Intermittent Right Lower Rib Pain: When to Consult a Gastroenterologist?

Intermittent pain in the right lower rib area?

Hello Doctor, my father has stage I lung adenocarcinoma and early-stage hypertension (with a systolic blood pressure of about 130).
He underwent a right upper lobectomy at the end of December last year, and a follow-up low-dose computed tomography (LDCT) scan in early October this year was normal.
However, starting in November, he has been experiencing intermittent pain in the lower right rib area; the pain is not constant and occurs occasionally as sharp pain.
Seven years ago, he had 1/3 of his stomach removed.
In early December, his surgeon arranged for regular gastroscopy, which showed mild gastric and duodenal ulcers.
In mid-December, he also had an abdominal ultrasound at the clinic to rule out gallstones and kidney issues (the doctor did not specifically mention the liver).
I would like to ask if it is advisable for him to consult a hepatobiliary and gastroenterology specialist?

Zhua, 20~29 year old female. Ask Date: 2023/12/16

Dr. Chen Shidian reply Gastroenterology and Hepatology

If pain persists after taking gastric medication, a referral to a gastroenterologist may be considered.

Reply Date: 2023/12/16

More Info

When it comes to intermittent right lower rib pain, especially in the context of your father's medical history, it is essential to approach the situation with careful consideration. Given that your father has a history of lung cancer and has undergone significant surgeries, including a partial gastrectomy, it is prudent to consult a gastroenterologist for further evaluation.

The intermittent nature of the pain can be indicative of several underlying issues. Since your father has previously been diagnosed with mild gastric and duodenal ulcers, it is possible that the pain could be related to these conditions. Ulcers can cause referred pain, and discomfort in the rib area may be a manifestation of gastrointestinal distress. Additionally, the fact that he has had a partial gastrectomy could lead to changes in digestion and absorption, potentially resulting in discomfort.

Moreover, the recent history of lung surgery raises the possibility of referred pain from thoracic structures or even post-surgical complications. While the LDCT scan showed normal results, it is important to remember that some issues may not be visible on imaging studies. Therefore, if the pain persists or worsens, it is advisable to seek further evaluation.

Consulting a gastroenterologist is recommended for several reasons:
1. Comprehensive Evaluation: A gastroenterologist can perform a thorough assessment, including a detailed history and physical examination, to determine the potential causes of the pain. They may recommend additional diagnostic tests, such as an upper endoscopy (EGD) to evaluate the status of the ulcers and check for any complications.

2. Management of Ulcers: If the pain is indeed related to the existing ulcers, the gastroenterologist can provide appropriate management strategies, including medication adjustments or dietary recommendations. This is particularly important since your father has a history of gastrointestinal issues.

3. Assessment of Other Conditions: The gastroenterologist can also evaluate for other potential causes of the pain, such as gallbladder disease, pancreatitis, or even liver issues, especially considering the previous ultrasound did not specifically address the liver.

4. Coordination of Care: Given your father's complex medical history, a gastroenterologist can work collaboratively with his oncologist and primary care physician to ensure that all aspects of his health are being monitored and managed effectively.

In terms of lifestyle and dietary considerations, it may be beneficial for your father to maintain a diet that is gentle on the stomach, avoiding spicy, acidic, or overly fatty foods that could exacerbate ulcer symptoms. Staying hydrated and eating smaller, more frequent meals can also help manage gastrointestinal discomfort.

In conclusion, given your father's medical history and the nature of his symptoms, it is advisable to consult a gastroenterologist. They can provide a comprehensive evaluation and tailored management plan to address the intermittent right lower rib pain and ensure that any underlying issues are appropriately managed. Early intervention can be crucial in preventing complications and improving quality of life.

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