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Pain In The Side Of The Ribs, Flanks, Shoulder Blades

Posted on Sat, 10 Aug 2019

Question: Pain in the side of the ribs, flanks, shoulder blades and upper abdomen accompanied with burping/belching and gassy feeling in the chest.

The image shows the locations where i feel the pain, its really random and its not triggered by a certain event. The encircled area is where the pain originates and spreads. When pressed on the area it hurts, again this is not always but really random.

I have no family history of cancer. I dont smoke and drink, I am bit over weight and have been having GERD issues for almost a year.

Follow up: Dr. Bhagyesh V. Patel (0 minute later)

Pain in the side of the ribs, flanks, shoulder blades and upper abdomen accompanied with burping/belching and gassy feeling in the chest.

The image shows the locations where i feel the pain, its really random and its not triggered by a certain event. The encircled area is where the pain originates and spreads. When pressed on the area it hurts, again this is not always but really random.

I have no family history of cancer. I dont smoke and drink, I am bit over weight and have been having GERD issues for almost a year.

Answered by Dr. Bhagyesh V. Patel (31 minutes later)

Brief Answer:
gastric reflux related issue most likely.need details.

Detailed Answer:
Hello and welcome to Ask A Doctor services.
I have read your query and here is my advise with attached photograph.

* As per my clinical experience, the location of pain origin with narrated history is
suggestive of epigastric pain from reflux related condition most likely.

Kindly provide me further details so that I can answer your query completely.

1. Is there any alteration with bowel movements ?
2. Associated heaviness after particular meals ?
3. When was last ultrasound carried out ?

Awaiting for your response.
Regards.

Dr Bhagyesh ( MS consultant surgeon )

Above answer was peer-reviewed by : Dr. Kampana

Answered by Dr. Bhagyesh V. Patel (0 minute later)

Above answer was peer-reviewed by : Dr. Kampana

Follow up: Dr. Bhagyesh V. Patel (29 minutes later)

I got a Ultrasound, CT scan with contrast and endoscopy done in April, this year.

Is this related to some bile duct issue?

Follow up: Dr. Bhagyesh V. Patel (0 minute later)

I got a Ultrasound, CT scan with contrast and endoscopy done in April, this year.

Is this related to some bile duct issue?

Answered by Dr. Bhagyesh V. Patel (10 hours later)

Brief Answer:
follow up .

Detailed Answer:
Hi
Thanks for the details.

* There can be various organs responsible for the condition of acid reflux and indigestion
with dyspepsia as stomach, pancreas, liver, gall bladder, bile drainage system or else.

Unless there is particular changes depicted in the biliary tree or liver, one can not stamp it as bile duct issue.

Many of the times, functional bowel dysfunction also presents in same manner where all reports turn out to be negative and patient has symptoms of varying degree.

Would like to address your further doubts ahead.
Thanks.

Above answer was peer-reviewed by : Dr. Prasad

Answered by Dr. Bhagyesh V. Patel (0 minute later)

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Bhagyesh V. Patel (2 hours later)

I have done CT scan of abdomen with contrast, US of abdomen, Endoscopy - All Normal.

I have done LFT, GGT, CBC, Lipase, Amylase -All Normal.

I have done stool test for fat malabsorption, elastase, candida, H-pylori - All Normal

1.) Are these test sufficient to rule out anything to do with bile ducts?
2.) Is there anything else I should be doing to check the pancreas or gallbladder as the symptoms are identical to that with these organs?
3.) Is this gastritis related?

Follow up: Dr. Bhagyesh V. Patel (0 minute later)

Follow up: Dr. Bhagyesh V. Patel (8 minutes later)

Also, whats causing the pain under the ribs and right flank and shoulder blades. The shoulder blades and right flank pain is more like pressure than pain and on a scale of 10 I would say its 2-3.

The pain under the ribs whenever I get it is like 2-3 out of 10.

Follow up: Dr. Bhagyesh V. Patel (0 minute later)

Answered by Dr. Bhagyesh V. Patel (3 hours later)

Brief Answer:
follow up .

Detailed Answer:
Hi XXXXXXX
Thanks for the details.

* As per your description, all the relevant investigations have been carried out so far as
pancreas and stomach, intestine issues are concerned.
and there is no chance of yours having bile duct issues.

Still, I would like to get information regarding the status of stomach or intestine biopsy if performed along with the scopy as there can be mentioning about the status of stomach protective layer, intestine brush border integrity and rest of the things needed to diagnose histology of the intestine tract disturbances.

Thanks.
Wish you great day ahead.

Above answer was peer-reviewed by : Dr. Raju A.T

Answered by Dr. Bhagyesh V. Patel (0 minute later)

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Bhagyesh V. Patel (22 hours later)

I have had 2 endoscopy with biopsy: 1 in December last year and they found a polyp in the duodenum area which came back as normal after biopsy. The 2nd one was done in May this year with biopsy and all normal.

