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Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 18964
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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I have a pain just under my rib cage that occurs when I drink

Resolved Question:

I have a pain just under my rib cage that occurs when I drink anything but not when I eat. I have had a scan for gall stones but this has shown as clear. I had surgery years ago in my stomach for a gangerene bowel and had to have some bowel removed. The doctor has suggested that it may be to do with scar tissue from this. However the operation was 20 years ago but they dont seem to know what else maybe causing it.
Submitted: 2 years ago.
Category: Medical
Expert:  Dr. D. Love replied 2 years ago.
Hello from JustAnswer.
How long has this been bothering you?
What type of scan for gallstones was done?
Have you had any other evaluation, such as blood tests or endoscopy?
Customer: replied 2 years ago.
I am not sure of the scan type. I did have a blood test that came back clear. It has been going on since September it was more painful initially then it eased but it has not changed since
Expert:  Dr. D. Love replied 2 years ago.
Pain under the right rib cage is most worrisome for gallbladder disease, particularly if the pain is more severe or persistent. It is also common for gallbladder pain to be worse with oral intake, although it is not usually limited to liquid intake.
The usual first test for gallstones is an ultrasound, which uses sound wave to take pictures of the gallbladder. In someone with symptoms worrisome for gallbladder disease, a hepatobiliary scan may also be done, which is a nuclear radiology study that involves injecting a nuclear dye into a vein and then taking multiple pictures over time to see how the dye is picked up by the liver and passes through the bile ducts and into the gallbladder.
The majority of people with gallbladder disease have gallstone, but there is a minority that have inflammation without gallstones. An ultrasound is excellent at detecting gallstones, but is not good at detecting gallbladder disease without stones, while the hepatobiliary scan is good at detecting gallbladder disease without stones.
If you have only had an ultrasound, then it would be appropriate to consider a hepatobiliary scan.
There are other conditions that can cause pain in the right upper abdomen that is worse with oral intake. There is no condition that will only be worse with liquid oral intake, but it would be reasonable to consider conditions that can be worse with general oral intake. The other common conditions would be gastritis or other acid irritation syndromes and pancreatitis. You many have had tests for pancreatitis, since the test is a blood test, but tests for gastritis would usually involve an endoscopy.
It is true that scarring from prior surgery can cause abdominal pain, but pain from scarring is not characteristic that it would be worse with oral intake.
So, it would be appropriate to consider a hepatobiliary scan if the only test has been an ultrasound. It also may be appropriate to consider an endoscopy.
If I can provide any further information, please let me know.
Customer: replied 2 years ago.
Would gastritis go on this long? What would be the normal treatment for this condition. Also if it were to be related to my gallbladder is there any remedy that I could try to relieve it. Or is the best cause of action going back to my GP?
Expert:  Dr. D. Love replied 2 years ago.
Yes, gastritis can exist as an acute gastritis or a chronic gastritis, and a chronic gastritis can last this long.
The usual first treatment for gastritis is a medicine to suppress stomach acid, such as ranitidine or omeprazole.
The usual treatment for gallbladder disease is surgical removal, so it would be best to go back to your doctor.
Customer: replied 2 years ago.
OK and finally - I have kept this information deliberately till last as I wanted to seek advice first from a normal patients point of view. I was diagnosed with breast cancer May 2014 and had a mastectomy removal of glands and have a very intense course of chemo. I am also taking Tamoxifen I stopped the chemo last year in October so have had no treatment since then. My doctor has referred me back to my oncologist as she is erring the side of caution based on my history. My oncologist is going to screen me for cancerous cells. If it transpired that his could be a cause would you expect the symptoms I am experiencing to be of that vain. After having had cancer I have never any pain whilst having the tumour so wonder whether this is a possibility.
Expert:  Dr. D. Love replied 2 years ago.
Abdominal pain is not one of the more common symptoms that is an indication that breast cancer has returned, but it is possible. It also is possible that breast cancer can spread to the liver, and while it will not cause symptoms in most women, it can cause right upper abdominal discomfort or pain, although it usually is not exacerbated by oral intake.
If an ultrasound was done, it would detect many of the cases of spread of breast cancer to the liver, particularly metastases that are likely to be causing pain, as these tend to be larger. A CT scan is more sensitive at detecting whether there is any spread of breast cancer to the liver.
Customer: replied 2 years ago.
Is it likely the other scan would have picked anything up if it was large enough to cause discomfort
Expert:  Dr. D. Love replied 2 years ago.
If it was an ultrasound, yes. If it was a CT scan, then even more so. If it was a hepatobiliary scan, then no, it is not good at detecting tumors.
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Customer: replied 2 years ago.
OK thank you