Pain under right ribs, 18 cm liver on ultrasound, normal labs

Hi all,

This is my first post here. I'm 27 years old, and for about four years now, I have been having intermittent pain in my right upper abdominal quadrant. Sometimes this pain is kind of a vague and dull ache, other times it is a bit sharper and more localized. It is always on the right side under the ribs.

During this time, I have had LFTs (including AST, ALT, ALP, albumin, bilirubin, and globulin) drawn on probably six separate occasions, and never have any of these results been abnormal, save for when I had mononucleosis in 2013, which I was told was to be expected. I had an ultrasound done in '13 which showed "mild fatty infiltration" and a liver span of 14.7 inches. I had another sonogram done in September of '16 which reported that the liver was "homogenous in architecture without focal abnormalities. Prominent, measuring 18 cm."

My gastroenterologist says that although this 18 cm measurement falls slightly outside of what is typically considered the normal range, it is nothing to be concerned about because the report does not talk about any fatty infiltration or remark on any other findings that would suggest liver damage, and especially since my enzymes have never been outside the normal range.

My most recent LFT numbers, collected 11/30/16, were:

AST: 26

ALT: 24

ALP: 70

Bilirubin total: 0.7

Albumin: 4.9

I continue to have the upper right quadrant discomfort, though, especially after I drink alcohol. I am probably a heavier drinker than most -- it's not uncommon for me to have 3-4 beers on a weeknight and anywhere between 6-10 on a weekend. I am cutting down -- in fact I went six weeks without any alcohol at all in September/October -- and that does seem to help with the discomfort somewhat, though not entirely.

My gastroenterologist thinks the symptoms are more likely due to trapped gas in the hepatic flexure of the large intestine or intestinal spasm rather than an issue with the liver. My question is, can a liver of 18 cm really be a normal variant, especially since it was significantly smaller in the last sonogram? Has anyone else experienced a similar situation?

I know I should probably be satisfied with the results and move on, but I just can't shake the idea that something is wrong with my liver.

Any feedback or sharing of relevant experiences would be appreciated. And full disclosure, I'm American, not a Brit, though I did study in York for six months in college.

Thanks!

8 Replies

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  • Hi, Welcome, no problem about you not being a Brit, we all share a liver disease of some sort. There is a wealth of help and friends on here, but please remember no matter what advice is given always see your doctor. Alcohol seems to cause you some discomfort so may cut down a bit more. Hope it all goes well for you.

  • Hi Sean

    A warm welcome to this chat forum I am finding it so supportive. First time I have really ever been a part of one so many good people here.Also join PBS foundation perhaps for info.

    I just read your post I can't really answer your questions but do know my same rib pain started in my 20s I thought it was a bruise or just carrying my child around.I am now in late fifties just recently diagnosed likely PBC. I think it's great you are asking questions now. Request a specific search perhaps .

  • Had similar with enough wind to fly a kite and constant gurgling in my stomach initially it was thought I had gall stones so I Had an ultrasound which showed I didn't have gallstones but had got an enlarged fatty liver.

    Basic treatment was a change to a Mediterranean diet, ditched all white breads and white flour based products, changed to brown rice, brown pasta and minimum 15 minutes exercise a day, also had to ditch all take away foods, and pastries. Also was set a target by my doctor to get as close to BMi score in the green as I could, which meant lose some weight fat boy ! But the thing with the weight loss is it has to be done slowly as you can damage your liver by losing it quickly just had to look at losing 1 to 2 kilos per week.

    A year on I have gone down from 118kg to 96kg, and the pain in my ribs only comes back as a reminder if I have the wrong foods,

    Apparently most people in the west have fatty livers but it only becomes painfull when it starts to crowd your other organs through enlargement.

    Good luck with your diagnosis.

  • I was told all the things you were told almost exact situation but when I had a fibroscan done it indicated moderate to severe fibrosis. Doctors are quick to rule that possibility out and I was told the same thing about trapped gas. If you are a heavy drinker I suggest you get a fibroscan done to find out if you have any damage. Lft's and ultrasound would not show that

  • Thanks, I just sent a note to my doctor about the fibroscan. I didn't mention that I also had a HIDA scan which was normal... Did you have a full panel of normal liver blood work before you were diagnosed with PBC?

  • Hi,I had similar pain for sometime before been diagnosed with PBC.

    Maybe ask for a test for that.

    Hope you get it sorted.

  • I would ask for AMA blood test to rule out PBC right upper belly pain under the ribs is my first symptom of PBC , if you haven't had it yet and don't drink anymore let your liver heal , good luck let us know.

  • I'm 32 male and it sounds like I have the exact same problem. Diagnosed with haemachromatosis 8 months ago and have exact same symptoms as yourself. Pain was that bad last week I couldn't breathe and my work had to call an ambulance, I've been waiting for scan results for over 4 weeks now. The wait continues 👎🏻

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