Upper right quadrant pain

General Discussion
29

Well, my believe is when You have a number of people talking about a thing which beforehand wasn’t a fact, you have to agree to an extent that that thing is real. I understand that there are other health issues outside hbv, but I also feel the pressure on that part of my body too which is so uncomfortable sometimes. It’s like carrying a load inside. It doesn’t really mean that I feel pain, it’s just a feel of a load and when I lean on my right side and I have cause to make my right lat bend, I tend to feel the pain.

Secondly, does chb makes someone lean? I’m experiencing reduction in weight and muscle mass and I’ve been eating well lately so I don’t think it’s lack of food. So I’m curious.

Thanks.

30

Dear @Adedeji_Joseph,

I completely understand and think that this pain is real. I also think that people without HBV also get stomach pains as well, but we are more trained to worry about such things and tend to interpret it differently. There are certainly times where this sort of pain can be caused by HBV, but if ALTs are normal and fibrosis is low, then it is also important to consider other causes as well. As you see above, there are many people who have been able to treat their pain with reflux medicine, or altering their posture or other things. It is better to find out what may be wrong and not just accept it as a symptom of HBV.

Regarding your second question, I don’t know the answer to this, but these studies indicate that HBV is associated with lower levels of fatty liver, on average - https://aasldpubs.onlinelibrary.wiley.com/doi/10.1002/hep.28917, Hepatitis B virus infection and the risk of nonalcoholic fatty liver disease: a meta-analysis - PMC, Analysis Of Risk Factors For Nonalcoholic Fatty-Liver Disease In Hepatitis B Virus Infection: A Case–Control Study - PMC

The reasons behind this are still not really known.

Hope this helps,
Thomas

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31

My husband was experiencing severe abdominal pain and upper right quadrant pain and even groin pain which is what lead him to the ER. This is when he was diagnosed with HepB. His AST and ALT were extremely high at that time and he had an elevated Bili level. The CT and Ultrasound were listed as “unremarkable” yet noted a slight swelling to his liver and in the wall of his gallbladder too. They put him on Prednisone and Hydrocodine for pain.
As he got worse (MUCH higher AST, ALT, and Bili) his pain increased immensely. Once he became jaundice, his pain was excruciating. The Drs did explain that though the liver has no nerves, when it is not functioning properly it can effect other organs and systems that do and that was the reason for his severe pain? I am not a science person and can only relay what was experienced. But it has subsided quite a bit since he is less jaundice and his ALT & AST are coming down.

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33

Hi everyone,

This is my first post. I am so thankful to @ThomasTu to have founded this forum and honestly it has given me more mental relief than any google info or anti-anxiety pill. My husband was diagnosed with CHB in Oct’21. We had our first baby 21 days before the diagnosis and due to all international flights being cancelled because of Covid, none of our parents could visit us. It was extremely difficult to accept this news and with no support we were very scared and completely lost.
His viral load in Oct’21 was 75IU/ml and ALT was 65. His liver stiffness score was 8.04kpa and necroinflammation was 0.39. His platelets were 128000.
Surprisingly after 6 months of good exercise and eating habits, his viral load in May’22 was not detectable and ALT was 27. His platelets were still at 128000.
But, the last few months he has been on numerous trips and outings, missed his workouts and eaten out a lot and his results in Dec’22 came back much worse. His viral load is 328IU/ml now and ALT is 39. His platelets are a low of 96000. He is also complaining of a soreness in his upper right side of the abdomen with relief after bowel movement.
We have an appointment with the specialist day after and I am having sleepless nights. I hope his liver fibrosis has not progressed further. Please do enlighten me if something similar happened to anyone.

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34

I also have pain on my side abdomen, I don’t know if mine is ulcer or my liver…I did live me test and doc confirmed my liver is ok but i still have pains and tingling on my right side

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35

Hi @SS090711

Welcome to the forum. Thanks for your kind words and your question.

It’s very difficult to know what is causing this in your husband because many things can cause this sensation (as we have discussed in the above and other threads: Titling feet and pain on the righ shoulder blade). It is best for you to see your specialist to examine him appropriately and take his history into account. The low platelet count is not a general sign of Hep B, so this could relate to another health issue.

Hope this helps,
Thomas

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36

Dear everyone

I have the same question about pain on the right ribs cage. I would like to share my experience

I always feel the pain on the right ribs cage some time in the front some time at the back. Sometime strong some time mild and something not feel anything at all. This has been on going for years.

