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Heavy drinker, back pain, abdominal pain, constipation, diarrhoea, anxiety

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Practicing since : 2000
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Soreness on ribs/side/back
Hello. I have been a heavy drinker for about 7 years. 6 months ago I woke up with pressure and an uncomfortable feeling in my upper right abdomen. I was given a full blood work up and an ultrasound. The ultrasound was normal and the only abnormality on the blood test was that my ALT level was mildly raised to 60. I abstained from drinking entirely for a month and then began again but at a greatly reduced amount. The pressure/sorness lasted about three months and then became quite rare, though one time I had a sharp pain where I couldn’t breathe deeply that lasted a couple minutes and an occasional achey (achy) back. I returned to the doctor and the ALT level had dropped to 32 and everything else remained normal. A few nights ago I went out drinking with friends. I had a good amount of drinks but purposely much less than I used to, nothing outrageous. The next day I had very brief pains that would pop up ocassionaly in my upper right abdomen, my right side, and some soreness in my lower back. The following day I had a sharp pain on my right ribs about six inches below my armpit. It was ok if I held still and lasted about 5 minutes. It’s been two more days and the quick pains are still popping up briefly, either on that far right side of the ribs or in my upper abdomen just to the right of the bottom of the sternum, seemingly worse in the mornings.

I have also had an erratic bowel pattern, constipation followed by diarrhea in particular this week. I also have had anxiety issues. I have also noticed my top two right ab muscles protrude more than any others, seen best when laying on my back. This is also the area of much of the discomfort (not sore to touch though). Could it be one of these and alcohol aggravates the issue? The Dr thinks it's not the liver and the test results are positive but I'm stressed that that's what it is. My mind can't help but go to the most serious reason, ha! Thank you for any insights!
Posted Wed, 2 May 2012 in Abdominal Pain
Answered by Dr. Poorna Chandra K.S 7 hours later

At the outset I would like to admit that without a physical examination and knowing the exact location of the pain, my answers are intelligent guesses at best.

Right lower chest pain with back ache in relation to alcohol gan be secondary to-

1) Anterior pulmonary or plueral infection or fluid collection - due to, either an alcohol associated immunodefecient stage or pleurisy.
2) Alcoholic pericarditis.
3) Alcoholic pancreatitis.
4) Alcoholic hepatitis and liver abscess - Alcohol intake predisposes one to liver abscess, espesially the amoebic one. Alcoholic hepatitis can take a long time to resolve after cessation of intake and returns quickly even with a single drink.
5) Duodenal or a distal Gastric ulcer - discomfort in the Right upper quadrant of the abdomen.

Constipation could be because of reduced fibre intake or any of the above lised causes (2, 3, 4).
Hence consult your Primary care physician to get a good physical examination and the relavent investigations.

Hope I have answered all your queries. Please write back to me if you have any doubts.

Wishing you speedy recovery.

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