Chronic Right Upper Abdomen Discomfort: Causes and Solutions

Persistent discomfort in the right upper abdomen?

Hello, doctor.
I have been experiencing discomfort in my upper right abdomen for a long time (about 5 to 7 years), which feels like abdominal pain, bloating, and even muscle cramps that extend to my back, causing back pain.
Sometimes, during an episode, when I press on my abdomen, it feels hard.
Each time I experience pain, I take medications like Jin Shizi to relieve gas and stomach pain, but they are completely ineffective.
The pain is so severe that I can't sit or stand comfortably, and it even wakes me up at night.
At its worst, it feels like a rod is piercing through my upper right abdomen.
I have had blood tests, abdominal ultrasounds, and a colonoscopy, and the doctors have all said that everything appears normal.
However, I experience pain at least once every 3 to 6 months, and occasionally, I have pain two to three times in a week, with each episode lasting for two days.
Eating exacerbates the pain, and not eating leaves me hungry.
This is really troubling, and I am unsure where to turn next for medical help.
Thank you.

Miss Yan, 20~29 year old female. Ask Date: 2015/09/15

Dr. Lin Minghui reply Gastroenterology and Hepatology

Hello, it is recommended to schedule an upper gastrointestinal endoscopy with Dr.
Lin Ming-Hui, attending physician of the Gastroenterology Department at Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2015/09/15

More Info

Chronic discomfort in the right upper abdomen can be a perplexing issue, especially when it has persisted for several years without a clear diagnosis. Given your symptoms of abdominal pain, bloating, and discomfort that sometimes radiates to your back, it is essential to consider various potential causes and management strategies.

Firstly, the right upper quadrant of the abdomen houses several vital organs, including the liver, gallbladder, pancreas, and parts of the intestines. Discomfort in this area can stem from issues related to any of these organs. Since you have undergone blood tests, abdominal ultrasound, and colonoscopy with normal results, it may be beneficial to explore other conditions that might not be easily detectable through these standard tests.

1. Functional Gastrointestinal Disorders: Conditions such as Irritable Bowel Syndrome (IBS) or Functional Dyspepsia can cause chronic abdominal discomfort. These disorders often do not show any structural abnormalities on imaging or lab tests but can lead to significant symptoms, including pain, bloating, and changes in bowel habits. A gastroenterologist specializing in functional disorders may provide insights and management options.

2. Gallbladder Issues: Even if your ultrasound did not reveal gallstones, gallbladder dysfunction (such as biliary dyskinesia) can cause similar symptoms. This condition occurs when the gallbladder does not empty properly, leading to pain after eating, particularly fatty meals. A HIDA scan can assess gallbladder function more accurately.

3. Musculoskeletal Pain: Given that your pain sometimes feels like a muscle cramp and radiates to your back, it could be related to musculoskeletal issues. Conditions such as costochondritis or muscle strain can mimic abdominal pain. A physical examination by a healthcare provider may help identify if your discomfort is musculoskeletal in nature.

4. Pancreatitis: Although your tests may not have indicated this, chronic pancreatitis can cause recurrent abdominal pain. This condition can sometimes be subtle and may require specific imaging or tests to diagnose.

5. Dietary Factors: Consider keeping a food diary to identify any potential food triggers that may exacerbate your symptoms. Certain foods can lead to bloating and discomfort, especially if you have food intolerances or sensitivities.

6. Stress and Anxiety: Psychological factors can significantly impact gastrointestinal health. Chronic stress and anxiety can lead to or exacerbate gastrointestinal symptoms. Consulting with a mental health professional or a gastroenterologist who understands the gut-brain connection may be beneficial.

7. Referral to a Specialist: If your current healthcare provider has not been able to provide relief, consider seeking a second opinion from a gastroenterologist or a pain specialist. They may offer different diagnostic approaches or treatment options, including medications, dietary changes, or even alternative therapies.

In terms of management, since over-the-counter medications have not provided relief, it may be worthwhile to explore prescription medications that target specific symptoms, such as antispasmodics for cramping or medications that address motility issues. Additionally, lifestyle modifications, including dietary changes, regular exercise, and stress management techniques, can also play a crucial role in alleviating symptoms.

In conclusion, chronic right upper abdominal discomfort can arise from various causes, and a multidisciplinary approach may be necessary for effective management. It is essential to communicate openly with your healthcare providers about your symptoms and concerns, as this will help guide further evaluation and treatment.

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