My liver hurts

March 2, 2005 11:08 AM

I am having a hard time getting satisfactory answers about why my liver hurts. I've been to a couple doctors and have done some searching online, and I can't really match my symptoms to anything. I thought I'd check here to see if anyone had any ideas I hadn't thought of yet.

I've been having fairly constant shart pain in my upper abdomen and right flank for about six days, with the pain increasing when I eat or move/twist/step hard. I am also tired, headachey, and generally feel kind of gross. I've been to a regular doctor, who sent me to an emergency room. They said there is nothing wrong with my appendix or gallbladder, and that blood tests indicated mild inflammation of the liver, but with no appreciable cause. They emphasized that this was REALLY mild, and so it's odd that I should be having so much pain. They tested for mono, which was negative. Is there anything they missed? Can you think of anything else I should ask/do? No one seems to be able to tell me anything except "wait it out and hope it goes away."

posted by ohio to health & fitness (17 comments total)

my roomate has just been diagnosed with Gilbert's syndrome, but I don't know if pain is one of the symptoms.
posted by killy willy at 11:19 AM on March 2, 2005

Have you had a Hepatitis test? I assume that you have, since this is the first line with liver stuff. Also, I hope this isn't too obvious, and also I assume it was asked by docs etc, but how much do you drink? I mean alcohol. Do you take medications that are cleared through the liver? Tylenol, for instance?

I agree that this seems strange since the problem was acute enough not only to visit your doctor but also to be sent by her to the ER.
posted by OmieWise at 11:38 AM on March 2, 2005

I've had the same problem in the past. What I believe was happening was mechanical pressure on my liver from my lower ribs. I don't know about you but I am 220 lbs and a fairly muscular male. When I was not working out and my bulk was shifting (read: forming a gut) it seemed to worsen, especially while I was sitting. This seems to support my mechanical theory. Furthermore, when I was working out I had no symptoms. I had to stop working out last May because I am in school full time, working, family, etc. and since then...right around Christmas it seemed to start to happen again. I am getting bulkier now, too (thanks to the holidays) so this seems to, once again, support my mechanical theory.

By the way, I am a registered nurse and have pretty good knowledge of anatomy so that's what helped me form my theory. If your tests are all negative, I would guess that it may be mechanical and exercise may help. If you tell me that you do exercise and you are in no way overweight, then I really cannot offer anything else.
posted by SparkyPine at 11:48 AM on March 2, 2005

I'll second the above, and remind you that livers don't hurt. The capsule surrounding can, if it is stretched or poked or damaged, but the liver-y insides have no pain receptors.

Does the pain change if you get on your hands and knees and let your abdominal contents "hang" freely?

(Hi Sparkypine.. another RN here.)
posted by reflecked at 12:01 PM on March 2, 2005

And if the nerve tissue surrounding your liver is poked, you actually feel the pain in your right shoulder!
posted by dchase at 1:02 PM on March 2, 2005

hmmmm. Yes, they tested for hepatitis and it was all negative. The only abnormal test were the ones that suggested liver inflammation. I think it is unlikely, although possible, that my ribs are the problem. I exercise, am not overweight, and the pain came on kind of suddenly. I tried getting on my hands and knees and there was some discomfort but the sharp pain didn't get worse or better. well shoot.
It's interesting to know that livers don't hurt; no one told me that yet. Could I have somehow injured the capsule? Would the inflammation stretch it, causing it to hurt? Could increased abdominal muscle strength be a problem? I do a lot of weight training (it's a class. i know) and maybe my muscles got too strong and are pushing on my liver? maybe I'm just crazy. . .
posted by ohio at 1:07 PM on March 2, 2005

I recently went through some abdominal pain and after some lab work my doctor reached the conclusion that my liver was the problem. By the time I went in for the classic "further testing," it seems the problem had gone away. But after talking to the docs, I was left with the impression that this type of problem generally comes about when the liver is trying to process more toxins than it can handle. In this case, the MD thinks I was just taking too much tylenol at the time.

