Upper Right Abdominal Discomfort: Diagnostic Questions and Insights

Questions regarding discomfort in the right upper abdomen?

Recently, I have been experiencing discomfort in the upper right abdomen, specifically three fingerbreadths above the navel and near the lower edge of the rib cage.
There is a daily dull pain accompanied by a strong burning sensation (since November until now), which does not vary before or after meals.
I have undergone gastroscopy, colonoscopy, and ultrasound, all of which showed no abnormalities except for mild gastritis.
After taking medication for one to two months without improvement, I now experience intense pressure and burning pain almost all day.
I am considering undergoing an abdominal MRI and a low-dose chest CT scan.
I would like to ask if the low-dose chest CT can cover all skeletal issues that a regular X-ray can detect, in addition to checking for nodules or lung cancer? Or are there certain conditions, such as lesions in the diaphragm, that can only be detected by X-ray? Thank you, doctor.

Liu, 30~39 year old female. Ask Date: 2022/02/10

Dr. Xiao Yongxun reply Family Medicine

1.
Common diagnoses for right upper quadrant pain include gallstones, gallbladder tumors, liver abscesses, liver tumors, bile duct stones, subdiaphragmatic abscesses, neuropathic pain due to spinal lesions, rib fractures or costal cartilage fractures, duodenal ulcers or gastric ulcers, pancreatitis, pancreatic tumors, duodenal tumors, and right lower lobe pneumonia or tumors, among others; additionally, there are many rare diseases that may also present.

2.
The initial design of low-dose chest computed tomography (CT) was primarily for lung cancer screening and early detection; however, it may occasionally incidentally discover gallstones, liver tumors, pancreatic tumors, etc.
Nevertheless, due to the lack of contrast agents, some tumors or lesions may not be detectable.
3.
Since you have scheduled an abdominal magnetic resonance imaging (MRI) scan, it can complement the limitations of the aforementioned examinations.
4.
As you are using low-dose chest CT and abdominal MRI for screening to identify the cause, rather than seeking evidence for known possible diagnoses, it may still be advisable to have a thorough discussion with your attending physician or family doctor.

Reply Date: 2022/02/10

More Info

Upper right abdominal discomfort can be a complex issue, often requiring a thorough evaluation to determine the underlying cause. Given your symptoms of persistent pain and burning sensation in the upper right abdomen, along with a history of mild gastritis and previous imaging studies showing no significant abnormalities, it is essential to consider a few key points.

Firstly, the location of your discomfort is significant. The area just below the rib cage on the right side is where several important organs are located, including the liver, gallbladder, and parts of the gastrointestinal tract. Since you have a history of gallbladder issues, including previous surgery for gallstones, it is possible that you might be experiencing post-cholecystectomy syndrome, which can manifest as abdominal pain and discomfort due to changes in bile flow or other digestive issues.

Your plan to undergo an abdominal MRI and a low-dose chest CT scan is a prudent step. An MRI can provide detailed images of soft tissues and may help identify any abnormalities in the liver or surrounding structures that were not visible on previous imaging. The low-dose chest CT scan, while primarily aimed at detecting lung nodules or cancers, can also provide some information about the upper abdomen, particularly if there are any masses or abnormalities pressing against the diaphragm or adjacent structures.

Regarding your question about the capabilities of low-dose chest CT versus standard X-rays, it is important to note that while low-dose CT scans can provide more detailed images than X-rays, they are not specifically designed to evaluate bone structures. X-rays are typically better suited for assessing bony abnormalities, such as fractures or degenerative changes. However, a chest CT can incidentally reveal some bony issues, but it may not be as comprehensive as a dedicated skeletal X-ray.

In terms of your ongoing symptoms, if the MRI and CT scans do not reveal any significant abnormalities, further evaluation may be warranted. This could include consultations with specialists such as a gastroenterologist or a hepatologist, who can provide insights into potential functional issues related to your digestive system. Additionally, if there are concerns about your symptoms being related to gastrointestinal motility or functional disorders, tests such as an upper GI series or esophageal motility studies might be considered.

It is also worth considering other potential causes of upper right abdominal pain, such as peptic ulcer disease, pancreatitis, or even referred pain from conditions affecting the spine or diaphragm. Given that you have experienced these symptoms for several months, it is crucial to maintain open communication with your healthcare provider and ensure that all potential causes are thoroughly investigated.

In summary, while your current imaging studies are a good step towards understanding your symptoms, it is essential to continue working closely with your healthcare team to explore all possible avenues for diagnosis and treatment. If your symptoms persist despite negative imaging results, further evaluation and possibly a multidisciplinary approach may be necessary to identify the underlying cause and provide appropriate management.

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