OpenHealth Q&A

Concerns About Intermittent RUQ Pain, Fatty Stools, and Elevated Liver Enzymes – Could This Indicate a Liver or Gallbladder Issue?

**Age:** 25 **Gender:** Female **Current Medications:** None (Previous use of Hydroxychloroquine for malaria prevention in December) **Pre-existing Conditions:** Gastroesophageal reflux disease (GERD), irritable bowel syndrome (IBS), history of cytomegalovirus-type mononucleosis (2020) --- Hello everyone, I am seeking some feedback while I await further medical testing. Since contracting a CMV-type mononucleosis infection in 2020, I have struggled with various health concerns. Though I seemed to recover, I subsequently experienced gastrointestinal issues. Initially, I had elevated levels of direct bilirubin. After undergoing a colonoscopy, an abdominal CT scan, and an ultrasound—none of which revealed any abnormalities—I was diagnosed with GERD and IBS. My concerns predominantly center on gastrointestinal symptoms, but in January 2025, I began experiencing an alarming new symptom. **Details of the Incident:** - I experienced two instances of pain in the right upper quadrant (RUQ) on the same day. - The first occurred in the afternoon while I was seated, commencing as a mild pressure under my right ribs that intensified into a severe, sharp pain that also radiated toward my chest and right shoulder. This episode lasted under ten minutes, leaving me feeling utterly exhausted. - Concerned, I visited the emergency room where they ruled out a heart attack and other critical conditions. - Later that evening, around 6 PM during dinner, I suffered another episode identical to the first. - A follow-up visit to the ER involved blood tests, which indicated increased liver enzymes (ALT and AST). - An abdominal ultrasound, however, showed no signs of issues in the liver, pancreas, or gallbladder. - The physician doubted gallstones were the cause since the specific enzyme levels didn’t suggest that. - I mentioned my prior consumption of Hydroxychloroquine for malaria prevention while abroad, which can be hepatotoxic, leading them to consider a possible drug-induced liver injury (DILI). **What Followed:** - Within a few days, I was symptom-free, and my liver enzyme levels began to normalize. - For a while, I had no additional problems. **Current Symptoms:** - Since that time, I have experienced intermittent RUQ pain, frequently coinciding with my menstrual cycle but also occurring sporadically. - The nature of the pain varies; occasionally it’s sharp, other times it’s more of a tender sensation beneath the ribs, or simply a feeling of pressure. - I have also encountered fatty stools, which have intensified recently; I’m uncertain whether this is due to my IBS or another factor. - Furthermore, I’ve noted lower back pain, mostly in the evening, that feels as if something is lodged in my lower back on the right side. - Sleep quality has diminished, and I’ve been grappling with health anxiety, exacerbated by my online research on these symptoms. **Next Steps:** - I have a liver panel blood test and more imaging studies scheduled shortly. --- Could these ongoing symptoms still be related to the DILI, or is it possible there are undetected issues with my gallbladder or pancreas from the initial imaging? Have others experienced anything similar? I would greatly appreciate any insights as I wait for my upcoming tests. Thank you very much for your help!

Answers (1)

6/18/2025, 11:31:13 AM

OpenHealth AI

It’s understandable to feel concerned about your gastrointestinal symptoms, especially given your medical history and the recent episodes of pain. Based on the information you've provided, it seems your symptoms could potentially be linked to the liver enzyme elevations, but it's also possible they’re related to other factors like IBS or hormonal changes.

Key Points

• Intermittent right upper quadrant (RUQ) pain and elevated liver enzymes are important symptoms to monitor.
• Your previous history of cytomegalovirus (CMV) infection and liver enzyme elevations raises the possibility of drug-induced liver injury (DILI) or other liver concerns.
• Fatty stools and lower back pain could relate to digestive issues, possibly influenced by IBS or dietary factors.

Explanation

Your symptoms, particularly the RUQ pain coinciding with your menstrual cycle and recent fatty stools, could indicate issues with digestion or liver function. DILI can sometimes present with elevated enzymes that normalize with time. However, persistent symptoms warrant continued investigation. An absence of gallstones on imaging, while reassuring, does not fully rule out gallbladder dysfunction. Your history of GERD and IBS, along with the new symptoms, need to be taken into account as well.

Next Steps

1. Continue Monitoring Symptoms: Keep a detailed diary of your symptoms, noting when they occur, their duration, and any food or activities that might trigger them. This can help identify patterns related to your IBS or hormonal changes.

2. Dietary Modifications: Given your symptoms of fatty stools, consider adjusting your diet to minimize high-fat and greasy foods. Incorporate more fiber-rich foods, fruits, and vegetables which may aid digestion.

3. Hydration and Rest: Ensure you're staying well-hydrated and getting adequate rest, as these can significantly impact gastrointestinal health and overall well-being.

4. Manage Anxiety: Since health anxiety can exacerbate physical symptoms, consider techniques such as mindfulness or breathing exercises to cope with anxiety. Talking to a mental health professional may also help.

5. Follow-Up on Test Results: Ensure you discuss your ongoing symptoms in detail with your healthcare provider when you have your upcoming liver panel and imaging studies. It might be valuable to ask if further tests (like a more detailed ultrasound or specialized liver tests) are warranted based on your current concerns.

Remember, it's crucial to trust your healthcare team, and you’re taking the right steps by seeking further testing and managing your symptoms. If you experience any new or worsening symptoms, don't hesitate to follow up with your healthcare provider promptly. Let me know if you have specific areas you want to explore further!