Currently, even though I do blood test and the result are normal ALT, FibroScan ( F0-F1 ), ultrasound but I still feel the pain. Sometime the pain go a little bit stronger when I eat full or sometime when I am too much hungry.

I notice the pain is increasing while I sit too long especially driving long road. If I am actively doing physical activity I usually don’t notice the pain.

This may be sound silly but the pain is true.

Thanks for sharing everyone.

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37

Last year I had a mild HBV flare, and my ALT never went above 60 (although a lot of other bloodwork spiked, in general blood test results were nasty)

Before and after that I had fluctuating upper right quadrant discomfort. Then up until a few weeks ago it started getting so bad that I felt like I had a football stuck in my chest, and it tended to get worse particularly after eating

Then I went for a FibroScan and it showed 9.1kPa fibrosis, and moderate steatosis

But here’s what I want everyone to know: I started taking 3 grams of NAC (N-acetylcysteine) at night, and even after the first day I felt 80% better regarding the upper right quadrant discomfort. After I week I felt so much better I went to a different hospital and got another FibroScan. It showed no fibrosis (<5 kPa) and no steatosis. The doctor couldn’t believe it because I showed her my previous result from a week ago. I predicted this would be the case since the upper right quadrant discomfort had almost entirely gone

I can share the FibroScan result images here if anyone wants to see proof

I think it would be good if anyone reading this that’s experiencing the same issues were to try taking NAC and post the results if it works for them or not. And if it works for most people it would be good to spread the message - because I’m extremely grateful myself for it and it’d be nice if everyone knew it were something potentially worth trying

I would like to add something else that I noticed when I had intense upper right quadrant discomfort: If I laid on my back and breathed out, and put my hand over my liver and compressed it (just pushed down for a few seconds), then took my hand off and just breathed normally - I would get about 15-20 seconds of the discomfort being completely gone and it’d feel normal. So this tells me that it would have been caused by the blood not flowing out of it properly - pushing down on it would squeeze the blood out so it’d stop feeling inflamed for a little while. So in my case I believe I got misdiagnosed with fibrosis just because I had a lot of liver inflammation. So perhaps NAC is mostly useful for those of you having liver inflammation (which can be misdiagnosed as fibrosis)

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38

Dear @ThomasTu, @bob, @SamanthaMech, @SS090711, and @senhour,

I’m back. It’s been more than a year since I last posted, and I cannot believe how fast time has gone by. When I last posted, I was relocating to a place with limited quality healthcare options so I am reconsidering some options including relocating to a larger metropolitan area with more options.

Here are my updates and I’d like to get @ThomasTu input. Then I will share similar experiences to others who have posted.

  1. Since diagnosis with HepB in March 2021 through donating blood, I’ve had two “unremarkable” ultrasounds of the abdomen. But, this past February, my third ultrasound found “mild coarsening of the echo pattern of the liver but there is no intrahepatic mass or intrahepatic biliary dilatation.” The results also found that my liver “measures 16cm” and there were “no ascites.” The scary “scarring” word was used but my doctor’s office said that the ultrasound was not the best test to identify scarring. I meet with my doctor Friday assuming she does not cancel again.

In addition, my AST is 28 and my ALT is 21. The doctor said all blood work, including kidney and liver, were “fine.”

@ThomasTu, what are your thoughts on these finds and what should I ask my doctor?

  1. That annoying upper right quadrant pain.

I have experienced what others have described since, coincidentally, my March 2021 diagnosis. Here is what I’m dealing with:

. Throbbing sensation but no pain
. Subtle “flash sensations” of sharp pain but nothing that causes me to say “ouch.” It comes and goes instantly.
. Feels like pressure in my bowel or intestines which feel good with massaging or bowel movement.
. Obvious discomfort down right side of back, cross middle of back, near right shoulder blade.

I agree with @ThomasTu that non-HepB conditions can cause the same sensations. But the fact that there appears to be a lot of similarity among us suggests as reasonable correlation between HepB and our upper right quadrant pain/discomfort. I think telling out stories could possibly inform the medical profession so our health care system can be proactive in educating us about what could happen and how to treat.

In closing, my latest ultrasound worries me, especially since I had already drastically changed eating habits, am not a drinker, am not a smoker, and lost a LOT of weight (about 50% gained back since covid mess).