So with all these investigations, what could the issue be?

Gastritis/IBS as you are suggesting that the bile ducts issues are probably not the reason for my symptoms?

Thanks for all the help

Follow up: Dr. Bhagyesh V. Patel (0 minute later)

Answered by Dr. Bhagyesh V. Patel (1 hour later)

Brief Answer:
follow up .

Detailed Answer:
Hi
Welcome for follow up.

* Usually bile duct problems do not show up with all the normal parameters, unless
some very specific issues of enzyme deficiencies of the liver conditions.

I quote more of possible reason from immune process affecting the digestive tract and in which case an expert immune specialist may be of much help to diagnose with specific antibodies against particular gut portion through in depth evaluation.

As there was benign duodenal polyp found in December, though it has been excised, there can be alteration in bicarbonate secretion through secretin which is vital for the stomach contents processing ahead.

So far as IBS is concerned, the symptoms of bowel movement alteration are much vital supportive clinical tool to mark toward the same.

* In a nutshell, issue is at micro level and the analysis of multi variant parameters will
reveal some positive result over a period of time most likely.
It is not a straight forward diagnosis to be stamped at the first glance.

* But I would quote at this point to start deep breathing exercises and YOGA on very
regular basis which are best known therapy for this type of gut disorder and you will
find immense benefit over a period of time with patience irrespective of what ever the
reason will come out.

* Stress is your major enemy and you have to avoid it till best with maintenance of
sound regular sleep and dietary precautions as well.

Wish you great day.
Thanks.

Above answer was peer-reviewed by : Dr. Raju A.T

Answered by Dr. Bhagyesh V. Patel (0 minute later)

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Bhagyesh V. Patel (4 hours later)

So are there any other tests I should be doing for the symptoms ?

By the look of it is there anything to worry as of now?

Follow up: Dr. Bhagyesh V. Patel (0 minute later)

So are there any other tests I should be doing for the symptoms ?

By the look of it is there anything to worry as of now?

Follow up: Dr. Bhagyesh V. Patel (0 minute later)

In a nutshell, issue is at micro level and the analysis of multi variant parameters will
reveal some positive result over a period of time most likely.
It is not a straight forward diagnosis to be stamped at the first glance

What should I be doing as my next step?

Follow up: Dr. Bhagyesh V. Patel (0 minute later)

Follow up: Dr. Bhagyesh V. Patel (4 minutes later)

My biggest question here what is causing the pain in the upper abdomen when pressed at and which spreads to the ribs ?

Follow up: Dr. Bhagyesh V. Patel (0 minute later)

My biggest question here what is causing the pain in the upper abdomen when pressed at and which spreads to the ribs ?

Answered by Dr. Bhagyesh V. Patel (3 hours later)

Brief Answer:
follow up .

Detailed Answer:
Hi

* There is no serious issue at this point to worry about for critical problem of some sort.

* The prime cause of upper abdomen pain when pressed and spreading to ribs is usually
stomach acid content irritating the wall and giving referred pain over the lower rib
parts.

* Currently my best recommendation is to
avoid stress ( number one possible cause for your condition as per my clinical
experience )
do thorough meditations
avoid panic of underlying major medical disorder
give nature time to heal the tissue on its own

* I do not agree with further need of extensive work up beyond what have been
performed, just symptomatic therapy with further decisions over due course of time.

* Overall life style changes and basic management are much worthy than just medicines
which can be of proton pump inhibitor, stress relievers, anti anxiety and digestive
support for the gut.

Thanks.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Answered by Dr. Bhagyesh V. Patel (0 minute later)

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Bhagyesh V. Patel (44 hours later)

Dr. I got my MRCP/MRI done this week and its come back as normal.

Is this enough to completely reassure and rule out all bile duct issues and as you suggested to focus on the acidity part?

Follow up: Dr. Bhagyesh V. Patel (0 minute later)

Dr. I got my MRCP/MRI done this week and its come back as normal.

Is this enough to completely reassure and rule out all bile duct issues and as you suggested to focus on the acidity part?

Answered by Dr. Bhagyesh V. Patel (1 hour later)

Brief Answer:
MRCP normal means clear bile duct system absolutely.

Detailed Answer:
Hi XXXXXXX
Welcome for follow up.

* MRCP /MRI is last evaluation to be done for bile duct issues which will
reveal every minor aspect of underlying tissue structure and possible
abnormality if any.

So now be rest assured for the same and focus on previous discussion management to cover the condition over a period of time.

Thank you.

Above answer was peer-reviewed by : Dr. Kampana

Answered by Dr. Bhagyesh V. Patel (0 minute later)