Persistent Discomfort in the Upper Right Abdomen: Causes and Next Steps

Persistent discomfort in the right upper abdomen?

For the past two months, I have been experiencing a tight, burning sensation in the upper right part of my abdomen (approximately from just above the navel to just below the lower rib margin).
At the end of last month, I had an abdominal ultrasound which showed only mild fatty liver.
Subsequently, I underwent an upper endoscopy and a colonoscopy, and the reports indicated only mild gastroesophageal reflux and gastritis, along with the removal of two benign polyps.
I have been taking the prescribed gastric medication 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 feel this discomfort, but during the day while I am active, I frequently experience this sensation.
It does not reach the level of pain, but it feels tight and warm.
"It happens like this every day." After resting at night, the symptoms lessen, but they recur the next day, which is quite bothersome.
I would like to ask the doctor three questions: 1.
What additional tests should I consider to confirm if there are any other issues? 2.
If I want to undergo a self-paid CT scan, which area should be scanned? 3.
Which other specialty should I consult to clarify the cause of my symptoms? Thank you, doctor.

Ken, 30~39 year old female. Ask Date: 2021/12/25

Dr. Cai Anshun reply Gastroenterology and Hepatology

Hello, since you have already undergone abdominal ultrasound, gastroscopy, and colonoscopy, most diseases in the right upper abdomen can be diagnosed.
You may want to review your dietary habits to see if they are contributing to your gastric discomfort, such as the consumption of caffeinated beverages, alcohol, smoking, sweets, and spicy or fried foods.
Additionally, high stress levels or poor posture may cause abdominal pressure.
A chest and abdominal CT scan can evaluate the right lower lobe of the lung or the pancreas (which is more difficult to assess with ultrasound).
Changhua Hospital cares about your health.
Dr.
Tsai An-Shun.

Reply Date: 2021/12/25

More Info

Persistent discomfort in the upper right abdomen can be concerning, especially given your history of gastrointestinal issues and the recent findings from your ultrasound, endoscopy, and colonoscopy. Based on the information you've provided, let's address your questions and provide some insights into potential causes and next steps.

1. Further Investigations: Given that your recent tests have shown mild fatty liver, gastroesophageal reflux disease (GERD), and gastritis, it's essential to consider other potential causes for your discomfort. Since you experience a tight, burning sensation primarily during the day and not at night, this could suggest a functional gastrointestinal issue, such as a motility disorder or even stress-related symptoms. However, it’s also crucial to rule out any other underlying conditions. You might consider discussing with your physician the possibility of additional imaging studies, such as a CT scan of the abdomen, which can provide a more detailed view of the liver, gallbladder, pancreas, and other abdominal organs.
2. CT Scan Recommendations: If you decide to pursue a CT scan, it would be advisable to focus on the abdomen, specifically the upper abdomen. This area includes the liver, gallbladder, pancreas, and the duodenum, which can help identify any structural abnormalities, inflammation, or other issues that might not have been visible on the ultrasound. Additionally, if there is any concern about the gallbladder, such as gallstones or sludge, a CT scan can provide valuable information.

3. Specialist Consultations: Given the complexity of your symptoms, it may be beneficial to consult with a gastroenterologist, who specializes in digestive system disorders. They can provide a comprehensive evaluation and may recommend further testing, such as a gastric emptying study if a motility disorder is suspected. If your symptoms persist despite treatment, a referral to a hepatologist (liver specialist) might also be warranted, especially considering your mild fatty liver diagnosis.

Additional Considerations
- Lifestyle Factors: Since you mentioned that your symptoms are less pronounced when lying down, consider evaluating your daily activities, diet, and stress levels. Sometimes, dietary triggers (like fatty foods, caffeine, or spicy foods) can exacerbate symptoms of GERD or gastritis. Keeping a food diary may help identify any correlations between your diet and symptoms.

- Medication Review: Ensure that the medications you are taking for your gastritis and GERD are being taken as prescribed. Sometimes, medications can take time to fully alleviate symptoms, and adjustments may be necessary.

- Functional Disorders: It’s also worth noting that functional gastrointestinal disorders, such as functional dyspepsia or irritable bowel syndrome (IBS), can present with similar symptoms. These conditions often require a different approach to management, focusing on dietary changes, stress management, and sometimes medications that target gut motility or visceral hypersensitivity.

In summary, while your recent tests have ruled out some serious conditions, the persistence of your symptoms warrants further investigation. A CT scan of the abdomen focusing on the upper region, along with a consultation with a gastroenterologist, would be prudent next steps. Additionally, consider lifestyle modifications and a thorough review of your current medications to optimize your treatment plan. Always communicate openly with your healthcare provider about your symptoms and concerns to ensure a comprehensive approach to your health.

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