Which Specialist Should I See for Right Upper Abdomen Discomfort?

Not sure which specialty to see?

Hello, doctor.
I have been experiencing discomfort in my upper right abdomen (not a constant pain, nor a sharp pain) for almost two years.
It feels like there is something inside, and occasionally pressing on the right upper rib causes pain.
I consulted a hepatobiliary and gastroenterology specialist, who said it is not related to my liver (I have a history of hepatitis B) and suggested I see a neurologist and a rehabilitation specialist.
Recently, my CA-125 level was 47 during a health check.
Could this have any implications? Additionally, which specialty should I consult for the discomfort in my upper right abdomen?

Xiangjiao, 50~59 year old female. Ask Date: 2023/04/21

Dr. Lin Wuxuan reply Internal Medicine

Hello, 1.
The CA125 level is 47; it is recommended to follow up with a gynecologist.
2.
For upper abdominal pain and rib pain, if liver, gallbladder, and gastrointestinal diseases have been ruled out, it is advisable to consult a cardiologist for further evaluation.
Thank you.

Reply Date: 2023/04/21

More Info

When experiencing discomfort in the right upper abdomen, especially if it has persisted for nearly two years, it is essential to approach the situation methodically. Given your symptoms and the fact that you have a history of hepatitis B, it is prudent to consider several factors before determining the appropriate specialist to consult.

Firstly, the right upper abdomen houses several vital organs, including the liver, gallbladder, pancreas, and parts of the intestines. Since you have already consulted a hepatologist or a gastroenterologist who ruled out liver-related issues, it may be beneficial to explore other potential causes of your discomfort. The recommendation to see a neurologist and a rehabilitation specialist suggests that there may be a consideration of nerve-related issues or musculoskeletal problems contributing to your symptoms.

The CA-125 test you mentioned, which returned a value of 47, is primarily used as a tumor marker for ovarian cancer but can also be elevated in other conditions, including endometriosis, pelvic inflammatory disease, and even benign conditions. While an elevated CA-125 level can be concerning, it is not definitive for cancer, and further evaluation is necessary to understand its significance in your case. It is crucial to discuss this result with your healthcare provider, as they may recommend additional imaging studies, such as an ultrasound or CT scan, to investigate further.

Given your situation, I would recommend the following steps:
1. Consult a Gastroenterologist: Since your discomfort is in the upper abdomen, a gastroenterologist can perform a thorough evaluation of your digestive system. They may recommend imaging studies or endoscopic procedures to rule out any gastrointestinal issues that may not have been previously considered.

2. See a Neurologist: If your discomfort is suspected to be related to nerve issues, a neurologist can assess for conditions such as neuropathy or nerve entrapment that could be causing referred pain or discomfort in the abdominal area.

3. Consider a Gynecologist: Given the elevated CA-125 level, it may be wise to consult a gynecologist, especially if there are any gynecological symptoms present. They can evaluate for any potential issues related to the reproductive organs that could be contributing to your abdominal discomfort.

4. Follow-Up on CA-125: Discuss the implications of your CA-125 result with your primary care physician or the specialist you choose to see. They may recommend further testing or monitoring to determine the cause of the elevation.

5. Physical Therapy or Rehabilitation: If musculoskeletal issues are suspected, a rehabilitation specialist or physical therapist can provide exercises and treatments to alleviate discomfort and improve function.

In summary, while your right upper abdomen discomfort has been evaluated by a gastroenterologist, further exploration with a neurologist, gynecologist, and possibly a rehabilitation specialist may provide a more comprehensive understanding of your symptoms. It is essential to communicate openly with your healthcare providers about your concerns, symptoms, and the significance of your CA-125 levels to ensure a thorough and effective evaluation.

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