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Dr. Andrew Rynne

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What causes persistent upper right quadrant pain after cholecystectomy?

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Dr. T Chandrakant

General Surgeon

Practicing since :1984

Answered : 17288 Questions

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Posted on Fri, 3 Mar 2017 in Abdominal Pain
Question: What would left upper back pain, upper right abdominal pain (dull), and general stomach discomfort combined probably/possibly be? The RUQ pain has been persistent for 10 months and is most pronounced when i sit (versus stand or lay down). I should also say that i do not have a gallbladder anymore. My GI doc thinks that the RUQ pain is mosy likely pancreatic related, even though the only basic abnormality is that my trypsin count is a little low, yet the new left upper back pain is the frightening thing. 30 year old male here.
doctor
Answered by Dr. T Chandrakant 4 hours later
Brief Answer:
pl give additional information

Detailed Answer:
Hi.
Thanks for your query.
Noted the history and understood your concerns.
Persistent right upper quadrant pain in spite of cholecystectomy, more in sitiing position, already seen by a Gastroenterologist can be due to costochondritis along with the inflamed upper abdominal muscles. There can be either relief or increase in pain if you press on the lowest ribs.
Please give additional information:
What are the investigations done?
Please post the ultrasonography and CT scan reports.
Is the pain related to stress and/ or anxiety?
Does the back pain correspond in level with upper quadrant pain? Does it increase on movement of back?
Does pressure on it increase or reduce the back pain?
Any other information that you would like to share?

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. T Chandrakant 5 hours later
Hello,

This feels visceral, due to the pain & nausea that comes across the abdomen (sometimes will be the right side, sometimes the left). But I haven't actually sought out muscle or cartilage inflammation.

Investigations done: A CT scan about 9 months ago, just showed fatty liver. CBC Count, Metabolic Panel, and Amylase tests, all came back normal. I'm at work now so I can't post the CT results unfortunately. The ER physician said that the test was normal, sans fatty liver. I believe he focused the exam mostly on the liver,if that means anything.

The "usual" back pain does often correspond with the RUQ pain, particularly after eating, yet the back pain is not always present. This is definitely a much more anterior abdominal pain (RUQ, stomach, intestinal, etc.).

It doesn't seem to increase with movement of the back (whether flexing or stretching).

Applying pressure actually reduces the pain. The primary pain is right at or just below the lowest right rib, but will occasionally be on the left side or in the center of the abdomen.

The only info to share is that I'm trying to think about this being cancerous. Considering that it's slowly gotten worse over the past 10 months, and that I'm feeling slightly nauseous, I just want to know what it is.
doctor
Answered by Dr. T Chandrakant 4 hours later
Brief Answer:
As detailed below.

Detailed Answer:
Thanks for your detailed feedback.
Cancer would have been noted on CT scan.
Applying pressure relieves pain indicate Costochondritis as explained above.
Upper GI Endoscopy should have been done to see if there is any gastric ulcer which can mimic the pain as explained by you particularly the referred back pain associated with upper abdominal pain.
Please discuss these points with your Doctor so that clinical examination can be done and further investigations advised to find the cause and to get an appropriate treatment.
Repeat CT scan would be advisable in view of continued pain over 10 months, may find probable cause.

I hope this answer helps you, please feel free to ask for further relevant queries if you feel that there is a gap of communication.


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. T Chandrakant 16 minutes later
My GI doc initially wanted to do an endoscopy but felt that an MRI would be just as useable; i have the MRI scheduled in less than a week. Would the MRI pickup items such as an ulcer or something?
doctor
Answered by Dr. T Chandrakant 16 minutes later
Brief Answer:
As detailed below.

Detailed Answer:
MRI can not detect many things, hence the need of an upper GI Endoscopy.
MRI would pick up mass or abnormalities of liver, pancreas, lymph nodes. But may not pick up small superficial ulcers, erosions that only an upper GI Endoscopy can find out.
Please insist for an Upper GI Endoscopy.

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