Pain below right ribcage

[Csbass828]

I have had multiple CT scans and MRIs and none of them show cirrhosis, but they show fatty liver. I've had a burning pain below my right rib cage for over a month...it hurts bad! My last liver enzyme tests were within range. I have been on a diet since this started and I've lost 18lbs, but still have fatty liver. None of my imaging tests have shown an enlarged liver. I don't understand this. Has anyone here had a similar situation?

[Richard-Allen]

The liver is the body’s sugar factory. One of the 500 jobs the liver carry's out is making sure there is enough food for all the muscles in our body. These muscles constantly need fuel to work. Even when our eyes blink, our muscles are burning up fuel. That lung full of air you’ve just taken needs fuel too.

This liver is constantly turning sugars into glucose which the muscles use as food. If there is too much glucose then the liver sees this as being a precious food and saves it for another time. So excess glucose beyond what the body needs for immediate energy is converted into glycogen, a storage form of carbohydrate, or converted into fat and stored in body fat cells.

The liver likes to keep a small amount of fat, just in case it needs an urgent supply of food later on. But too much fat is bad for the liver.

Now, the liver doesn’t have any pain receptors so it can’t tell you when it’s being damaged. This is just as well as some of the chemicals the liver has to process can be very toxic, so if it did have pain receptors, we’d all most likely be constantly doubled up in pain.

This isn’t to say we can’t feel any pain from the liver area. The liver is surrounded by a thin membrane. This is called the “Glisson Capsule”. Now, this membrane does have pain receptors, so if the liver were to become inflamed and enlarged, this membrane stretches and this can cause pain and discomfort.

Also, the gallbladder can cause pain in that area too, so this would need to be ruled out as being a possible cause. Even if you've had the gallbladder removed, some leftover stones can still get stuck in the bile duct and cause problems.

Although fatty liver needs to be understood and managed, The cause needs to be understood better too.

If the liver is struggling or fighting a possible infection, then the fat can begin to build up.

There is presently a study going on at Birmingham University where they have found that for a person who has a gum infection (Periodontitis), the brushing action can force bacteria down into the gum which then finds its way into the blood system and onto the liver. The result is the liver has to fight this bacterial infection, in turn, brings about an increase in fat in the liver.

So, I’d look to see if you presently have any other bodily infection going on at the moment. Then look at your diet and lifestyle. With fatty liver, there’s nothing done that can’t be fixed.

Hope this helps

Richard

[Csbass828 in reply to Richard-Allen]

Thanks for your reply. I am on a very low carb,low fat diet . I had my gallbladder removed 2 months ago. This pain really got bad about a week after the gallbladder removal. I've been to the hospital several times since then with no answers. I am not drinking any alcohol at all. I'm just hoping that this isn't something serious. I really don't know how it couldn't be, because I've been hurting so long. I have not been checked for any infections that I'm aware of even though I've been to the hospital 4 times because of this pain.

[Richard-Allen in reply to Csbass828]

As I mentioned earlier. Sometimes when the gallbladder has been removed, some of the stones can be missed. These can then often become stuck in the bile duct, which impedes the flow of bile. This then causes the bile to become backed up into the liver. There is a danger here that it can become infected and cause damage to the liver.

This can sometimes become a cat-and-mouse game.

The patient goes to the Doctor, who carries out a blood test, and the results come back showing some of the enzymes to be high. The doctor thinks this might just be a possible infection, so repeats the test three weeks later. By this time the blocked gallstone has become dislodged and the bile Is flowing freely again. So the enzymes all return to normal.

Six months later, something totally unconnected happens and the Doctor calls for another liver blood test. Here once again the stone has become stuck again and the liver enzymes have risen once more. The Doctor at this point should refer someone for an ultrasound scan to see what’s going on.

I’m certainly not saying this is your problem, but it is just one of many possibilities that need to be ruled out to find out what is causing you this trouble.

Your doctor will be on the case and monitoring your progress.

Good Luck

Richard

Gallstones in the bile duct

[Csbass828 in reply to Richard-Allen]

Thanks for your reply. They haven't seen any other stones on imaging unfortunately, that's what has got me so concerned.

[WW_ell in reply to Richard-Allen]

Richard, this is a very informative and well written post - thank you!

[Doraflora in reply to Richard-Allen]

Hello Richard-Allen. Thank you for explaining things so thoroughly.

My husband has just had blood tests and his Gamma GT was 88iul (range 0-70). The gp described it as “elevated”. All his other results were ok though (apart from a high ferritin level).

He had been taking quite a few paracetamol for - what has just been diagnosed as spinal spendosis - at the time of having his bloods done. Could this affect his blood tests? He was in an awful lot of pain at the time.

The gp has also suggested he slightly reduce his alcohol consumption and he will have his bloods retested in 3 months.

Is 88iul really over the top?

[Herman7275]

Not a dr, with fatty liver You can have fibrosis and not be cirrhosis, I found in 2018 that was my problem, still no cirrhosis but have helped fatty liver and fibrosis. Been on low carbohydrates diet and exercise, which is the answer , no alcohol ever again. Which was not my problem ,I have nash & NAFLD.. I have pain in right side. But staying true to diet and exercise is the answer for most!!

[Csbass828 in reply to Herman7275]

Do you know if you get rid of NASH?

[Herman7275 in reply to Csbass828]

I reversed my fatty liver, am not sure about NASH, will take a determined person to stay on a extreme low carbohydrates diet and exercise. And will depend on what your fibrosis is tated at F-2 or 3or 4. But anything is possible and the more you try the better your liver will get better and thats the best....

[Csbass828 in reply to Herman7275]

I just got my hidascan results of F0-F1. I've been on a diet for a month. My liver enzyme levels are within range as well. I had gone to the hospital for pain the day before I had the fibrosure blood test and they had given me pain medicine that I believe spiked my enzyme levels at the time that test was taken.I believe that threw the test out of wack because my levels had never been that high and I've been tested many times with only mildly elevated levels due to fatty liver. I'm still in pain though. I stopped eating carbs and sugar and my ketones went through the roof. My doctor told me I needed to reintroduce some carbs in my diet, but I want to get rid of this fatty liver. It's a catch 22. I lost 20lbs in a month, but I still have a fatty liver

[Herman7275 in reply to Csbass828]

You must limit carbs ,I kept track daily of carbs, fat, protein. Look up My Fitness Pal an app on your cell phone ,plus it will give you your numbers when you decide different foods.I have been on low carb diet since 2019. I was limited to 30 carbs daily. I had my annual fibroscan, the end of September. I was marked F2-F3 moderate fibrosis. My fibrosis liver stiffness measurement of 8.9kPa, liver fat assessment 239 decibels/m(dB/m. I hope this helps you, any questions or thoughts let me know!

[Csbass828 in reply to Herman7275]

Thanks for the info. I meant fibroscan not hidascan.

[Csbass828]

Thanks for your reply