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Having upper abdominal pain. Ultrasound showed not enlarged liver. Is there any complication?

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General Surgeon
Practicing since : 2008
Answered : 5376 Questions
Hello Doctor i been having right upper quadrant pain with 3 weeks my doc said he thought it was muscular after physical exam so i went to a second doc who examined me also and is sending me for ultrasound of the upper abdomen around my liver area she says by physical exam she didnt feel that it was enlarged is this a good sign ? What liver related prob could be causing the flank pain ? I know my doc is only ruling things out i did have hodgkins in 2005 in remission since 2006 but i have myself panicked now because if this pain i am so worried , i dont have jaundice but suffer loose bowel movement after eating certain things although at present my appetite is not good at all , my doc asked the ultrasound person in a letter to look for hepatic lesions ? Would this indicate something suspicious ? I am ill with worry , is it a good sign if the liver doesnt seem enlarged by physical exam she also did a lot of "tapping" in that area what was that for? Thanks for your help
Posted Tue, 23 Apr 2013 in Abdominal Pain
Answered by Dr. Grzegorz Stanko 30 minutes later

Thank you for the query.

Right upper abdominal pain is usually caused by gallstones or peptic ulcer. Pancreas disease can also give such symptom. Large intestine is located in the close neighborhood of the liver and sometimes pain from it can be present in this area.
Not enlarged liver means that it has regular size so this is a very good sign. Liver when healthy should not be present below the ribs.
Any liver tumor or lesion usually does not give any pain at all (especially in the early stage). And before the pain, jaundice appears, so you should not be worry about any lymphoma or cancer.
Ultrasound is pretty good to rule out any lesions in liver (like cysts, abscesses or tumors) and if any will be present, it should be visualized in the ultrasound. And if any lesion will appear (except the cyst), biopsy will be necessary. But like I have said before, liver lesions does not give pain at all.
Ultrasound will also tell if there are any stones int eh gallbladder or bile ducts.

Tapping in the liver area is a part of regular physical exam, and if you find it painful, gallstones are most probable.

So once again, please do not worry, cancer usually does not hurt. It is something less serious if it hurts.

Hope this will help. Feel free to ask further questions.
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Follow-up: Having upper abdominal pain. Ultrasound showed not enlarged liver. Is there any complication? 19 hours later
Thank you for your answer Doctor I just wanted to say I don't have a gall bladder it was removed in 1986 I find that the less I eat the better I feel but of course that won't do but I know for my own sake I am not eating anything with gluten in it as I feel it doesn't suit me, even though doc says I am not coeliac because I had blood test I do get diarrhoea from time to time though, it's worrying that my appetite is going or is this my anxiety I am worried about the liver pancaras area even though your answer indicates that when the liver isn't enlarged its a good sign I know I only have to wait till sat to have ultrasound but my anxiety sometimes gets the better of me I also notice when I go to bed with hot water bottle if I have the pain I put the heat on the opposite side and it eases,can liver pain ease with heat ??
Answered by Dr. Grzegorz Stanko 3 hours later
Heat generally helps with pain due to smooth muscles relaxation. So this means that your pain is caused by muscles spasm. Liver itself generally does not cause pain. In great majority of cases bile ducts (or gallbladder) and liver ducts are the structures causing pain in case of some disease.
If it is about the cancer, it causes pain when affects nerves fibers. Such pain can not be eased with heat. So this means your pain is not cancer related.
Lack of appetite can indicate either bile ducts problems or stomach problem (usually peptic ulcer). In both conditions, heat will be helpful.
I know anxiety is hard to deal with, but I hope you will find my answers a bit helpful.
Just note that if ultrasound wont give any answer, upper GI endoscopy will be necessary.

Hope this will help.
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Follow-up: Having upper abdominal pain. Ultrasound showed not enlarged liver. Is there any complication? 2 hours later
Hello again Doctor
Thanks for your replies, much appreciated, I am not sure if I have said in my last email to you or not about the yellow colour on the bathroom paper after Bowel movement, I eat only 2 slices of dry gluten free bread today and drank 2 Actimel probiotics to make it easy on my tummy and I have been in the bathroom all evening, the reason I use gluten free bread is because I find that anything containing gluten doesnt suit me anyway. Admittedly it is not a lot of feceas(spelling)when I go to toilet but it is quite loose, what causes this when I am not eating?? At this stage this side pain has been going on a month, I had a major panic attack this evening. Thanks again Dr for your patience and support I am very interested in trying to narrow down the symptoms to prevent myself from getting over anxious as with me as you know its all about the FEAR of the return of the dreaded C word
Answered by Dr. Grzegorz Stanko 13 minutes later
Even if you are not eating, the bile, stomach acid, pancreas acid are secreted to the intestine. The food you have eaten 3 days ago, can still be present in the intestines as well. Moreover, intestines do produce mucus. Intestines cells are also very active so the new ones are migrating to the surface and the old ones are excreted with the stool. All this together can create a stool even without eating.
Yellow color is caused by bile present in the stool. This is quite normal. However if the stool passage is accelerated or the bile secretion is increased, there will be more bile in the final stool.
So still no reason to panic and thinking about the C.
Such stool can point to bile ducts problem. Pancreas inflammation can also cause such stools. And so is anxiety (brain can stimulate intestines and it does when stress appears).
Ultrasound is a good start in you path to proper diagnose. Next step should be liver tests (AST,ALT, GGTP), amylase and lipase. If nothing will be found, stool tests might be helpful as sometimes also severe bacterial infection can give loose motions (however it does not give such located abdominal pain).

