Right Upper Abdominal Pain and Dark Brown Stool Causes

Right upper quadrant pain with bloody stools?

I have a slight dull pain in my upper right abdomen, and during bowel movements, I notice some dark brown discoloration (though I don't believe it's blood in the stool).
The doctor tested and found a positive reaction for occult blood (++++), but after undergoing an upper gastrointestinal endoscopy, everything appeared normal.
What could be the cause? Generally, dark brown blood in the stool is mostly associated with the upper gastrointestinal tract, so could there be an issue with my lower gastrointestinal tract? Thank you.

ja, 10~19 year old female. Ask Date: 2005/04/27

Dr. Yuan Hongdao reply Gastroenterology and Hepatology

Hello, in general, bleeding from the stomach, esophagus, or duodenum can cause stools to appear tarry (very dark).
Bleeding from the colon, rectum, or anus typically results in stools that are dark red, bright red, or deep brown, which is considered normal.
A positive fecal occult blood test (if not due to hemorrhoidal bleeding) usually warrants an upper gastrointestinal endoscopy.
If that is normal, a colonoscopy should be performed.
Sometimes, a positive occult blood test can occur after consuming red meat (such as beef), radishes, certain melons, sweet potatoes, or broccoli, but this is relatively uncommon.
It is recommended to avoid these foods for three days and then repeat the fecal occult blood test.
Additionally, a colonoscopy may be considered to rule out any organic lesions.
Dr.
Chen Zhi-Ping, Internal Medicine.

Reply Date: 2005/04/27

More Info

Right upper abdominal pain accompanied by dark brown stool can be concerning, and it’s essential to understand the potential causes and implications of these symptoms. Based on your description, it seems that you are experiencing mild pain in the right upper quadrant of your abdomen, along with dark brown stools and a positive fecal occult blood test.

Potential Causes of Right Upper Abdominal Pain
1. Liver and Gallbladder Issues: Given the location of your pain, conditions related to the liver or gallbladder could be a factor. This includes gallstones, cholecystitis (inflammation of the gallbladder), or liver diseases such as hepatitis. These conditions can cause referred pain to the right upper abdomen.

2. Pancreatitis: Inflammation of the pancreas can also cause pain in the upper abdomen, typically radiating to the back. It can be acute or chronic and may be associated with gallstones or alcohol consumption.

3. Gastrointestinal Disorders: Conditions such as peptic ulcers or gastritis can lead to upper abdominal pain. While these typically cause upper GI bleeding, they can sometimes present with dark stools if bleeding occurs.

4. Musculoskeletal Pain: Sometimes, pain in the upper abdomen can be due to muscle strain or rib issues, especially if there is no accompanying gastrointestinal symptomatology.

Understanding Dark Brown Stool
Dark brown stool can have several causes, and while it can indicate bleeding in the upper gastrointestinal tract, it is not exclusively so. The color can be influenced by:
- Diet: Foods such as beets, black licorice, or iron supplements can darken stool.

- Bile Production: The presence of bile can also affect stool color. If bile is not adequately reaching the intestines, it can lead to darker stools.

- Medications: Certain medications, including those containing iron or bismuth, can darken stool.

Positive Fecal Occult Blood Test
A positive fecal occult blood test indicates the presence of blood in the stool, which can arise from various sources:
- Upper GI Bleeding: As mentioned, this can be due to ulcers or gastritis.

- Lower GI Issues: Conditions such as hemorrhoids, diverticulosis, or colorectal polyps can also cause bleeding.

Diagnostic Considerations
Since you have undergone an upper endoscopy (esophagogastroduodenoscopy, EGD) that returned normal results, it is essential to consider further evaluation of the lower gastrointestinal tract. A colonoscopy may be warranted to assess for potential sources of bleeding in the lower GI tract, especially if you continue to have symptoms or if the stool color changes.

Next Steps
1. Consult a Gastroenterologist: Given your symptoms and the positive fecal occult blood test, it would be prudent to follow up with a gastroenterologist. They may recommend a colonoscopy to rule out any lower GI issues.

2. Monitor Symptoms: Keep track of any changes in your symptoms, including the frequency and severity of the abdominal pain, changes in stool color, or any new symptoms such as nausea, vomiting, or weight loss.

3. Dietary Review: Consider reviewing your diet to identify any foods that may be contributing to the dark stool.
4. Follow-Up Testing: Depending on your gastroenterologist's recommendations, further imaging studies (like an abdominal ultrasound or CT scan) may be necessary to evaluate the liver, gallbladder, and pancreas.

In conclusion, while your symptoms may not immediately indicate a severe condition, the combination of right upper abdominal pain and a positive fecal occult blood test warrants further investigation to rule out any underlying issues. Early diagnosis and treatment are crucial for effective management.

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