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Dr. Andrew Rynne

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Suggest treatment for chronic right upper quadrant pain

Answered by
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Dr. T Chandrakant

General Surgeon

Practicing since :1984

Answered : 16512 Questions

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Posted on Thu, 23 Mar 2017 in Digestion and Bowels
Question: I have been having chronic RUQ pain although I had my gallbladder removed 20 years ago. Last night I awoke with severe, almost unbearable pain from my rectum through my lower abdomen and into my RUQ. I thought I had pulled a stomach muscle due to a 33 pound grandson. However, I also have been experiencing very painful hands, knees, pelvic and elbows - not the joint specifically, more like the bones or area just around the joint. I do not have insurance so can't go to the doctor. My hands throb, and it feels like the bones more than the joints. I had trouble sitting through mass. I have put on 10 pounds in 4 months. The pain last night was so intense I felt I couldn't breathe, although I had no SOB.
doctor
Answered by Dr. T Chandrakant 46 minutes later
Brief Answer:
Looks to be procto-colitis as per the history

Detailed Answer:
Hi.
Thanks for your query.
To recapitulate: Female/55 - gall bladder removed 0 years ago - chronic RUQ pain - last night awoke with unbearable pain from rectum through lower abdomen into RUQ - thought of pulled stomach muscle - also have painful hands, knees, pelvis and elbows - more like bones just around joints - trouble sitting through mass - 10 pounds weight gain in 4 months - no insurance - can not go to Doctor - tried NSAIDs ...

As per the history you have suggested this looks to be a problem related to colitis causing secondary pains in body as explained by you. This is so as the pulled muscles can not cause the pain starting in rectum and going through lower abdomen to RUQ but can be due to Procto-colitis.

Please give additional information for me to assist you better:
Since when have you got RUQ pain?
What is the type of pain- burning/ twisting/ throbbing/ spasmodic ?
Any changes in bowel habits or passing mucus or blood in stool?
Does the pain in abdomen and the near joints correlate?
Do your get any swelling near the joints?
Any fever or chills during such attacks?
Any other information that you would like to share?
Awaiting for your detailed history as it helps to come to a conclusion in some cases.

Awaiting.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. T Chandrakant 53 minutes later
I do not know if joint and abdominal pain are related - just giving complete symptoms in case. i do not have joint swelling, warmth, fever or chills. My stomach pain started about 1 month ago and waxes and wanes to some extent but is always there like a bothersome toothache. It throbs/aches but does not radiate through to back or up into shoulder like gallbladder sx. I feel full quickly and thought RUQ pain may be gas so took something which resulted in minimal belching. Pain can be exacerbated/relieved while lying down by changing positions. Is not acute but can be tiresome. Deep palpation can exacerbate pain but not always. Bowel movements are WNL for me. Uptake in drinking recently (2-3 glasses of wine per night) but have given up for lent. Sitting up in bed helps with the sourness/nausea. No vomiting.
doctor
Answered by Dr. T Chandrakant 16 minutes later
Brief Answer:
Take medicines as tell me the results.

Detailed Answer:
Thanks for your feedback.
As per the additional history you have provided there looks to be two issues.
There can be gastritis as some symptoms indicate like feeling full quickly, minimal belching.
The pain in the upper right quadrant can be due to colitis as indicated by tenderness on deep palpation.
There is another possibility of IBS that is irritable bowel syndrome. But to prove this to be IBS one needs normal investigations of blood, stool, urine, ultrasound, upper GI Endoscopy, colonoscopy and CT scan of the abdomen.
Since you have no insurance at the moment, it may be difficult to undergo all such tests.

Hence I would advise you to take a PPI like Omeprazole, take antacid gel/liquid every three hours, particularly when on empty stomach.
Take antispasmodic round the clock and see the results. I hope that you get these medicines as OTC in nearby Pharmacy.

Please take and give feedback.
Take care.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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