Upper Right Abdominal Pain and its Different Causes

Patient

Q: For the past three weeks i have had upper right abdomen pain along with chest pain and diarrhea. I was in the ER last week and they did an Ultrasound checking for Gallstones, this was clear. They then sent me home saying that the cartilage around my ribs is inflamed. Would be good to have a second opinion as we are not convinced this is whats causing the pain, sickness and diarrhea.

Doctor

A:   Costochondritis (inflamed cartilage around the ribs) typically causes chest pain. The explanation of the pain is this: the chest wall has ribs, muscles and cartilages; when you breathe deep or cough, the chest wall tends to expand, thereby, stretching the inflamed cartilage, hence, the pain. If the chest pain occurs when you breathe deep, then it is likely costochondritis. On the other hand, the ultrasound is sensitive for detecting gallstones. However, before gallstones form, a biliary sludge (collection of fat deposits that has the consistency of a fruit shake) may form first. If an analogy should be made: sand + water = soft, fluid like form. Removing water from this mixture would eventually turn into a stone. In other words, a biliary sludge usually forms first before gallstones are formed. Biliary sludge may not be detected by ultrasound. Symptoms are also similar to that of gallstone disease. I am not sure if the diarrhea you are having is part of this condition as sometimes, it’s subjective. If what you meant was an increase in frequency (5-7 per day) and watery consistency of stools, then it is diarrhea. You always have the right to seek for a second opinion. If your symptoms have been going on for 3 weeks already, then I think it needs further tests and urgent attention. I do hope I have enlightened you in some way. Take care always.    

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