Upper Right Abdominal Discomfort: Causes and Next Steps - Pulmonology

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Understanding upper right abdominal discomfort can be quite complex, especially given the variety of potential causes. Based on your description, it seems that you have been experiencing a persistent sensation of tightness and warmth in the upper right abdomen for about a month and a half. You have undergone several diagnostic tests, including an abdominal ultrasound, gastroscopy, and colonoscopy, which have revealed some benign conditions but no significant abnormalities aside from mild fatty liver, gastroesophageal reflux disease (GERD), and gastritis.

The symptoms you describe—tightness and a warm sensation—can be attributed to several factors. Given that these sensations are more pronounced during the day and lessen when you lie down, it may suggest that they are related to physical activity or posture. Here are some potential explanations for your symptoms:
1. Muscle Strain or Tension: If you have been more active during the day, it is possible that the discomfort is due to muscle strain or tension in the abdominal wall or diaphragm. This can lead to sensations of tightness or discomfort, especially if you are engaging in activities that involve twisting or heavy lifting.

2. Visceral Pain: The organs in the upper right abdomen include the liver, gallbladder, and parts of the intestines. Conditions affecting these organs, such as mild inflammation or irritation, can sometimes manifest as discomfort or a sensation of tightness. Even though your ultrasound did not show significant abnormalities, mild conditions can still cause discomfort.

3. Gastroesophageal Reflux Disease (GERD): Since you have been diagnosed with GERD, it is possible that acid reflux could contribute to your symptoms. GERD can cause discomfort in the upper abdomen and chest, especially after meals or when lying flat.

4. Psychosomatic Factors: Anxiety and stress can also manifest as physical symptoms, including abdominal discomfort. If you are experiencing anxiety, it could exacerbate your perception of discomfort.

Given that your symptoms have persisted despite previous evaluations, it may be worthwhile to consider further diagnostic imaging. A CT scan can provide a more detailed view of the abdominal organs and may help identify any subtle issues that were not visible on ultrasound. If you decide to pursue a CT scan, it is generally advisable to perform an abdominal CT scan, which will cover the area of concern. A chest CT can be done separately if there are specific concerns regarding the thoracic cavity.

In terms of whether to do a combined chest and abdominal CT scan, this is often possible, but it depends on the specific protocols of the imaging facility. Discussing this with your healthcare provider can help determine the best approach based on your symptoms and medical history.

Lastly, it is essential to maintain open communication with your healthcare provider regarding your symptoms. If the discomfort persists or worsens, or if you develop new symptoms such as significant pain, changes in bowel habits, or weight loss, you should seek further evaluation promptly. Keeping a symptom diary that tracks when the discomfort occurs, its intensity, and any associated activities can also be helpful for your healthcare provider in diagnosing the issue.

In conclusion, while your symptoms may not indicate a severe underlying condition, they warrant further investigation to ensure that no significant issues are overlooked. Your proactive approach to your health is commendable, and continuing to seek answers will help you find relief.