You should try some anxiety treatment as well. Nowadays we do have great medicines (called SSRI) which can greatly improve your life comfort. And this comfort is extremely important for proper organism function (including abdomen).

Hope this will help.
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Follow-up: Having upper abdominal pain. Ultrasound showed not enlarged liver. Is there any complication? 1 hour later
Hello again Dr
Thank you for your great replies, you must think me a very anxious over reacting person, I will give you list of my meds including the dr just putting me on 2 Xanax a day and wants to UP my Prozac from 40mg to 60mg I not sure this is a lot of Prozac to be dealing with. I am on GLucophage 3 a day for diabtes, Lipitor , Elotroxin, Nexium, 1 nuseal aspirin 75mg (sometimes I blame that for the pain) but here i am diagnosing myself again, its going on so long, I am scared Also I am in XXXXXXX the doctors wont give too much Xanax to people as they say "they are addictive" I dont have my own transport and the local councelling office told me there was a waiting list to be seen for EIGHT weeks. I am just drained from it all Dr
Answered by Dr. Grzegorz Stanko 8 hours later

I know what anxiety is, I really do. And how hard is it to deal with it day by day.
Here is what comes to my mind with your medicines list.
Prozac is quite old medicine, seems to be more famous than effective. As you still have some fear attacks Prozac seems to be partially ineffective for you. That is why I suggest you to discuss with your doctor (if possible) about changing it to Sertaline (less side effects, can be more effective with anxiety) instead of Prozac dose increasing. Just note that it takes about 2 weeks before Sertaline will start working.
Xanax is good, however it is addictive indeed. Instead of it, I suggest you to try Hydroxyzine. This medicine does not cause addiction at all, moreover it has mild muscle relaxing effect and anti vomiting effect what can be very helpful with digestive tract symptoms.
Aspirin when taken regularly can cause some stomach inflammation and it can cause some abdominal pain. So it will be good to have endoscopy (like I have mentioned before) if the ultrasound wont give any answers.
From your medicines I can see that you do suffer from hypothyroidism. I suggest you to check your TSH level as sometimes too high dose of Elotroxin can cause loose motions as well.

Hope this will help.
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Follow-up: Having upper abdominal pain. Ultrasound showed not enlarged liver. Is there any complication? 13 hours later
Hello Dr
I had no pain today and was happy I ate one small pot of light porridge, as I said I am not eating tonight I had one plain no fried chicken fillet, with carrots that is all I had, after an hour had to have bowel movement while in bathroom ache came back to my side, I sat watching tv after, had to go bathroom again this time a longer bowel movement there was such noise and gurgling in tummy I thought something had "exploded" after that toilet episode the pain left again, there has to be some bowel problem I am now convinced of it. If you saw the tiny portion of food I ate today and hardly none with 2 weeks I know I am waiting for ultrasound on sat but I. Know that wont show bowel, and I am being referred for a colonoscopy so now that my anxious mind has tried to narrow down the symptoms I am thinking about my bowel or colon now, there is no sign at all of any blood thankfully. My blood tests that were taken tues came back ok today I don't think it showed anything liver wise, I await a copy of those. I really am now scared its prob my bowel or colon, what are the symptoms for colon problems /cancer I shouldn't think like this but I do, thank you again doctor you have been very patient with me
Answered by Dr. Grzegorz Stanko 14 hours later

I do not know how old are you, but if you are older than 50, colon cancer should be always ruled out.
Typical symptoms of colon cancer are abdominal pain, usually on the left lower side, weight lost, anemia in blood work, constipation or constipation alternately with diarrhea. Blood in stool can be visible however usually it is hidden (it is called occult blood).
Your symptoms can be caused by bowels problem, however it sound more like a small intestine. Sometimes such symptoms do appear with partial bowels obstruction as a result of abdominal adhesions for example or due to inflammatory bowels disease.
But stress and anxiety can also cause very same symptoms. So it is hard to tell. Food allergy can also give abdominal pain and diarrhea shortly after the meal.
But all of it seems to be just a theory and it would be easier knowing at least abdominal ultrasound result and be able to examine your abdomen.
Ultrasound can visualize some bowels diseases and if any obstruction present, it should be visible in the ultrasound (however to confirm it, abdominal X-ray should be done).

What you can do by your own to rule out colon cancer is to make FOBT (fecal occult blood test). It should be available in every pharmacy and you can do it at home. As you do not eat for so long, stool sample collecting for this test can be hard.

You definitely should have diagnostics and ultrasound might not be the last test. I hope you will get better soon.

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Follow-up: Having upper abdominal pain. Ultrasound showed not enlarged liver. Is there any complication? 32 hours later
Dear Dr
I had upper abdominal ultrasound this morning, the doctor said she couldnt see any problem with liver or pancaras and my spleen was fine, she said to her it would appear to be multiskeletal, she also performed acapuncture as she is highly qualified Consultant Radiologist & Multiskeletal Physican amongst other things. She advised excercises which she gave me on a sheet of paper I will see how things go as colonoscopy would be next if the tummy upset continued, i ate a little potatoe today and I was ok so perhaps all will be good, thank you a million times for all your help I will highly recommend you and this service
Kind Regards
Answered by Dr. Grzegorz Stanko 12 hours later

Muscles or bones pains does not affect bowels so please be skeptical to such diagnose (maybe it is correct diagnose but it does not seem like one). However exercises are very good way to deal with anxiety and so is acupuncture so maybe it will work for you. I hope it will.
All the best for you.
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