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Abdominal upper right quadrant pain, just below ribs

Hi,
I too have upper right quad pain just below my ribs. I am a male, 46yrs old 6ft and weigh 175 lbs. My pain comes and goes and has for about 6 months. It is not severe pain, but at times is more annoying than anything. It feels like there is something in there pinching me. I went to an internal med MD in July. He ran blood tests that all came back fine. He sent me to have an abdominal ultrasound which showed only "healthy" organs. No dilated bile duct, no gall stones, liver enzymes were in normal range. It is 4 months later and the pain is still happening. When I sit, or bend at the waist, I can feel the pain. It is not a deep, internal pain, but seems close to the surface, just to the right of that little cartlidge/bone that splits the rib cage...just to the right of the stomach. What the heck could it be? My MD put me on Nexium, thinking maybe it is peptic in nature, but 60 days of Nexium and still the pain persists. I am freaking out because my dad passed away this past March due to a rare appendix cancer (pseudomixoma peritonei) that several MD's could not find, nor diagnose properly once they found it, another story in itself...so you know how the paranoia sets in. I don't have a lot of faith in MD's right now. Anyone out there have any input? Can the liver be screwed up for this long and still avoid being detected? Can inflamation be detected by ultrasound? It feels like it's burning, not like heartburn, but a firey sensation...hard to describe. Someone, please help me settle my fly away brain...thanks.
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Avatar universal
Was your pancreatitis caused by your ERCP procedure or did you have pancreatitis beforehand? I know that pancreatitis is one of the risks involved with ERCP, among other things.  I will also list some doctors (below) that might offer you some help.

I also hope this will be helpful for anyone who might be suffering from Sphincter of Oddi  Dysfunction (SOD).  So, for others reading this & have had your gall bladder removed, or have other biliary disorders, you might ask your GI about the possibility of SOD.  One thing I would advise anyone who thinks they have SOD (or their doctor suspects they have SOD) would be to try meds before having an ERCP or surgery on the duct itself.  

I will try to make my story short as possible.  (I have a tendency to over state things sometimes).  I began having pain 2 years ago & the only way I could describe the pain is as if someone was stabbing me under my right rib cage & it exited out my back.  My GP sent me to GI doc, who initially thought I had an ulcer.  I knew it wasn't that, because I have had ulcers & reflux in the past & the symptoms weren't the same.  The pain was so severe, that it literally affected everything aspect of my life & I found myself avoiding going out at all, if I didn't have to.

The GI doc ordered an upper endoscopy & also referred me to her partner, who ordered CT scans of cervical & thoracic spine as well as abdominal CT.  I was told everything was "normal" & I was "fine".  After the endoscopy, I was given pics she had taken during the procedure. Once I arrived home & the anesthesia wore off, I noticed that everything looked normal, except the tissue around the ductal opening, by the duodenal bulb, was severely red & irritated.  So, the following day, I called her office & asked her about it & if she felt further investigation was warranted. She asked me why I thought I needed further testing & I told her I was a former nurse (now retired) & the pics indicated to me that it was more than likely related to bile & pancreatic juices.  She finally agreed to perform an MRCP, but after that test, she again told me that both the CT & MRCP showed everything was "normal" & I needed no further tests.  

Since, I am not overly trusting of medical professionals (comes from working around them for so many years), I asked for copies of the MRCP & CT scan.  After I received the results & radiology reports, I discovered that not only did I have dilated intrahepatic & extrahepatic ducts, but also an adrenal tumor & a mass in my pelvis, that the radiologist "felt" was an ovary.  They never told me anything about this.  I called her office & told her, "why would you think the mass is an "ovary", when I had a TAH 27 years ago?  I told her i had no female organs, so it would be difficult for the "mass" to be an ovary.  Again, she refused to do anything, even refer me to anyone else.  So, I asked her nurse for copies of my entire patient file.  This is exactly why I would advise anyone who has medical tests to ALWAYS ask for copies of any tests you have performed, so you can read for yourself what the tests show.  I noticed in her notes, that she mentioned the mass & even mentioned that I had a TAH & would consult with me before proceeding.  But, she didn't!

