluation, especially since they have persisted for over a month.

Given that your recent tests have ruled out significant gastrointestinal issues, including fatty liver, gastroesophageal reflux disease (GERD), and benign polyps, it is reasonable to consider other potential causes for your discomfort. The fact that your symptoms seem to improve when lying down suggests that they may be related to postural changes or possibly muscular tension rather than an acute abdominal pathology.

The recommendation from your gastroenterologist to consult a neurologist could be appropriate, particularly if there is a suspicion that your symptoms may have a neurological component. Neurological issues can sometimes manifest as abdominal discomfort, especially if there is nerve involvement or if the discomfort is related to stress or anxiety, which can lead to muscle tension in the abdominal area.

In addition to neurological causes, it is also important to consider musculoskeletal factors. Since you mentioned that the discomfort is less pronounced when you are resting, it could be related to muscle strain or tension in the abdominal wall or surrounding structures. Activities that involve twisting or heavy lifting could exacerbate these symptoms, and a physical examination by a healthcare professional could help determine if this is the case.

Furthermore, your history of benign gastrointestinal issues and the absence of alarming symptoms such as significant weight loss, fever, or changes in bowel habits are reassuring. However, if your symptoms persist or worsen, it is crucial to follow up with your healthcare provider. They may recommend additional imaging studies, such as an MRI or CT scan, to evaluate the abdominal structures more comprehensively if they suspect any underlying conditions that were not visible on previous tests.

In summary, consulting a neurologist could be a reasonable next step, especially if you believe that your symptoms may be related to nerve function or stress. However, it is also essential to keep an open line of communication with your primary care physician or gastroenterologist, who can help coordinate your care and ensure that all potential causes of your symptoms are explored. If you experience any new or worsening symptoms, do not hesitate to seek immediate medical attention. Your health and well-being are paramount, and addressing these concerns with the appropriate specialists will help you find relief and clarity regarding your condition.

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