[24F] With sudden onset upper right abdominal tenderness

Patient Description

A 24-year-old female reports experiencing sudden onset tenderness under the rib cage on the upper right side for the past day. The tenderness is described as both sharp and dull, with a severity rating of 5 out of 10. The patient has no history of injury to the area. She has not experienced fever, nausea, vomiting, or changes in urine or stool color, although she had not had a bowel movement for three days until today. The patient has a history of a fatty liver but lost 150 pounds following gastric sleeve surgery five years ago. She is currently taking gabapentin 400 mg four times a day and has no known drug allergies. There have been no recent changes in her diet or medications, and she has not traveled recently. The patient denies any yellowing of the skin or eyes, pain radiating to the back or shoulder, bloating, or abdominal swelling.

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Arora's Assessment

What might be happening

Based on the information you've provided, here are some possible explanations for your symptoms:

  1. Gallbladder Issues:

    • Gallstones or Cholecystitis: The sharp and dull tenderness under your right rib cage could be related to your gallbladder. Gallstones or inflammation of the gallbladder (cholecystitis) can cause pain in this area. This pain often comes on suddenly and can be quite severe.
    • Typical Treatments/Testing: An ultrasound or other imaging tests can help diagnose gallbladder issues. Treatment may include medications to dissolve gallstones or, in some cases, surgery to remove the gallbladder.
  2. Liver Issues:

    • Fatty Liver Disease: Given your history of a fatty liver, it's possible that liver issues could be contributing to your symptoms. Fatty liver disease can cause discomfort in the upper right abdomen.
    • Typical Treatments/Testing: Blood tests to check liver function, imaging tests like an ultrasound, and lifestyle changes such as diet and exercise are common approaches to managing fatty liver disease.
  3. Nutritional Deficiencies:

    • Low Magnesium and Low White Blood Cells: These deficiencies can contribute to fatigue, weakness, and changes in appetite. They may also be related to your gastric sleeve surgery and subsequent weight loss.
    • Typical Treatments/Testing: Blood tests to monitor nutrient levels and supplements or dietary changes to address deficiencies.

What you can do

Gallbladder Issues:

  • Seek Medical Attention: Given the sudden onset and location of your pain, it's important to see a healthcare provider to rule out gallbladder issues. They may recommend an ultrasound or other imaging tests.
  • Dietary Changes: Avoid fatty and greasy foods, which can exacerbate gallbladder symptoms.

Liver Issues:

  • Follow Up on Liver Health: Given your history of fatty liver, it's important to monitor your liver health. Your healthcare provider may recommend blood tests and imaging studies.
  • Healthy Lifestyle: Continue to maintain a healthy diet and exercise routine to support liver health.

Nutritional Deficiencies:

  • Supplements: Consider taking magnesium supplements as recommended by your healthcare provider.
  • Dietary Adjustments: Incorporate magnesium-rich foods into your diet, such as leafy greens, nuts, seeds, and whole grains.
  • Monitor White Blood Cells: Follow up with your healthcare provider to monitor your white blood cell count and address any underlying causes.

General Tips:

  • Stay Hydrated: Drink plenty of water to help with overall health and digestion.
  • Rest: Ensure you get adequate rest to help your body recover.
  • Track Symptoms: Use MDandMe to journal your symptoms, track progress, get insights, and share longitudinal medical notes with your provider.

What you should look out for

Given the severity and sudden onset of your symptoms, you should seek medical care as soon as possible. Reasons to seek care even more urgently include:

  • Severe or Worsening Pain: If the pain becomes more severe or spreads to other areas.
  • Fever or Chills: These could indicate an infection.
  • Yellowing of Skin or Eyes: This could be a sign of liver issues.
  • Persistent Nausea or Vomiting: This could indicate a more serious underlying condition.
  • Changes in Urine or Stool Color: Dark urine or pale stools can be signs of liver or gallbladder issues.

Remember, while I can provide information and suggestions, it's important to consult with a healthcare professional for a formal diagnosis and appropriate treatment. If you have more questions or need further assistance, feel free to continue the conversation.

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4 mo ago


People Also Ask


What are the common symptoms of gallbladder issues like gallstones or cholecystitis?

Common symptoms of gallbladder issues include sudden and severe pain in the upper right abdomen, pain that may radiate to the back or shoulder, nausea, vomiting, and sometimes fever. The pain often occurs after eating fatty meals.


How can fatty liver disease cause discomfort in the upper right abdomen?

Fatty liver disease can cause discomfort in the upper right abdomen due to the accumulation of fat in liver cells, which can lead to liver enlargement and inflammation, causing pain or tenderness in the area.


What are the potential nutritional deficiencies after gastric sleeve surgery?

Potential nutritional deficiencies after gastric sleeve surgery include deficiencies in vitamins and minerals such as vitamin B12, iron, calcium, and magnesium, due to reduced food intake and absorption.


What lifestyle changes can help manage fatty liver disease?

Lifestyle changes to manage fatty liver disease include maintaining a healthy weight, following a balanced diet low in saturated fats and sugars, engaging in regular physical activity, and avoiding alcohol.

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