Thank you everyone and stay hopeful.

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Dear @hopefulone,

Great to hear from you again, and glad that your blood results seem to be fine. Your doctor’s advice appears sound. There doesn’t appear to be anything that is worrisome and you seem to be going about it the right way.

Thomas

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40

Hi @hopefulone
So good to hear from you. I am in no position to comment regarding your lab findings as i have no expert knowledge. But, as an informed wife of a chronic hep B patient I see very little to worry about in your message. Little bit of scarring is no reason to worry as it can be reversed. Your ALT/AST are great too! I am sure you will get good news and guidance from your doctor. Please update regarding your doctor visit.
The upper quadrant pain is a problem with my husband too. It is very nagging and gives him trouble too. The shoulder blade pain also happens. However, his GI has said that it is related to other issues( he has costochondritis so that adds to the pain and also his posture while working on the laptop and certain foods that cause gas and bloating).
His platelets had dropped a lot so he had to undergo a liver biopsy and result came out good. No significant fibrosis and no sign of cirrhosis. So, the pain is not related to the liver.
Don’t worry and take good care of yourself!

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41

Dear @SS090711,

Thank you for your kind words of encouragement. I really needed to hear them. I will keep community posted on progress when I learn something new. Dealing with other work-related problems also (ughh!). I really rely a lot on my faith, positive scriptures, and healing YouTube videos when I go to bed so positive messages can seep into my subconscious when sleeping.

Take care everyone!

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42

Hello @ThomasTu, @Joan_Block, @SS090711 and everyone:

I have a few updates since last post:

  1. I moved to a new location where there is a research university and many more health services. I meet with my new doctor in two weeks who is also affiliated with Infectious Diseases Society of America.

  2. I will be scheduling an elastography to see if the “mild coarsening” on my liver is abnormal. My former doctor said that the observation tends to be “subjective” based on the radiologist. She also mentioned that it is possible that it has always been there but never deemed to be an issue by the past two radiologists. So more waiting, more anxiety, more stress.

  3. Got new HBV Real-Time PCR Quant results:

. HBV IU/ml is now 1,400 which is UP from 350 in October 2021 (a whopping 400% increase!)
. log10 HBV IU/ml is 3.146 which is UP from 2.544 in October 2021

What does all of this mean when it says the reportable range for this essay is 10 IU/ml to 1 billion IU/ml?

Do people typically start medication with these numbers? My doctor has not mentioned medication.

Are there theories on why such a high % increase?

  1. Two blood tests show that I am NOW also pre-diabetic (I know that at least one grandparent had diabetes). What concerns me is that I had already altered my diet, lost weight, and had exercise routine but still pre-diabetic.

Any other thoughts are also welcome. I try so hard to stay positive but a lot is happening so fast since my March 2021 diagnosis.

Thank you so much! This community is incredibly uplifting and helpful to my mental health concerns related to my HepB.

43

Hi @bob,

Thank you for sharing your story. I had hoped to see some feedback regarding your NAC experience. Are you comfortable sharing your viral load, AST, and ALT numbers? I posted mine in this thread as well.

I hope you are still doing well. Stay hopeful.

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Sure @hopefulone. Back when I got a 9.1kPa on fibroscan (moderate bordering on severe liver fibrosis), AFP was at 45, ALT was at about 45 too, and viral load was around 1000-2000 and most of the other results were not very remarkable. Since then I started TAF and within the first couple of months viral load became undetectable, and AFP went down to 19

Now I still get the feeling of having a swollen liver when I stop taking NAC, though it’s not as intense, and NAC does make it go away. Since there’s nothing to make it mad anymore I guess I probably do have some fibrosis, I’m not sure what NAC does exactly, maybe it somehow makes liver stiffness decrease overnight even in cases of having fibrosis? I can’t really understand it and I don’t think anyone does at present

45

@bob,

Thank you for sharing your “numbers.” I find that people sharing numbers are really helpful. One thing I seem to be learning based on the limited experiences shared in this community is that liver impact is a crap shoot. I once thought that high viral load was a sure contributor to liver damage based on something else I read somewhere in this forum but that does not seem to be the case at all. It also seems that, like you say, there’s a lot of limited understanding out there which is why this forum is a kind of data source for researchers.

