Persistent Tightness and Heat in the Upper Right Abdomen: What to Do?

Persistent tightness and heat sensation in the upper right abdomen?

Recently, I have been experiencing a tight sensation in the upper right abdomen (approximately from above the navel to just below the rib cage) that sometimes feels warm.
This has persisted for about a month and a half.
At the end of last month, I had an abdominal ultrasound that showed no abnormalities, except for mild fatty liver.
Subsequently, I underwent both an upper endoscopy and a colonoscopy, which revealed only gastroesophageal reflux disease (GERD) and gastritis, along with the removal of two benign polyps.
I have been taking the prescribed medication for my stomach for about two weeks now, and the occasional nausea I previously experienced has disappeared.
However, I still occasionally feel a tight, burning sensation in the upper right abdomen.

I have noticed a pattern: when I lie down to rest at night, I almost never experience this discomfort, but during the day while I am active, it frequently occurs.
The sensations are intermittent; sometimes they are present, sometimes they are not, and they never reach the level of pain, but I do feel tightness and warmth.
"It happens like this every day." After resting, the symptoms tend to lessen, which is quite bothersome.
I am unsure if I need to undergo any further tests to rule out other issues.
If I were to consider a self-paid CT scan, which area should I focus on? Thank you.

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

Dr. Hou Angting reply Family Medicine

Hello, regarding your discomfort in the upper right abdomen, it is recommended that you consult with a hepatobiliary and gastroenterology specialist to discuss the necessary examinations.
Wishing you good health.

Reply Date: 2021/12/24

More Info

It sounds like you're experiencing persistent discomfort in the upper right abdomen, characterized by tightness and a sensation of heat. Given that you've already undergone several diagnostic tests, including an abdominal ultrasound, gastroscopy, and colonoscopy, which have ruled out significant abnormalities aside from mild fatty liver, gastroesophageal reflux disease (GERD), and benign polyps, it's understandable that you're feeling frustrated and concerned about your ongoing symptoms.

The sensations you're describing—tightness and heat—could be attributed to several factors. Since your symptoms seem to improve when you're lying down and worsen during the day with activity, this might suggest a few possibilities:
1. Muscle Tension: Stress and anxiety can lead to muscle tension in the abdominal area, which may manifest as tightness. If you're experiencing stress, it could be contributing to your symptoms. Consider incorporating relaxation techniques, such as deep breathing exercises, yoga, or mindfulness meditation, to help alleviate tension.

2. Gastrointestinal Issues: Since you have a history of GERD and gastritis, it's possible that your symptoms are related to these conditions. GERD can cause discomfort that may feel like tightness or heat, especially after eating or during physical activity. Ensure you're following dietary recommendations to manage GERD, such as avoiding spicy foods, caffeine, and large meals.

3. Fatty Liver: While mild fatty liver is often asymptomatic, it can sometimes contribute to discomfort in the upper right abdomen. Maintaining a healthy diet, regular exercise, and avoiding alcohol can help manage this condition.

4. Visceral Sensitivity: Some individuals have heightened sensitivity to sensations in the abdominal area, which can lead to discomfort even in the absence of significant pathology. This can be exacerbated by anxiety or stress.

5. Gallbladder Issues: Although your ultrasound did not indicate any gallbladder problems, gallstones or inflammation can sometimes cause similar symptoms. If your discomfort persists, it may be worth discussing this possibility with your healthcare provider.

Regarding further investigations, if you are considering a CT scan, it would be advisable to focus on the abdomen, specifically the upper abdomen, to evaluate the liver, gallbladder, and any potential issues with the pancreas or other structures. However, before proceeding with any additional imaging, it's essential to discuss your ongoing symptoms with your healthcare provider. They can help determine whether further testing is necessary based on your clinical history and current symptoms.

In the meantime, keeping a symptom diary may help identify any patterns or triggers associated with your discomfort. Note when the symptoms occur, their intensity, and any activities or foods that may correlate with the onset of symptoms. This information can be valuable for your healthcare provider in determining the next steps in your evaluation and management.

Lastly, if you find that your symptoms are significantly impacting your quality of life or causing you distress, don't hesitate to reach out to your healthcare provider for support. They can offer guidance on managing your symptoms and may refer you to a specialist if needed. Remember, it's important to advocate for your health and seek the care you need.

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