RUQ pain (long read)

by Alex
(England )

I am 23 year old male, otherwise healthy, non smoker (use an electronic cigarette).

My longest standing symptom is RUQ pain that started October 2011, this is chronic in nature and the only aggregating factor I seem to find is stress, it comes in waves of pain lasting no longer than around six seconds, however recently (27/11/13-present) it has gotten more frequent and painful and seems to be aggravated by standing up straight or bending then standing. (No fever, blood pressure normal)

I am not sure if the two are related. But on May 18th (I had taken loperamide to help my nervous stomach) I started vomiting (night of wedding) and this carried on for approximately 9 weeks nearly every day,antiemetics metoclopramide,domperidone and buccastem had limited effectiveness in controlling the severe nausea,vomiting, and feeling of fullness. I am never usually a sicky person and somewhat emetophobic so it was a very harrowing experience.

I have also been a long term sufferer of IBS like symptoms such as urgency, and occasionally diarrhoea, sometimes mucus but never constipation, also self diagnosed lactose intolerant. I have also had episodes of bright red rectal bleeding not within the stool but in the toilet bowl so have used uniroid hydrocortisone suppositories and it stopped. But the pain doesn’t seem to be related to bowel movements, or the vomiting itself.

GP ordered LFT and ALT came back as 61, then two weeks later 111. Also abdominal ultrasound in June was normal other than mild splenagolmy @ 13.7cm

I tried omeprazole for 2 days and gastro suggested stopping if it hadn’t started working already. I had an appointment to see a private gastroenterologist and he suggested that it was anxiety of the wedding that had triggered the whole thing, but he would endoscope both ends to put my mind at ease,however i could not have the procedure done on the day due to extreme anxiety, and that the RUQ pain could just be fatty liver owing to him being able to ‘pinch an inch’ on my abdomen and noted that he was not expecting to find anything sinister. Also that the enzymes & mild enlarged spleen could have been EBV as I had had a mild sore throat around 4 days after vomiting began. Also he noted I had suffered with depression in 2011 and that i took zopiclone to sleep occasionally making him lean even more toward a mental issue.

My GP prescribed pregabalin 150mg daily to help with the anxiety, i was on this for approx 3 months, and also tried amitryptaline to help sleep for a week and this didn’t help the pain or insomnia. So discontinued and now on mirtazapine for sleep & anxiety , and mebeverine as I suggested trying an antispasmodic for the pain.

Blood test 17/9 showed ALT at 81 I was then referred to see a hepatologist on 10 oct, but 16-18 week wait) then 23/10 ALT at 126 so appointment was expedited however still waiting to be seen as it stands.

I don’t feel generally anxious,just anxious about the pain and what may be wrong.

I also had a private ultrasound 29/10 which was normal gallbladder thin walled, spleen mildly enlarged @ 14cm, no focal pathology.

I don’t have the exact dates to hand but over the course of my symptoms I have had the following blood tests:

LFT’s
U&E
Inflammatory markers
Hepatitis C and B
9 am cortisol
Ferritin
EBV IGM (indicated past infection)
Auto-immune profile
Copper test for Wilson’s disease
FBC
Lipid profile (HDL very slightly low)
Fasting glucose test
Coeliac
Thyroid function test
All within range other than ALT levels said above and AST ~60
Dipstick urinalysis normal.
Went to optician eyes are normal.
Dentist normal (clutching at straws!)
2x ultrasounds normal other than spleen

I have been taking a probiotic multivitamin daily, ginger capsules to aid with nausea (gastro suggested),and fish oil supplement. Also tried milk thistle for a couple of weeks at a time.

I have totally ABSTAINED from alcohol since around May 22, as with paracetamol and other NSAIDs through fear of making things worse, so have not used any pain relief.

Since the vomiting and nausea stopped, my main problems are the RUQ pain, I can press under the rib and feel pain much greater than the left side, ALT^, and general feeling of unwell.

Not sure it’s worth mentioning i had a moderate alcohol intake previous to my symtpoms, and on my stag do i consumed a large amount of alcohol (mid April 2013) which resulted in vomiting and a 2 day hangover.

I am desperate to find a diagnosis, or some indication of what may be wrong, what tests could be done (or repeated) other than LFT’s whilst I am waiting for hepatologist? (estimated late February 2014!)