Persistent Pain Near Ribs: Possible Gastrointestinal Issues

Persistent pain near the ribs?

At the beginning of the month, I was diagnosed with pancreatitis at the hospital after blood tests indicated inflammation.
However, it has been a month, and there has been no improvement.
I have been trying to maintain a light diet, but the pain in my upper left abdomen near the rib cage has been getting worse.
Recently, I noticed what seems to be a hard lump, and I also experience pain in my left shoulder.
Coughing is quite painful as well.
I used to have bowel movements 2 to 3 times a day, but now I am experiencing constipation.
My appetite has decreased, but I do not feel nauseous or have the urge to vomit; I just feel pain when I take deep breaths.

Wang Xiaoxi, 30~39 year old female. Ask Date: 2022/02/02

Dr. Lin Minghui reply Gastroenterology and Hepatology

Hello, a 31-year-old female is experiencing persistent pain near the rib cage.
She has a history of pancreatitis, which can be commonly caused by factors such as alcohol consumption, gallstones, bile duct stones, autoimmune diseases, hypertriglyceridemia, and certain medications.
Symptomatic treatment is necessary to prevent recurrence of symptoms.
Complications of pancreatitis include abdominal pain, pancreatic necrosis, intra-abdominal infection, bowel obstruction, pleural effusion and infection, and the formation of pancreatic pseudocysts.
Chronic pancreatitis can lead to complications such as obstructive jaundice and worsening abdominal pain due to bile duct obstruction, as well as infection of pancreatic pseudocysts.
If the pancreas experiences repeated inflammation over time, there is an increased risk of pancreatic cancer.
Pain in the left upper abdomen near the rib cage, which worsens with deep breathing and coughing, should be evaluated if symptoms persist.
It is advisable to seek outpatient medical attention to assess for any complications of pancreatitis or other underlying causes.
Wishing you health and safety! Sincerely, Dr.
Ming-Hui Lin, Attending Physician, Department of Gastroenterology, Taoyuan General Hospital, Ministry of Health and Welfare.

Reply Date: 2022/02/02

More Info

Persistent pain near the ribs, especially after a recent episode of pancreatitis, can be concerning and may indicate underlying gastrointestinal or other systemic issues. Given your symptoms, it is essential to consider several factors that could contribute to your discomfort.

Firstly, the pain you are experiencing in the left upper abdomen near the ribs could be related to the pancreas, especially since you mentioned a recent episode of pancreatitis. Pancreatitis can lead to inflammation and irritation of surrounding tissues, which may cause persistent pain. If the inflammation has not resolved, it could explain why you are still experiencing discomfort a month later. Additionally, the presence of a hard lump could indicate a localized area of inflammation or even a pseudocyst, which can occur as a complication of pancreatitis.

The pain radiating to your left shoulder and worsening with coughing could suggest referred pain, which is common in conditions affecting the diaphragm or the upper abdominal organs. The diaphragm shares nerve pathways with the shoulder, so irritation in the upper abdomen can manifest as shoulder pain. This is particularly relevant if there is ongoing inflammation or irritation in the area.

Your change in bowel habits, from regular bowel movements to constipation, is also noteworthy. Constipation can result from several factors, including dietary changes, decreased physical activity, or even the pain itself leading to a reluctance to eat or drink adequately. The fact that you are experiencing a decreased appetite may further exacerbate this issue. It is crucial to maintain adequate hydration and fiber intake to help alleviate constipation.

Given your symptoms, it is advisable to follow up with your healthcare provider for further evaluation. They may recommend imaging studies, such as an abdominal ultrasound or CT scan, to assess the pancreas and surrounding structures for any complications, such as fluid collections or masses. Additionally, blood tests to check for markers of inflammation or pancreatic function may be warranted.

It is also essential to consider other potential causes of your symptoms. Conditions such as gastritis, peptic ulcers, or even gallbladder disease could present with similar symptoms. A thorough evaluation by a gastroenterologist may be beneficial to rule out these possibilities.

In summary, your persistent pain near the ribs, especially following pancreatitis, warrants further investigation. The presence of a hard lump, shoulder pain, changes in bowel habits, and decreased appetite are all significant symptoms that should be addressed. Please consult your healthcare provider for a comprehensive evaluation and appropriate management. It is crucial to address these symptoms promptly to prevent any potential complications and to improve your overall quality of life.

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