Are you currently taking any meds or fat soluble vitamins? Is it possible that you've given your liver a bit more than it can handle?
posted by Clay201 at 1:31 PM on March 2, 2005

I don't see any mention of stones anywhere...
posted by SparkyPine at 2:15 PM on March 2, 2005

If your feeling hypochondriacal despite the all-clear from the ER this might help you :
Table of Differential Diagnoses for Abdo Pain
Though in med school they taught us that if you couldn't come up with a plausible diagnosis in a viva exam, just guess at TB or syphilis, since they can cause practically every sign or symptom
posted by roofus at 2:17 PM on March 2, 2005

There's a number of tests that indicate "liver inflammation." Was it ALT/AST?

Any other symptoms? Fever? Yellow in your corneas or under your tongue? Do you drink alcohol, take any medications? The differential diagnosis for "liver inflammation" is very broad, and I'm assuming they tried to rule out most of the causes at the ER. That is, of course, assuming this is liver-related at all.

Could be some other GI organ. Could be musculoskeletal or kidney, if it's in your flank. Keep hydrated, get plenty of fluids and rest, and follow-up with your doctor. Maybe hold off on major strenuous exercise, if that's making it worse. This could be due to a muscle tear; did it start after you worked out?

You're right that it's the increased stretching of the liver capsule (the peritoneum) causes the pain, usually due to some fluid in there, but I don't believe your abs/obliques should be doing that; they're pretty exterior to your abdominal cavity/peritoneum.
posted by gramcracker at 2:43 PM on March 2, 2005

thanks for all the suggestions! I ended up calling a doctor I know from home that I trust and she told me that there are "thousands" of viruses that cause mono like symptoms and that my symptoms sounded like mono. She said that some of these viruses do cause liver inflammation (the AST/ALT levels going up) and that I should try to treat myself as if I had mono. Lots of rest, fluids, watch for jaundice, go back to the hospital if I start puking or if the pain becomes unbearable.
I am very frustrated that the other doctors weren't able to even give me that simple advice, but I feel a little better about it now. Unfortunately my stomach doesn't feel better!
posted by ohio at 3:00 PM on March 2, 2005

Any chance of it being a kidney stone? My first stone created a radiating pain from my flank all the up to my diaphragm and down to my crotch. I think most pass within a few hours of you first noticing it, but I've had nurses tell me that it can sometimes take days.
posted by letitrain at 3:18 PM on March 2, 2005

Though in med school they taught us that if you couldn't come up with a plausible diagnosis in a viva exam, just guess at TB or syphilis, since they can cause practically every sign or symptom

Or lupus. Don't forget lupus, the disease of a thousand differentials.
posted by LittleMissCranky at 4:16 PM on March 2, 2005

I can tell you that for the past few months, I've suffered with an abdominal stitch ... it's not so much painful as uncomfortable, and it's related to the nerve that also services my lower back. And it seems that about 2 days before I get laid low with a lower back spasm, the stitch will flair up and hurt, thereby warning me to start doing my stretching exercises.
posted by crunchland at 10:21 PM on March 2, 2005

I had hepatitis when I was younger, and developed a "feeling" for the state of my liver after that. I can tell when it's unhappy (like from drinking too much) and the feeling is a kind of "pressure" in the lower right abdominal cavity. Although subtle, it is hard to ignore as I'm sure ohio found out.

If further medical investigation craps out, I can tell you what medicines help relieve that bad liver feeling in my case. One is the herb "milk thistle". Widely available, this can really help if taken before or during drinking. Another is the chinese herbal concoction known as "chi pai di haun haung". It's a few different herbs, roots and fungi together. If my liver isn't feeling too well, this latter one can bring a feeling of relief within a couple of hours. Your mileage may vary, natch.
posted by telstar at 2:20 AM on March 3, 2005 [1 favorite]

My clinical guess is gallstones, or maybe one big one that you might have already passed. Ultrasound isn't particularly sensitive in detecting these. But they're so common, and they cause exactly what you describe (RUQ pain, Murphy sign, elevated transaminases).

Viral infection also seems not unlikely.

If I were your doctor, I'd tell you to wait it out until it goes away; and if you start having fevers or the pain worsens instead of improves, head back to the E/R.

But I'm not your doctor, and I don't treat people over the Internet. So I can't be responsible for what happens to you. The last two sentences brought to you courtesy of John Edwards and his "professional" colleagues.
posted by ikkyu2 at 8:08 AM on March 3, 2005

Also, there's no reason to think Gilbert syndrome is involved here.
posted by ikkyu2 at 8:09 AM on March 3, 2005