What causes severe mid and upper right quadrant pain?
Eryne S asked:
What can cause severe upper and mid right quadrant pain?
I have been experiencing severe abdominal pain for the last 3 days to the point of being intolerable at times. It is in the mid and upper right quadrant. I do not have nausea, vomiting, constipation or urinary symptoms. I have had a laproscopic gallbladder removal, total hysterectomy and appendectomy. After my gallbladder was removed, I had to have an ERCP because a gallstone lodged in my common bile duct (1989). I have an appointment with a gastroenterologist next Wednesday, but I am not sure I can tolerate this pain that long. I am on Ultram 100mg every 6 hours, which does not resolve my pain. The pain is constant, but more severe at times.
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What can cause severe upper and mid right quadrant pain?
I have been experiencing severe abdominal pain for the last 3 days to the point of being intolerable at times. It is in the mid and upper right quadrant. I do not have nausea, vomiting, constipation or urinary symptoms. I have had a laproscopic gallbladder removal, total hysterectomy and appendectomy. After my gallbladder was removed, I had to have an ERCP because a gallstone lodged in my common bile duct (1989). I have an appointment with a gastroenterologist next Wednesday, but I am not sure I can tolerate this pain that long. I am on Ultram 100mg every 6 hours, which does not resolve my pain. The pain is constant, but more severe at times.
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I was going to say gallstones, but I guess you don’t have your gallbladder anymore, and it would be unlikely that you have another stone lodged in your bile duct this far out. Other possibilities are a gastric ulcer, pancreatitis, or you could have a fluid collection where your gallbladder was (a bilioma, or a bile leak). I hope your doctor figures it out and I hope your pain goes away!
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A broken rib, dislocated shoulder, pinched nerve, another stone in your bile duct, a hernia at the site of recent surgeries, a liver or pancreas infection, blockage in your intestinal tract, an infection in the lining of the wall of your right lung (there’s a technical name, like pleuracy but I know that’s spelled incorrectly), and believe it or not, in women, a heart attack.
Ultram sucks for severe pain. You need Vicodin.
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Did you have a stent put in when you had your ERCP? If you had that might have helped. Sounds like you may have pancreatitis if your pain gets worse go to the ER. My co-worker just had this same affliction that you are having. She is fine now because they inserted the stent and then she passed it in her stool. She was in severe pain. Hope you feel better soon.
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The term acute abdomen defines a clinical syndrome characterised by the sudden onset of severe abdominal pain requiring emergency medical or surgical treatment. A prompt and accurate diagnosis is essential. The differential diagnosis includes an enormous spectrum of disorders, ranging from simple self-limited disease to conditions that require emergency surgery. There is no way to predict or prevent an acute abdomen. It can occur in anyone, anywhere.
Abdominal pain
Although most causes of abdominal pain are related to diseases of the gastrointestinal tract, urinary tract and the gynaecological subsystem, one must be aware of abdominal pain from other causes. The subjective nature of pain and the fact that common symptoms may arise from a broad spectrum of diseases combine to make interpretation difficult. Time of onset of pain, its location, its referral, and whether a change in character occurs with various postures, needs to be highlighted.
It is important to notice the site of pain at the onset from the site at the time of presentation. Pattern of radiation of pain is helpful — right shoulder (gall bladder), left shoulder (spleen), mid back (pancreas), flank (urinary tract), groin (urinary tract).
Factors that precipitate or relieve pain should be enquired — relationship to eating (stomach, gall bladder, pancreas), urination (kidney), position (pancreas), or menstruation.
Location of pain (Fig. 2)
Appendix pain usually occurs in the lower right abdomen. It may start as a vague discomfort around and just above the umbilicus and later a sharper pain in the lower right quadrant of the abdomen, with possible nausea, vomiting and loss of appetite, fever and pain on pressing the lower right abdomen.
Gallstones can cause upper abdominal pain, nausea, vomiting, heartburn and back pain. Along with pain, one may have yellowing of the eyes (jaundice) and inflammation) of the pancreas (pancreatitis). Pain usually occurs in the upper right side of the abdomen and radiates to upper right side of the back. It usually begins one to three hours after a meal and persists for several hours. It may be accompanied by nausea and vomiting.
Kidney stones may cause severe pain in the flank (the area between the last rib and the hip) and/or pubic region. Chills, fever, frequent or difficult urination are common.
Upper mid-abdominal pain, between umbilicus and the end of the breast bone is because of peptic ulcer. Peptic ulcers are eroded areas in the protective lining of the stomach and are caused by excess stomach acids and other irritants.
Upper abdominal pain, diarrhoea, nausea and vomiting blood or what looks like coffee grounds may be because of gastritis (a painful inflammation of the lining of the stomach). Pain may be associated with heartburn (a burning sensation) from the upper abdomen and spreading into the lower breast bone and is caused by the flow of acid from the stomach into the food pipe.
In a patient with known inguinal hernia, increased or severe groin pain especially if accompanied by nausea and vomiting and groin bump feels very tender, is a pointer towards obstructed hernia or strangulated hernia (a part of the intestine gets pinched off). In event of an increasing pain in the abdomen, scrotum or groin, think of complication in a hernia and do not apply pressure to push hernia back into the abdominal wall.
Abdominal pain that begins in the midepigastrium, with a penetrating quality and radiating to back is a typical feature of acute pancreatitis. Nausea and vomiting frequently accompany the abdominal pain. Along with pain, patient may have fever, increased heart rate and abdominal distension. Pain may be relieved by sitting forward.