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Pain in abdomen after D&C for miscarriage. Treatment?

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I started having right side hip/pelvic pain and discomfort that radiated to my lower back and down my leg almost 2 months ago and found out I was pregnant. The doctor attributed it to a corpus luteum cyst on my right ovary. Unfortunately I miscarried the pregnancy at 6 weeks and opted for a D&C. Shortly after the surgery I began having pain in my middle to upper abdomen on the right side. It fluctuates in intensity with the mornings being better and getting worse in the evening. I can feel some pain/pressure below my right rib cage and on my side. It usually feels closer to the surface, and can be quite tender at times. I also have right side shoulder and back pain. The pain in my hip/pelvic region has decreased but some pressure can still be felt. The pain is worse when sitting, especially for longer periods, and better when I am up and moving around. I have no other symptoms beside this. Digestion appears to be normal. My last liver panel was normal and was taken about 8 months ago. I also had a normal CT scan almost 2 years ago, thought the doctor mentioned a "tiny spot" on my liver which wasn't of any concern. I also have scoliosis and have been under a lot of anxiety this past month. I am looking for thoughts as to what could be going on. I am worried it is liver or pancreatic related. Any guidance would be appreciated.


Category: Gastroenterologist, Medical

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Category: Hepatologist
Dr. Ratnakar Kini is online now

Expert:  Dr. Ratnakar Kini replied 4 Days.

Hi,
Thanks for posting your query at DoctorSpring.com
I am Dr.R.K and I am pleased to assist you.
Pain in the right upper and middle abdomen that radiates to the shoulder and back could be due to gallbladder related problem. It could be due to a stone in the gallbladder causing cholecystitis. An ultrasound scan of the abdomen may be done to rule out gallbladder issues.
The second possibility is right kidney issues. There could be a stone in the right urinary tract or the flow in the right urinary tract could be obstructed causing hydroureteronephrosis causing pain in the area you have mentioned.
This again can be confirmed with an ultrasound scan of the abdomen.
The third possibility is musculoskeletal pain due to scoliosis.
So the next step you have to do is to get an ultrasound scan of the abdomen done.
I hope that answers your question.
Let me know if I can assist you further.
Regards,
Dr.R.K.


Patient replied :

Thank you for your response. I saw my primary care physician today and described to her all of my symptoms. She is baffled. She took a urine sample, which she said was normal so she doesn't think it's kidneys. She also did a physical exam looking for the source of my pain. When she was pressing my abdomen I felt the pain/sensation more toward my lower right abdomen rather than upper, which is odd since when I am sitting up or standing it appears to be more toward the ribs. She took bloodwork for a CBC, metabolic panel, and some other markers for the liver and pancreas. Following these results she is suggesting a CT scan to investigate further. She said there is definitely some sort of inflammation. I am starting to worry about possible cancer. What other types of inflammation could this be? If my liver tests come back normal what are the chances that it could still be liver disease or cancer? I know I am young for a cancer diagnosis, but I also know it's possible. Any insight would be helpful. Thank you for your time.


Expert:  Dr. Ratnakar Kini replied 3 Days.

Hi,
Fatty liver can cause liver enlargement and vague pain on the right side and the liver panel can remain normal. Block in the right ureter causing hydronephrosis can cause discomfort in the same area. Mesentric lymphadenitis can cause similar symptoms.
As your doctor has suggested CT scan may be done to find the cause.
Regards.


Patient replied :

Thank you. I received my results from my doctor. She did a dipstick urine test and came back with trace proteins and trace leukocyte esterase, everything else normal. She also ran lipase and amylase, both normal. C-reactive protein normal. On my metabolic panel everything was well within normal, except bilirubin at 1.8. I have a history of elevated bilirubin, but this is the highest it's ever been. 8 months ago it was 0.8 and before that never higher than 1.5. She has always marked it up to Gilbert's. CBC was normal except elevated platelets at 500. I also have a history of higher platelets, usually in the 400's and a heamatologist told me this was probably due to iron deficiency, but I am inconsistent with my iron supplement. 500 is the highest I've ever had. I am assuming she's still going to want to do a CT just to check everything out, but do any of these results decrease my chances of certain conditions or point to others? I am appreciating the second opinion and my doctor can sometimes be hard to get in touch with, so I thank you for your time and guidance.


Expert:  Dr. Ratnakar Kini replied 2 Days.

Hi,
Thanks for getting back to me with more questions.
These tests reports do not point towards anything nor do they rule out anything as far as your symptoms are concerned.
May be a doubtful urinary tract infection and an unrelated Gilbert syndrome.
Let us wait for the CT scan report.
Regards,
Dr.R.K.


Dr. Ratnakar Kini
Category: Hepatologist
Experience: 
Fellowship - DM - TN Dr.MGR Medical UniversityResidency - TN Dr.MGR Medical University Medical School - Stanely Medical College, TN Dr.MGR Medical University
Dr. Ratnakar Kini and 4 other Medical Specialists are ready to help you

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