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Can gout cause discomfort under right side rib cage?

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Dr. Stephen Christensen

General & Family Physician

Practicing since :1986

Answered : 212 Questions

Posted on Mon, 24 Dec 2012 in Bones, Muscles and Joints
Question: can gout cause discomfort under right side rib cage... liver enzymes fine cbc numbers fine (billirubin 1.0, albunim 5.1, slightly dehydrated blood work done in boulder co.) ALP 67, AST 16, ALT 17 Uric Acid 8.5...have discomfort under ribs upper right side slight slight fullness after eating that seems to hang on...could the uric acid be causing it...seems to be more noticable after alcohol intake
Answered by Dr. Stephen Christensen 2 hours later
Hello. I'm Dr. Christensen.
I can understand your concern about this right rib and abdominal pain. Occasionally, people with untreated gout develop tophi, which are nodules of uric acid crystals that can be found in a variety of places, including the soft tissues around your ribs. Most tophi that cause symptoms are big enough to feel or see, though, so if you don't have any obvious lumps beneath your skin in the area of your discomfort, it's not likely your symptoms are due to gout.
Your history is somewhat concerning for a couple of other problems:
Gallbladder disease is a classic cause of discomfort in the upper right abdomen. Gallbladder pain is typically felt just beneath the right ribs, although it can radiate to the right mid-back or even the right shoulder. Gallbladder pain often increases after eating, too. (By the way, your liver enzymes don't have to be elevated if you have gallbladder problems.)
Another possibility here is peptic ulcer disease. Although ulcers usually get better after eating, I've had many patients whose ulcer pain actually increased following a meal. In addition, ulcers frequently get worse when people ingest something that irritates the stomach lining, such as spicy foods, aspirin or alcohol. Conversely, ulcer pain typically improves with antacids, so that's something to try if you haven't already done so. (I recommend liquid antacids, such as Maalox or Mylanta, rather than chewables.)
All things considered, it would be a good idea to see your doctor again if this pain persists. He/she can take a look to see if you have any gouty tophi or other problems that could be attributed to your gout. A quick abdominal exam is usually all it takes to allay (or confirm) suspicions about gallbladder disease. If your doc thinks that's what's going on, you'll probably be sent for an abdominal ultrasound. If ulcers top the list of possibilities after an initial evaluation, a test to rule out Helicobacter pylori infection (the most common cause of ulcers in developed countries) will be the next step, and you'll probably be started on acid-reducing therapy.
I hope that answers your question, and I hope you get to the bottom of this issue soon. I'll be available if you have further concerns.
Good luck!

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Stephen Christensen 12 minutes later
the uncomfortableness (not really pain per say) more like pressure or fullness is about 4-5 inches below the breastplate on the right side right where the ribcage curves
Answered by Dr. Stephen Christensen 48 minutes later
Without an examination it isn't possible to diagnose your problem. If the discomfort worsens when you press on the ribs themselves, this could be something within the chest wall, such as intercostal neuralgia (irritation of one of the nerves between your ribs), costochondritis (inflammation of the joints between your ribs and sternum) or rib-tip syndrome (inflammation or hypermobility in the cartilage at the end of a "floating" rib).
If the sensation gets worse when you push on your upper abdomen, gallbladder disease is still a good bet.
Your doctor can help you sort this out.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

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