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What Pain Management Strategy Is Recommended For Flares, Given Her Liver-friendly Requirements?
Question: History and Complaints
Age/Sex: 50-year-old female
Primary Complaint:
Intermittent, dull right upper quadrant (RUQ) pain for 8–9 months.
Pain episodes vary in intensity and last for hours or days, sometimes disappearing for weeks or months.
Unable to identify the trigger for food. may be after food but not sure
Observation:
A hard "hump" near the liver (RUQ) has been stable in size for 8–9 months. No tenderness associated with it.
Relevant Medical History
Non-Diabetic.
Non-Hypertensive.
History of Hysterectomy: Performed 15 years ago for unknown reasons (e.g., fibroids or other benign conditions).
Investigations Performed the past 8 months
Imaging
Ultrasound (multiple scans):
Mild fatty liver with no focal lesions or biliary dilatation.
Gallbladder normal on imaging, no stones or sludge detected.
No structural abnormalities noted.
CT/MRI:
Normal liver and gallbladder anatomy, with no masses, strictures, or significant abnormalities.
Lab Tests
Liver Function Tests (LFTs):
Normal results with no significant abnormalities.
Autoimmune Markers:
Negative (ANA and other autoimmune panels normal).
Tumor Markers:
CA19-9: Negative.
AFP (Alpha-Fetoprotein): Not elevated.
Pancreatic Enzymes:
Lipase and Amylase: Normal.
Treatments Tried
Ursodeoxycholic Acid (UDCA):
Dose: 300 mg twice daily for 7+ days.
Response: Reported some improvement in symptoms but still experiences occasional pain flares.
Pain Medications:
Meftal-Spas (Mefenamic Acid + Dicyclomine): Tried for acute flares; partial or no relief.
Paracetamol (500–650 mg): Mild relief during mild pain episodes. Ultracet - works for moderate pain
Lifestyle and Dietary Adjustments:
Low-fat, liver-friendly diet implemented since 8 months plus excercise
Current Concerns and Questions
Persistent Symptoms:
Occasional RUQ pain despite Ursocol and dietary changes.
Pain flares may be associated with specific food triggers or gallbladder/biliary spasms.
Palpable "Hump" in RUQ:
Hard, stable in size for 8–9 months.
Not tender, and no change noted during imaging.
Management Questions:
Should she continue Ursocol 300 mg twice daily beyond 1 month?
What pain management strategy is recommended for flares, given her liver-friendly requirements?
Any other tests or treatments to consider, especially for the persistent "hump"? or what needs to be done for further management since this is impacting quality of life
considering fibro scan/ HIDA CCK
Age/Sex: 50-year-old female
Primary Complaint:
Intermittent, dull right upper quadrant (RUQ) pain for 8–9 months.
Pain episodes vary in intensity and last for hours or days, sometimes disappearing for weeks or months.
Unable to identify the trigger for food. may be after food but not sure
Observation:
A hard "hump" near the liver (RUQ) has been stable in size for 8–9 months. No tenderness associated with it.
Relevant Medical History
Non-Diabetic.
Non-Hypertensive.
History of Hysterectomy: Performed 15 years ago for unknown reasons (e.g., fibroids or other benign conditions).
Investigations Performed the past 8 months
Imaging
Ultrasound (multiple scans):
Mild fatty liver with no focal lesions or biliary dilatation.
Gallbladder normal on imaging, no stones or sludge detected.
No structural abnormalities noted.
CT/MRI:
Normal liver and gallbladder anatomy, with no masses, strictures, or significant abnormalities.
Lab Tests
Liver Function Tests (LFTs):
Normal results with no significant abnormalities.
Autoimmune Markers:
Negative (ANA and other autoimmune panels normal).
Tumor Markers:
CA19-9: Negative.
AFP (Alpha-Fetoprotein): Not elevated.
Pancreatic Enzymes:
Lipase and Amylase: Normal.
Treatments Tried
Ursodeoxycholic Acid (UDCA):
Dose: 300 mg twice daily for 7+ days.
Response: Reported some improvement in symptoms but still experiences occasional pain flares.
Pain Medications:
Meftal-Spas (Mefenamic Acid + Dicyclomine): Tried for acute flares; partial or no relief.
Paracetamol (500–650 mg): Mild relief during mild pain episodes. Ultracet - works for moderate pain
Lifestyle and Dietary Adjustments:
Low-fat, liver-friendly diet implemented since 8 months plus excercise
Current Concerns and Questions
Persistent Symptoms:
Occasional RUQ pain despite Ursocol and dietary changes.
Pain flares may be associated with specific food triggers or gallbladder/biliary spasms.
Palpable "Hump" in RUQ:
Hard, stable in size for 8–9 months.
Not tender, and no change noted during imaging.
Management Questions:
Should she continue Ursocol 300 mg twice daily beyond 1 month?
What pain management strategy is recommended for flares, given her liver-friendly requirements?
Any other tests or treatments to consider, especially for the persistent "hump"? or what needs to be done for further management since this is impacting quality of life
considering fibro scan/ HIDA CCK
Brief Answer:
Has she ever been treated with antacids?
Detailed Answer:
Hi and thank you for choosing this forum for your query,
I am sorry for the problems you are facing
Before giving answers to your query I have to ask a few more questions,
Was any antacids ever?
See most common cause of RUQ pain in 99% cases is either chronic gastritis and gall bladder problems.
Now as gall bladder has been ruled out already and we are moving towards higher tests and investigations i just want to ask that was she ever been tested for gastritis(acid peptic disorder) or have ever taken PPi like pantocid, Rabeprazole etc
Waiting.
Has she ever been treated with antacids?
Detailed Answer:
Hi and thank you for choosing this forum for your query,
I am sorry for the problems you are facing
Before giving answers to your query I have to ask a few more questions,
Was any antacids ever?
See most common cause of RUQ pain in 99% cases is either chronic gastritis and gall bladder problems.
Now as gall bladder has been ruled out already and we are moving towards higher tests and investigations i just want to ask that was she ever been tested for gastritis(acid peptic disorder) or have ever taken PPi like pantocid, Rabeprazole etc
Waiting.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Hello sir,
Hope you are doing good. Thanks for your response.
She had undergone upper GI endsopy which was negative for any findings including GERD or any thing else. few months back she was on pantoprazole for a week in the past but have not used extensively.
Hope you are doing good. Thanks for your response.
She had undergone upper GI endsopy which was negative for any findings including GERD or any thing else. few months back she was on pantoprazole for a week in the past but have not used extensively.
Brief Answer:
Follow up
Detailed Answer:
Hi again,
Any relief when she was on pantoprazole?
1)When there is nothing wrong with gall bladder no sense of continuing it unnecessarily.
2)Use ultracet/Calpot T this time for pain instead of NSAIDS(pain killers).
It contain small amount of synthetic opioid and works excellently in visceral pain(pain originating from any organ or tissue) and it doesn't cause gastritis also.
3)Why no biopsy or fnac of that growth was done by gastro?
Make a pdf and attach it let me go through things in detail.
Waiting.
Follow up
Detailed Answer:
Hi again,
Any relief when she was on pantoprazole?
1)When there is nothing wrong with gall bladder no sense of continuing it unnecessarily.
2)Use ultracet/Calpot T this time for pain instead of NSAIDS(pain killers).
It contain small amount of synthetic opioid and works excellently in visceral pain(pain originating from any organ or tissue) and it doesn't cause gastritis also.
3)Why no biopsy or fnac of that growth was done by gastro?
Make a pdf and attach it let me go through things in detail.
Waiting.
Note: For further follow up on digestive issues share your reports here and Click here.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
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