What Causes Right-sided Dull Abdominal And Back Pain?

Posted on Mon, 15 Jun 2015

Question: I have had a dull ache on my right side, off and on for 2 months. It can ache right under my right rib, 2 inches below. Sometimes my back will ache on the right side. I have had normal blood work including bilirubin, amylase, and lipase; normal abdominal ultrasound, normal EGD, normal upper GI series and normal small bowel follow through. Many times, in the standing position I can press in on my right side 2 inches below my right rib and feel pain. If I tighten my stomach muscles, I can no longer feel the pain. Put on omperazole, Zantac; nothing helped. I cannot directly relate discomfort to a fatty meal. Sometimes also feel slight discomfort center of chest, epigastric area, and on left side. Not as consistent as this right side discomfort. Could this be my pancreas? I am a 41 yr old female, pretty healthy other than hypothyroid. No fever, no jaundice, no stool issues. I have lost some weight but not sure why. I have been trying to gain weight but honestly I'm sick of eating all the time. I'm 5'5" 119 lbs. my usual is 126. I was down to 113 while not feeling good and not eating much and then having to fast for tests. Any advice is greatly appreciated. I am currently waiting on a referral to another GI dr. No one is in a hurry around here, I've already waited 3 weeks.

I also have quite a bit of nausea that comes and goes, whether I eat or not. Again cannot relate it to any specific food or circumstance. Ty!

Answered by Dr. Dr. Klerida Shehu (22 hours later)

Brief Answer:
IBS/constipation to be determined by colonoscopy

Detailed Answer:
Hi XXXX,

I have gone through your medical history carefully and understood your concerns.

1. The pain you are feeling on your right side under your right rib is not due to pancreas as long as pancreatic function test was normal together with other endoscopic and ultrasound tests.

I want to know if you have had constipation problems recently?

Most probably, your symptoms are due to:
- constipation or
- IBS

2. If you have been constipated, I advise to avoid constipation:
- increase water intake
- take mild laxatives and stool softeners: lactulose, fiber, etc.
- increase physical activity
- avoid foods that would cause excessive gas: beans, fried, carbonated, etc.
3. I also want to know if you have done colonoscopy so far apart other examinations?

Colonoscopy will help determine whether organic changes are present in your colon. If it will be ok ,then, IBS is confirmed. In this case, duspatalin( mebeverine hydrochloride) is advised to dominate the pain.

4. You are also reporting to be hypothyroid. Can you please tell if you are taking any medication for that? It is common for hypothyroid patients to have digestive problems. Can you also provide the levels of thyroid hormones you have measured so far?

Thank you!
Dr.Klerida

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Follow up: Dr. Dr. Klerida Shehu (1 hour later)

I have had no constipation or diarrhea or any bowel issues or changes. I have not had a colonoscopy. I did have stool checked for H. Pylori which was negative.
I have been on levothyroxine 50 mcg for 4 years (found during pregnancy). My last TSH was a couple weeks ago and was 3.53, free thyroxine index 2.7, T3 uptake 33, and thyroxine 8.2; stating all within normal limits.
My symptoms are this every day ruq discomfort/ache that waxes and wanes and is mostly under my right rib, pain when abdomen pressed a couple inches below right rib cage, right upper back discomfort at times, lots of nausea, weight loss and difficulty putting weight back on regardless of what I eat.
I struggle with what to do as I am uncomfortable every day, concerned, and won't be able to get into this new GI for another 4 weeks. I can't find a good PCP here.
Thank you.

Answered by Dr. Dr. Klerida Shehu (4 hours later)

Brief Answer:
Still insist in running colonoscopy and exclude bowel problems first...

Detailed Answer:
Hi back XXXX,

Thank you for providing additional information.

I am happy to know that your thyroid hormones resulted within normal range as given by your lab.

Taking all into account, I still think you should schedule a colonscopy to evaluate the changes in your large bowels to exclude organic problems first.

Then, uro-genital problems should be also excluded through urine analysis and transvaginal ultrasound.

As your thyroid hormones are within normal range, should discuss with your doctor to revise the maintenance dosage (although minimal). Levothyroxine dosage can be adjust as per thyroid function test.

Taking an OTC pain-killer can be helpful in dominating the pain (e.g. buscopan).

Hope it was of help!
Dr.Klerida

Note: For further follow up on digestive issues share your reports here and Click here.

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