Unexplained Right Upper Abdominal Pain: Causes and When to See a Doctor

Frequent unexplained abdominal pain?

Hello, Dr.
Tsai.
I often experience unexplained pain in my upper right abdomen, which can radiate to my back, and it sometimes wakes me up at night.
I had an endoscopy, and the doctor said everything looks normal.
What could be the cause of this? If I need to see a doctor, which specialty should I consult?

Hsuān, 20~29 year old female. Ask Date: 2011/02/19

Dr. Cai Mengru reply Family Medicine

Dear Hsuan,
Hello, the right upper abdomen is the area of the liver, gallbladder, and part of the ribs.
It is uncommon for a 27-year-old female to have gallstones or cholecystitis.
Diagnosing the condition requires a detailed medical history and physical examination, including the nature of the pain, timing of episodes, frequency, and factors that exacerbate or relieve the symptoms.
The patient's past medical history and occupation may provide clues.
I recommend that you visit our Family Medicine outpatient clinic for further evaluation and examination.
Wishing you health and safety,
Dr.
Kao Ching-Yun
Family Medicine Department
Taoyuan Hospital, Department of Health

Reply Date: 2011/02/19

More Info

Unexplained right upper abdominal pain can be a perplexing issue, especially when it radiates to the back and disrupts your sleep. Given that you've already undergone an endoscopy with normal results, it’s essential to consider other potential causes and the appropriate next steps.

Possible Causes of Right Upper Abdominal Pain
1. Gallbladder Issues: One of the most common causes of right upper abdominal pain is gallbladder disease, particularly gallstones or cholecystitis (inflammation of the gallbladder). Symptoms often include pain after eating fatty meals, nausea, and sometimes jaundice.

2. Liver Conditions: Since the liver is located in the right upper quadrant, conditions such as hepatitis, fatty liver disease, or liver tumors can cause pain in this area. Given your history of chronic hepatitis B, it’s crucial to monitor liver health closely.

3. Kidney Problems: Kidney stones or infections can also manifest as pain in the right upper abdomen, often radiating to the back. Symptoms may include flank pain, hematuria (blood in urine), or changes in urination.

4. Gastrointestinal Disorders: Conditions like peptic ulcers, gastritis, or even functional gastrointestinal disorders can lead to discomfort in the upper abdomen. Although your endoscopy was normal, it’s worth considering that some issues may not be visible during such procedures.

5. Musculoskeletal Issues: Sometimes, pain in the upper abdomen can be referred from musculoskeletal problems, such as muscle strain or rib dysfunction. This is especially relevant if you have a history of physical activity that could lead to strain.

6. Pancreatic Issues: Although less common, pancreatitis can cause pain in the upper abdomen, which may radiate to the back. This is often accompanied by other symptoms like nausea and vomiting.

When to See a Doctor
If your pain persists, worsens, or is accompanied by other concerning symptoms such as fever, jaundice, significant changes in appetite, or unexplained weight loss, it is crucial to seek medical attention. Given the complexity of abdominal pain, it may be beneficial to consult with a specialist.

Which Specialist to See?
1. Gastroenterologist: Since your symptoms are primarily abdominal, a gastroenterologist would be the most appropriate specialist to evaluate your condition further. They can perform additional tests, such as imaging studies (ultrasound, CT scan) or laboratory tests to assess liver function and check for gallbladder issues.

2. Hepatologist: Given your history of chronic hepatitis B, a hepatologist may also be beneficial. They specialize in liver diseases and can provide targeted care and monitoring.

3. Pain Management Specialist: If the pain is chronic and significantly affects your quality of life, a pain management specialist may help in developing a comprehensive pain management plan.

Conclusion
In summary, unexplained right upper abdominal pain can stem from various causes, including gallbladder, liver, kidney, gastrointestinal, or musculoskeletal issues. Since your endoscopy results were normal, it’s essential to explore other diagnostic avenues. Consulting a gastroenterologist or hepatologist would be a prudent next step to determine the underlying cause of your pain and develop an appropriate treatment plan. Remember, persistent or severe symptoms warrant prompt medical evaluation to rule out serious conditions.

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