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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Have mild fatty liver and pain under rib cage. Which specialist should I consult?

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Dr. Gyanshankar Mishra

Pulmonologist

Practicing since :2003

Answered : 600 Questions

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Posted on Thu, 17 Jan 2013 in Lung and Chest disorders
Question: I have a pain in my right side under my rib cage, and it is always there but totally worse when lying down. It has been going on for awhile (At first I thought it might be muscular) but ben-gay, heating pads, and cold patches have not worked for some time now. It gets sharper when lying down and I get mild spasms there. I had a liver ultrasound in October of 2011 because of slight pain and it came out totally normal...liver, gallbladder and pancreas all normal. At that time my liver enzymes were all ok. Then in April of 2012 my ALT was normal but my AST was 52. I had another liver ultrasound ordered, 2nd one, and they said I had very mild fatty liver - and the ultrasound was unremarkable. My cholesterol was higher at 230, was in a cast all summer- hard to exersize ....I broke my foot this summer and was put on steriods and vicatin. And, I take clorazapam. I don't know why everything was ok and --now still pain, hard to sleep. Anyhow, was wondering what this pain could be and do I need to get yet another ultrasound - it would be my third in a short amount of time!? Strange because I had the pain the first time around and that came out normal ? My triglcerides are normal too. I did drink wine over the holidays somewhat? Drank tons of water too.
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Answered by Dr. Gyanshankar Mishra 16 hours later
Hi,
Thanks for posting the query on XXXXXXX After going through your reports (Your evaluation reports are of 2010), I would like to comment the following:

1. You seem to be having right sided chest pain for quiet some time now.

2. Your USG abdomen in april 2012 had shown fatty liver.

3. I suggest you visit a pulmonologist and rule out intrathoracic causes of chest pain.

4. Investigations required at this stage are repeat ultra sound chest and abdomen, Xray chest and if required CT thorax and abdomen. Any organic cause of the pain if present , should be picked up by these investigations.

5. A HIDA scan - liver & gall blader may be of some help.

I hope I have answered your query. I will be glad to answer follow up queries if any.
Please accept my answer if you have no follow up queries.

Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Gyanshankar Mishra 17 hours later

I am just getting scared that this could be my liver. Why would it hurt so much when just lying down? Why would it be so sharp?
Could it be the medications or the higher cholesterol affecting it or something else? Or, does a glass of wine bother it? I had a perfectly healthy liver my whole life and a perfectly healthy one in the Oct. 2011 ultrasound...what would make things go so wrong in that amount of time?
Will make an appt.

Thank you.
doctor
Answered by Dr. Gyanshankar Mishra 39 minutes later
Hi,
Thanks for the follow up query. After going through your query, I would like to comment the following:

1. The pain could be due to liver, gall blader or intra thoracic (Eg. Pleural pain).
2. Fatty liver is seen in females. However you need to cut down on your alcoholic beverage intake.
3. Only investigations as advised above will help in pinpointing the exact cause of the pain.
4. Medications or the higher cholesterol need to be taken with caution in cases of fatty liver. Please consult your physician regarding this.
5. You can also get a second opinion by getting yourself clinically evaluated by a gastroenterologist.
6. Your liver functions need to be monitored at regular intervals.

I hope I have answered your query. I will be glad to answer follow up queries if any.
Please accept my answer if you have no follow up queries.

Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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