So, after this rude awakening, my GP referred me to another GI doctor, who specialized in ERCP's & also a surgeon regarding the pelvic mass.  The surgeon refused to do anything, until an ERCP could be performed & a repeat CT.  The new GI doc refused to do an ERCP, (he felt it was too risky).  He suggested,  instead of the ERCP, an EUS (endoscopic ultrasound).  Since his hospital wasn't equipped to do EUS, he sent me to another hospital.  That test noted that I also had a dilated common bile duct.  So, that now added up to 3 dilated ducts.  This GI doc still refused to do an ERCP or any surgery (sphincterotomy or sphincterplasty) until my dilation was at 8-10 mm or larger.  I am currently between 5-6 mm.  I asked him if he could at least try me on some of the meds used for SOD, but I received a big NO.

The repeat CT was not the same type as I had before & performed at a small, local hospital, so still not sure what the mass is, as this radiologist,  failed to even mention in his report.  But, he noticed another anomalies (some of which turned out to be wrong).  So, now the surgeon has backed out of removing the mass, because now he says surgery is "too risky".  I told him, so is dying, but shouldn't a biopsy be done to see what the mass is?  He said I need to see a gynecologist.  That was another waste of time as she blew off all test results.  So, now my GP is now sending me to a gynecologist oncologist. I just hope I am not too late, if it is cancer as my health continues to deteriorate, without anyone offering hope or suggestions.  If all else, fails,, I can always go to VA hospital.  But, I know it takes forever to even get an appt. in VA hospital, let alone treatment.

Since everyone is refusing to offer any type of treatment, I started doing my own research on med options.  I see my GP next week, so I have called in advance to let him know what oral meds that can be used for SOD & will he at least "try" me on meds to see if it will alleviate the pain. But, with the luck I have been having with doctors, the past 2 years, I am not holding out hope for anything.  But, I will keep on fighting for treatment on not only the SOD, but also the pelvic mass & adrenal tumor.  The adrenal tumor is the least of my worries, right now, because more than likely is it just a benign adenoma, that can wait & just be monitored.

For those of you who do have symptoms of SOD, some of the meds used to treat it, are Calcium Channel Blockers, Nitrates, Gabapentin & low dose Amitriptyline.  I cannot use CCB, because of low B/P, so will probably try either Amitriptyline or Gabapentin.

Botox injections have also been used to treat the spasms, but that is not something I would be interested in trying.  Don't really feel like waiting for an appt. & then driving 2 hours to see the doctor.  For anyone interested, there is also the option to check into clinical trials for treatment.  

If my GP refuses to help with oral meds or they don't alleviate or reduce the pain & I am unable to get into VA into reasonable time, I have been researching specialists who work specifically with patients with SOD & pancreatitis.  They are all out of state (for me) but would be worth the travel, if the pain could be alleviated.  They all come highly recommended by other SOD patients.  These doctors have found a new way to use stents to keep the ducts patent longer. If anyone is interested, they are Dr. Peter Cotton at MUSC, Dr. Martin Freeman at Univ Of MN and Dr. Sherman at Univ of IN.  

I'd also suggest, that if you suspect you have SOD or pancreatitis, don't do like I did & go to just any GI doc, just because they are closer.  If the above docs wouldn't be worth it to you, take the time to find a doctor who specializes in pancreas & SOD issues.  Also take the time, to check reviews by other patients on websites that allow patients to review doctors, such as vitals, healthgrades, etc.  Your life is too important to just allow anyone to experiment with your health.

