Upper Right Abdominal Pain 3 months after Cholecystectomy

This post is a response by a doctor to a question one of our community members asked.

Al Asks:

I’ve been having upper right abdominal pain and right shoulder blade pain 3 months after cholecystectomy. After eating and waking in the morning.

Dr Nitesh’s reply:

Upper right abdominal pain and right shoulder pain are most commonly caused by acute cholecystitis. If the pain is right under the ribs, it can indicate liver pain. Even after cholecystectomy, gall stones can get lodged in the remaining stent of the bile duct and lead to choledocholithiasis. Both cholelithiasis and Choledocholithiasis can lead to abdominal apin after eating. Other common cause of abdominal pain after a diet is gastritis, but gastritis is usually in the mid part of upper abdomen and not on right. Symptoms with coledocholithiasis are similar to cholelithiasis and surgical intervention is the best possible management available.  Surgical intervention is indicated for choledocholithiais even in asymptomatic patients due to its potential life threatening complications like Pancreatitis and cholangitis. Imaging Modalities are usually used to confirm the diagnosis of choledocholithiasis.

Any pathology that leads to inflammation and swelling of liver capsule leads to pain in right upper quadrant of abdomen. Some people perceive it as pain in right shoulder due to common nerve supply. In severe cases this can also lead to back pain.

Inflammation and swelling of liver capsule can occur to various causes like Viral Hepatitis, Liver abscess, Alcoholic hepatitis, peri-ampullary mass, amoebic abscess in the liver etc. A doctor can order a set of blood tests and some imaging modalities if there is suspicion of any of the above causes. In case liver involvement in suspected the most common diagnostic modality ordered is a liver function test. For this test a blood sample is withdrawn and test result can help the doctor to reach at a diagnosis. Ultrasonography or CT scan of the abdomen can be ordered depending on the suspicion of the most probable diagnosis. Viral hepatitis can be confirmed by blood tests while making diagnosis of liver abscess may require aspiration of the abscess under ultrasonographic guidance.

Management of above scenarios are proceeded to once the diagnosis is made. Viral hepatitis is usually managed with anti-virals along with supportive measure. Liver abscess can be managed with antibiotics or they may need aspiration, if the abscess is large.

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