My recent bloodwork from January 2023 show that my ALT and AST are fine but my April 2023 viral load has gone from 350 to 1400 within a year of testing. Of my last three ultrasounds, the last one showed “mild coarsening” of on the liver so now I am going for an elastography since, apparently, “mild coarsening” is a subjective diagnosis based on the radiologist looking at the ultrasound – so more stress, frustration, and anxiety.

I was diagnosed March 2021 after donating blood at work.

Thank you again!

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46

Hi @hopefulone ,

No problem about response time. I also get it about post hopping- in fact, I am doing it right now with this response. No need to repeat content from a different post, I get all posts in my email anyhow- unless the spam filter hijacks them. I thought the number of HBV population in the world was more like 300 million but maybe that’s without the parameters you stated.

I am SO glad that you moved near a research university. I live within 45 minutes of a research university. My hepatologist works out of their liver transplant department as that department is the only one that has hepatologists at the university. I guess I am in good hands if/when I need a transplant.

I’m still not sure if I ever knew how to do log conversions. I think I thought I did at one point, but if I did, I have forgotten now… lol. I am pretty sure that “reportable range for this essay is 10 IU/ml to 1 billion IU/ml” is just the range of the possible results those tests can report. Minimum of 10 and max of 1 billion.

I’ll leave the rest to the experts. As you know, I am not an expert. I was just so stoked when I read that you were able to move somewhere close to much better healthcare. What a relief!

-Paul

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47

Good morning @PuallyHBV,

Thank you for your response and continued encouragement. Encouraging each other is SOOOO important since positivity probably produces some kind of chemical in our brain which triggers other chemicals which are probably good for our overall health. For me, my stress and anxiety are felt in the “pit of my stomach.”

I am sure my previous doctors probably meant well, but their Hep knowledge was just limited. I am not sure I was getting the best advice or responses to my concerns, especially the upper right quadrant pain and liver care. I never got a pamphlet, a resource number or website, or a list of “care” suggestions which is why the HepB Foundation is really a LIFE SAVER for so many people.

I saw the 2 billion infected number on the HepB Foundation website so I gather that’s credible information. I was very pleased to see the March 2023 press release on the Hep Foundation website encouraging more testing for adults 19 and over so more people can be informed.

It would be great if our health care system simply proactively included testing for HepB and the other major infectious diseases that have no symptoms (damn near all of them!) which would also save lives and reduce healthcare costs later in one’s life.

Well, thank you again, and stay healthy and hopeful.

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48

This is a small jump, but this is known to happen in some phases of HBV. It is important to continue monitoring to see if this is a sustained increase or just a blip.

This is the number of people with chronic HBV infection, 2 billion is the estimated number of people who have been exposed to HBV.

Hope this helps,
Thomas

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49

Hello @PuallyHBV,

How are you? From time to time, I find myself reading old messages. I think subconsciously I’m in search for something or some answers or some clarity. Or maybe I’m just searching for solidarity and community. I read your message from October 2021 or 2022 I believe where you talked about your troubles with abdomen pain.

First, how have those been for you? I apologize if I missed your update on this. Hard to keep all the stories attached to the right person sometimes. Do you still have these flareups?

Second, I have been dealing with very mild abdomen discomfort, ironically, since my diagnosis in March 2021. Given the nature of my work and the mental stress from the diagnosis, it’s hard to tell what’s the real cause. But I want to share my symptoms in case any relate or are familiar:

. Discomfort has been felt in all areas of the abdomen: bottom, middle, top, sides
. Bowel movements give me a lot of relief
. Constipation was also a probably (which has subsided since I cut back on the bananas! :smile:)
. Discomfort across the entire length of the base and sides of my rib cage
. Discomfort at the sternum
. Discomfort “band” around back and abdomen
. (new) Discomfort on right side and left side and both sides of the back where I thought I was having kidney issues (unremarkable on ultrasounds :pray:t5:)
. Throbbing sensation along the right side
. Discomfort and short bursts of “stinging” sensation around right shoulder blade

Massaging the abdomen area and bowel movement also give relief. I had a colonoscopy around the same time of diagnosis (yes, what a stressful period March/April 2021 was for my health). My GI walked me through my diagnosis, said that I was “fine,” told me not to worry so much, and theorized based on my testing results that I probably was infected at birth which no doctor has questioned at this point.

Hope you’re well.

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