Upper Abdominal Pain Near Ribs: Causes and Next Steps - Gastroenterology and Hepatology

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Upper abdominal pain, especially near the ribs, can be quite distressing and may arise from a variety of causes. Given your description of the pain being symmetrical and more pronounced when sitting, along with the absence of significant findings from previous examinations such as colonoscopy and upper endoscopy, we can explore several potential causes and next steps.


Possible Causes of Upper Abdominal Pain
1. Musculoskeletal Issues: Since you mentioned that the pain is more noticeable when sitting, it could be related to muscle strain or tension in the abdominal or intercostal muscles. Poor posture, prolonged sitting, or even stress can lead to muscle tightness, which may manifest as sharp or stabbing pain.

2. Gastrointestinal Issues: Although your previous tests (colonoscopy and endoscopy) did not reveal any significant issues, conditions such as functional dyspepsia or irritable bowel syndrome (IBS) could still be at play. These conditions can cause discomfort and pain in the upper abdomen, often associated with bloating or changes in bowel habits.

3. Gallbladder Issues: The presence of gallstones or "biliary sludge" (as indicated by your ultrasound) can lead to intermittent pain, especially after meals. While you may not have had gallbladder attacks recently, it’s worth considering that gallbladder-related pain can sometimes be less pronounced and may not always correlate with visible stones.

4. Liver Conditions: Fatty liver disease, which you mentioned, can sometimes cause discomfort in the upper abdomen. While it is often asymptomatic, inflammation or other liver-related issues could contribute to your symptoms.

5. Psychosomatic Factors: Stress and anxiety can manifest physically, leading to muscle tension and abdominal pain. If your healthcare providers have suggested that stress might be a contributing factor, it may be beneficial to explore stress management techniques or counseling.


Next Steps
1. Consult a Specialist: Given that you have seen multiple general practitioners without a definitive diagnosis, it may be beneficial to consult a specialist. A gastroenterologist can provide further insights into gastrointestinal issues, while a musculoskeletal specialist or physical therapist can assess for muscle-related problems.

2. Imaging Studies: If you haven't already, consider discussing further imaging studies such as an MRI or CT scan of the abdomen to rule out any underlying structural issues that may not have been visible on ultrasound.

3. Physical Therapy: If a musculoskeletal issue is suspected, physical therapy may help alleviate pain through targeted exercises and stretches. A physical therapist can also provide guidance on posture and ergonomics.

4. Stress Management: If stress is a contributing factor, consider incorporating relaxation techniques such as yoga, meditation, or deep-breathing exercises into your routine. Cognitive-behavioral therapy (CBT) can also be effective in managing anxiety and stress-related symptoms.

5. Follow-Up Testing: If symptoms persist, further tests such as liver function tests, additional imaging, or even a referral to a pain management specialist may be warranted.


Conclusion
In summary, upper abdominal pain near the ribs can stem from a variety of causes, including musculoskeletal issues, gastrointestinal conditions, and psychosomatic factors. Given your previous evaluations and the ongoing nature of your symptoms, it would be prudent to seek further evaluation from a specialist who can provide a more targeted approach to diagnosis and treatment. Addressing any potential stressors and considering physical therapy may also be beneficial in managing your symptoms. Always ensure to communicate openly with your healthcare providers about your concerns and the impact of your symptoms on your daily life.