[45F] With right rib pain, severe fatigue, jaundice, and diarrhea

Patient Description

A 45-year-old female presents with sudden onset of constant pain under the right rib for the past three days, rated 6 out of 10 in severity. The patient also reports severe fatigue, night sweats, diarrhea, yellowing of the skin or eyes (jaundice), loss of appetite, and recent weight loss. There are no changes in the color of urine or stool, no nausea or vomiting, and no abdominal swelling or bloating. The patient has a history of methamphetamine use for 17 years but does not consume alcohol, take any new medications or supplements, or have a family history of liver disease, gallbladder disease, or hepatitis. No recent travel or exposure to hepatitis. No known drug allergies and not currently on any medications.

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Arora's Assessment

What might be happening

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

  • Liver Disease: The combination of right upper abdominal pain, jaundice (yellowing of the skin and eyes), severe fatigue, and weight loss could indicate liver disease. Chronic methamphetamine use can lead to liver damage, which might explain your symptoms. Common liver conditions include hepatitis, cirrhosis, and liver cancer.

    • Typical Treatments and Testing: Blood tests to check liver function, imaging studies like an ultrasound or CT scan, and possibly a liver biopsy. Treatment depends on the specific condition but may include medications, lifestyle changes, and in severe cases, liver transplantation.
  • Gallbladder Disease: Pain under the right rib, especially if it is constant, could be related to gallbladder issues such as gallstones or cholecystitis (inflammation of the gallbladder).

    • Typical Treatments and Testing: Ultrasound of the abdomen, blood tests to check for infection or inflammation, and possibly surgery to remove the gallbladder if gallstones are present.
  • Pancreatitis: Inflammation of the pancreas can cause severe abdominal pain, jaundice, and digestive issues like diarrhea.

    • Typical Treatments and Testing: Blood tests to check pancreatic enzymes, imaging studies like a CT scan, and hospitalization for severe cases to manage pain and provide supportive care.

What you can do

While you should seek medical attention to get a formal diagnosis and appropriate treatment, here are some steps you can take in the meantime:

  1. Avoid Alcohol and Drugs: Since you have a history of methamphetamine use, it is crucial to avoid any substances that can further harm your liver or overall health.
  2. Stay Hydrated: Drink plenty of water to help manage diarrhea and prevent dehydration.
  3. Eat a Balanced Diet: Focus on a nutritious diet that is low in fat and high in fiber. Avoid fatty, greasy, or spicy foods that can exacerbate digestive issues.
  4. Rest: Ensure you get plenty of rest to help your body recover from fatigue and other symptoms.
  5. Monitor Symptoms: Keep track of your symptoms, including any changes in pain, jaundice, or digestive issues. Use the MDandMe journal to record your symptoms, track progress, and share this information with your healthcare provider.

What you should look out for

Seek medical attention more urgently if you experience any of the following:

  • Severe Abdominal Pain: If the pain becomes unbearable or spreads to other areas.
  • High Fever or Chills: Indicating a possible infection.
  • Confusion or Drowsiness: Signs of severe liver dysfunction.
  • Blood in Stool or Vomit: Indicating possible internal bleeding.
  • Inability to Eat or Drink: Leading to severe dehydration or malnutrition.

Remember, while I can provide information and suggestions, it is essential to consult a healthcare professional for a formal diagnosis and appropriate treatment.

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5 mo ago

People Also Ask


What are the common symptoms of liver disease?

Common symptoms of liver disease include jaundice (yellowing of the skin and eyes), abdominal pain, fatigue, weight loss, loss of appetite, and sometimes changes in urine or stool color.


How can methamphetamine use affect the liver?

Methamphetamine use can lead to liver damage by causing inflammation, fibrosis, and even cirrhosis over time. It can also increase the risk of liver infections and exacerbate existing liver conditions.


What are the typical diagnostic tests for gallbladder disease?

Typical diagnostic tests for gallbladder disease include an abdominal ultrasound to check for gallstones or inflammation, blood tests to detect infection or inflammation, and sometimes a CT scan for more detailed imaging.


What lifestyle changes can help manage symptoms of liver or gallbladder issues?

Lifestyle changes that can help manage symptoms include avoiding alcohol and drugs, staying hydrated, eating a balanced diet low in fat and high in fiber, getting plenty of rest, and monitoring symptoms closely to report any changes to a healthcare provider.


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