I hope this helps anyone who is still battling SOD & not finding help.
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1 Comments
How much it cost to see one of suggested Drs to perform the proccedure for SOD
Avatar universal
hi I have pretty much the same pain as your self for the last year now but when ever I go see my gp they keep saying its ibs or muscle pain I had my gallbladder removal many years ago , so iv ruled that out my self , are u yr self any closer to finding out what it is
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Avatar universal
Stop running!  It's not worth it. I used to run like you and all it did was use up valuable time.  There are plenty of other ways to stay healthy.  No need to aggravate your RUQ!
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763612 tn?1385231750
I suffered what we think was a duodenal ulcer Aug  2010, I called it upper right quadrant pain. I was neg for  h. pylori. Finally got the ulcer diagnosis  to work on in June of 2011- so I suffered for a year before I even began to take things to heal.   I began a protocol of a whole bunch of things, Took three rounds of Prilosec ( that otc drug help at once but then began to wear off after 3 rounds). Then I went gluten and nightshade free food wise, did Egosque body work and took lots of supplements DGL, L- Glutamine etc (search my former posts if you want to see more things that helped me with that pain).  After 6 months from June of 2011 to the first of 2012 I was finally free of pain. And I was pretty much pain free in 2012 and until Dec of 2013. Unfortunately  I began having abdominal pain again. A little different feeling this time began as a mild cramping gawing like discomfort. Maybe because it was a little different  pain (more lower center abdominal pain)  I did not even consider to try the ulcer protocol until  4 months later...Then I did try  the same protocols but this time I was not getting better. Also this time I did test positive for h pylori but my doctor did not think that would be a cause an ulcer.  It has been 6 more months now Oct 2014 and I am still having pain. Was better on a beach vacation so I've wondered about earthing (walking on the beach), was constipated then so no movements, was not eating the fiber or taking the boat load of supplements I  normally do, did not have to worry about what to eat because we were eating out each day, did not have A/C but host had a wonderfully open beach house with ocean air and we had great mild weather. The Host had one other thing that I now consider a factor.  He had 3 great dogs two labs one weimaraner. We loved on them and they loved on us. We had lost our little Iggy (Italian Greyhound) about the same time my pains began. He was almost 16 when we had to put him down.  I think the doggies  at the beach were giving me Oxytocin the feel good, love, trust, bonding hormone.  I remember changing our little dogs food from grain based to meat based (Blue) dog food in 2012 and walking with him- this may have helped him feel better (he really rallied- coat and appetite came back and he loved our walks). I think this in turn helped  me to heal.    I am considering asking my doctors to get a prescription for Oxytocin. I found out about Oxytocin some time ago when a friend gave me an article by Dr. Jonathan V. Wright about Oxytocin helping gut pain. I would rather have a dog.  Sadly at this point my husband says we will never have another dog. Hope and Pray he will reconsider for our health and physical well being. If you google 'dogs and oxytocin' you can learn more about that  phenomenon.

But for some supplement helps I  have found that within minutes of taking Black Seed Oil my pain is gone or greatly reduced. This is really a puzzle to me but I was also taking it while on the beach vacation because it was in the fridge and easy for me to access. I never bothered to dig out my other supplements in the bottom of my luggage.    I only take 1 tea a day usually in the evening.   I've only used the Amazing Herb brand that you can get at most all health foods stores.  Coptis (a chinese herbal) I got from my Chiropractor also takes my pain  away. Not as good as the Black Seed Oil. BTW both  the Coptis and the Black Seed Oil taste horrible!   I am not sure if these are healing my problem but am thankful that they take my pain away as I cannot take pain meds of any kind. Pain meds cause me bowel bleeding.

Until you get to the bottom of your pain Hope these ideas might help you and others who may see this.

I know God has a reason for our suffering - it is in some way to bless not to hurt.
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Avatar universal
I am a 23 year old female. my pain starts in the upper right side of my stomach and wraps all the way around my right side under my arm pit and to my spine. happens a few times a week. the pain seems to last for a few hours at a time. I have tried everything. nothing seems to work. I don't like going to the ER. kinda scared its my gallbladder. both my parents had theirs out due to stones. Anyone have an idea what this could be.
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Avatar universal
I have had the same pain and  symptoms ever since I  had my gallbladder taken out in 1986.   Have had ultra sounds, mri's, cat scans, and  numerous ERCP's  with stents placed in the pancreatic duct over the years.  Tons of lab work and many hospitalizations.  Surgery at the Mayo Clinic in 1993, which helped for awhile and then the pain & spasming started all over again.  I  have spastic pancreatic and liver ducts, and it is all connected to the gallbladder being removed.  Have had elevated enzyme levels and had sphinterotomy and sphinteroplasty's done.   What I  believe I have is Sphinter of Oddi Dysfunction.   Right now I am trying to find a Dr. or Clinic who has done studies on the type 111  Sphinter of Oddi Dysfunction to find a medication to control the pain and spasming besides pain meds., which I have to take now.   I currently am being seen at the U. of MN.  and recently heard that they had done a study on Sphinter of Oddi Dysfunction.  My appt. is in July, 2014, so hope they have some other answers.
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