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Dr. Saha
Dr. Saha, Doctor (MD)
Category: Health
Satisfied Customers: 17828
Experience:  35 years of experience
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I have persistent pain beneath my ribs on the right side. It

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I have persistent pain beneath my ribs on the right side. It responds to ibuprofen and to icing, but it never goes away. Exercise makes it much worse. I've had my gall bladder removed, seen a GI specialist, had a barium exam, stress test from a cardiologist and seen a physical therapist. So, I know it's not costochondritis, hiatal hernia, ulcers, pericarditis, or cancer. Previously, I had thought it was in the middle of my chest, but a accupuncturist prodded me and I was surprised to feel the sensitivity runs down my right all the way to my side, underneath my ribcage. Also, previously I thought pepto-bismal helped, but I think that was a temporary heartburn issue. Pepto no longer helps.
So, right now I'm thinking it's a liver problem. But, really, I'm just reading stuff on the Internet. My family doctor has given up. But, he's still willing to do referrals. So, I'd like any input that you can give me on how to talk to my doctor. What referrals do I ask for? Thanks!!!!!
Thank you for your question,
I’m Dr. Saha and I’ll try to help you.
Did you consult any other specialist besides GI, cardiologist & physical therapist?
What is the opinion of the GI specialist regarding liver problem?
Did you have any test for liver?
Did you have plain X ray or ultrasound, CT or MRI?
When did the symptom start?
Is there any other aggravating factor besides exercise?
How frequently do you take ibuprofen?
Customer: replied 4 years ago.

So sorry for the delay. I didn't expect you to answer so quickly!

Those are all the specialists I've seen.

The GI specialist had no opinion on the liver. He basically said "it's not GI, so I don't know."

I have never had any liver test.

I had a few ultrasounds. One for gall bladder, GI and one for heart. No CT, xray or MRI.

Symptoms started 3 years ago. It's been a battle. The only significant event before it was a very bad case of strep throat about 1.5 months before symptoms started. I took a lot of antibiotics and Tylenol during that time. It was also a very stressful time in my life.

I get IBS-like symptoms. When I get bloated, the pain is much, much worse. Basically, anything that jogs the area hurts. Exercise, poking at it, bloating, deep breathing. And the pain will last for days.

I started taking ibuprofen last fall. I take it once or twice a day.


Thank you David, for all the information,
The pain in the right upper side of the abdomen can be from a few factors.
Gall bladder is a common cause but you have got it operated already.
Peptic ulcer, reflux, pancreatitis have been ruled out, so also the heart issues.
As you had ultrasound that would detect change in liver.
I think doctor has also taken blood tests like bilirubin, ALT, AST, GGT etc which can be abnormal in liver diseases.
Sometimes pleural inflammation pain can be referred here which can increase in deep respiration.
X rays of the chest would detect it.
Muscular pain can occur which can be aggravated with movement or deep respiration.
But it is unlikely to stay for years.
Another possibility is a nerve impingement.
This can occur in the spine where it can be worse during movement.
This can cause increased sensitivity too.
An MRI scan of the spine can be taken if doctor feels.
You can discuss those issues with your doctor.
Ibuprofen can help in musculo-skeletal pain.
I hope this information helps.
I will be happy to assist, if you need any clarification.
Please feel free for any follow up query.
Best wishes.
Customer: replied 4 years ago.

Actually, I have high bilirubens on my yearly exams. I have not heard of ALT, AST or GGT. Is it possible that he just didn't test for these?

Usually AST, ALT, GGT etc are tested along with bilirubin.
It is likely that those were normal so the doctor did not mention it.
You can talk with doctor to confirm.
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