Right Upper Abdomen Discomfort: Liver, Gallbladder, or Nerves?

Dull and distended sensation next to the lower right rib cage?

Hello Doctor: In May of this year, I began to feel a sense of heaviness and bloating near the bottom of my rib cage, sometimes just below the lowest rib (which I believe is the rib junction).
Therefore, in mid-May, I went to Chang Gung Memorial Hospital for a comprehensive health check-up.
The results showed that all liver, gallbladder, and gastrointestinal data, as well as ultrasound and endoscopy, were normal, except for mild fatty liver.
After that, the uncomfortable feeling of heaviness disappeared.
Then in July, I participated in a company health check-up, and in early September, I saw the report indicating that my GPT was 107 (previously it was only 20 at Chang Gung).
However, during June to August, I experienced significant stress and emotional distress in my life, which could potentially explain the drastic change in GPT levels over those two months (in previous years, my company check-ups showed GPT levels below 40).
Subsequently, that feeling of heaviness reappeared, and occasionally I experience a very mild dizziness, but it does not affect my work or daily life.
I personally feel that it might be related to my mood or sympathetic nervous system issues (I would like to ask the doctor if there are sympathetic nerves in the abdominal area).
Based on my description, could you please advise if I might have issues with my liver, gallbladder, or gastrointestinal system, or if this is indeed a problem related to my sympathetic nervous system?

Xiao Xiao, 30~39 year old female. Ask Date: 2010/09/25

Dr. Chen Qifeng reply Gastroenterology and Hepatology

Hello, liver inflammation can lead to abnormal liver function, which may cause a feeling of discomfort or bloating in the upper abdomen; however, in fact, 70% of hepatitis cases are asymptomatic.
Additionally, elevated liver enzymes are one thing, but the most important factor is the underlying cause, particularly whether there is hepatitis B or C.
Wishing you good health, Dr.
Chen Chih-Feng, Taoyuan Hospital, Department of Health.

Reply Date: 2010/09/25

More Info

It sounds like you are experiencing discomfort in the right upper abdomen, which can be concerning, especially given your history as a hepatitis B carrier. The symptoms you describe, including a feeling of pressure or bloating near the lower ribs and fluctuations in liver enzyme levels (GPT), warrant careful consideration.

First, let's address the potential causes of your symptoms. The right upper quadrant (RUQ) of the abdomen houses several important organs, including the liver, gallbladder, and parts of the digestive system such as the duodenum. Discomfort in this area can arise from various conditions:
1. Liver Issues: Given your history of hepatitis B and the recent increase in your GPT levels, it's essential to monitor your liver function closely. Elevated liver enzymes can indicate liver inflammation or damage, which may be due to hepatitis B activity, fatty liver disease, or other factors. While you mentioned having mild fatty liver, this condition can sometimes lead to discomfort, especially if it progresses.

2. Gallbladder Problems: Conditions such as gallstones or cholecystitis can cause pain in the RUQ. Symptoms may include sharp pain, especially after eating fatty meals, and sometimes nausea. If you experience these symptoms, it would be prudent to consult a gastroenterologist.

3. Gastrointestinal Issues: Conditions like gastritis, peptic ulcers, or even functional gastrointestinal disorders can manifest as discomfort in the upper abdomen. Stress and anxiety can exacerbate these conditions, leading to symptoms like bloating and discomfort.

4. Nerve-Related Issues: The autonomic nervous system, which includes the sympathetic nervous system, can influence how we perceive pain and discomfort. Stress and anxiety can lead to heightened sensitivity to bodily sensations, which might explain the bloating and discomfort you are experiencing. The abdomen does have a complex network of nerves, and stress can indeed lead to gastrointestinal symptoms.

Given the fluctuations in your GPT levels and the recent stress in your life, it is possible that your symptoms are multifactorial. Stress can lead to physiological changes that may exacerbate existing conditions, including liver issues. It is also worth noting that emotional well-being can significantly impact physical health, particularly in individuals with chronic conditions.

Recommendations:
1. Follow-Up Testing: Since your GPT levels have risen significantly, I recommend that you follow up with your healthcare provider for further evaluation. This may include additional blood tests to assess liver function, viral load (HBV DNA), and possibly imaging studies if gallbladder issues are suspected.

2. Lifestyle Modifications: Focus on maintaining a healthy lifestyle, including a balanced diet low in saturated fats and sugars, regular exercise, and stress management techniques such as mindfulness or yoga. These can help improve both liver health and overall well-being.

3. Mental Health Support: Given the stress you mentioned, consider seeking support from a mental health professional. Addressing anxiety and stress can have a positive impact on your physical symptoms.

4. Regular Monitoring: As a hepatitis B carrier, it is crucial to have regular check-ups with a hepatologist or gastroenterologist. They can provide tailored advice and monitoring based on your specific health status.

In conclusion, while your symptoms could be related to liver or gallbladder issues, they may also stem from stress and anxiety. A comprehensive approach that includes medical evaluation, lifestyle changes, and mental health support will be beneficial in managing your symptoms and overall health.

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