Pain without elevated liver enzymes?

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Pain without elevated liver enzymes?

Postby dja » Tue Dec 07, 2004 07:02 pm

I spent today at L&D to be checked after having a very bad night. I experienced serious pain in my right upper quadrant for about 6 hours in the middle of the night. I promised myself that I'd call first thing this morning, so I did, and the nurse sent me to L&D where I had labs drawn. The great, fantastic, wonderful news is that the labs were normal. What I'm trying to recollect is whether I had normal PIH labs last time as things were starting to get out of hand. Has anyone here experienced some degree of right upper quadrant pain and NOT had bad labs? The pain was certainly nothing like when my liver had finally gotten really bad last time, but it was painful and kept me up all night. The doctors said it could be anything from heartburn (never had it before so I don't know what it's like), to gallbladder, to the baby kicking (I really don't thing so). I appreciate any input.

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Re : Pain without elevated liver enzymes?

Postby julie f » Tue Dec 07, 2004 08:49 pm

At 26 weeks (this pregnancy) I woke up from some upper right abdominal pain. It wasn't exactly like what I had last time but, it was enough to freak me out so, I went to L&D. They checked me out and my labs ended up being great. The pain eventually went away but, still comes back from time to time. I mentioned this to my peri and he explained that there is a lining (of cartilidge, I think) around the bottom of the rib cage and that it can sometimes become inflamed, causing that kind of uncomfortable pain.

I'd definitely mention the pain to him tomorrow and see what he has to say, he might be able to give you some extra reassurance.

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Re : Pain without elevated liver enzymes?

Postby alexp » Tue Dec 07, 2004 11:32 pm

Yup, I did! During my hospital stay with the girls, I had the right upper quadrant pain come back twice (was admitted with HELLP, so I knew what it felt like - this wasn't as bad, but it was the same kind of pain). Of course, being in the hospital, they did labs immediately both times...everything was fine. They thought it was either my gallbladder or that cartilidge thing Julie mentioned. I got better in a day or two.

(As it turned out, it was my gallbladder - I started having the exact same pain a few weeks ago, and the gallbladder definitely is to blame - no babies in there to my knowledge, lol. I'm having it removed on the 22nd.)

I'm glad to hear everything came out ok so far. [:)] Let us know what your doctor says.

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Re : Pain without elevated liver enzymes?

Postby tahoe4 » Wed Dec 08, 2004 07:07 am

With my first pregnancy I had heartburn (or what I thought was heartburn) for two weeks before I delivered. When I went in to deliver, labs showed that I had the beginnings of HELLP.

So during my second pregnancy I began to have heartburn towards the end and I was EXTREMELY paranoid thinking that it had to be my liver the entire time. I had labs drawn and they were completely normal. I was told by my dr to take Pepcid AC, which is the strongest OTC medicine on the market for heartburn. Unfortunately it didn't help and I had heartburn no matter what I ate. (As a side note, my GP ran a pancreas blood test to make sure it was functioning properly as that can sometimes cause pain which feels like heartburn.)

If I had it to do again, I would have them run labs every time I went in to the dr if I continued to have heartburn which wouldn't go away.


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Re : Pain without elevated liver enzymes?

Postby diane_uk » Wed Dec 08, 2004 09:14 am

My HELLP symptoms started with upper right pain, which I initially thought was trapped wind. By the time I got to hospital (45 minutes later) my liver had swelled so much that it was pressing on my lungs and I was not breathing.

Anyway... after baby was delivered and all was well, a couple of weeks later I got the shock of my life. One night I ended up in A&E with severe upper right pain again. I couldn't believe it. They ruled out HELLP straight away and gave me pethidene for the pain. A few hours later the pain subsided.
Turns out following an ultrasound I had developed gall stones during my pregnancy. Every time I ate a high-fat meal I ended up with the same pain again - usually lasted 30 minutes to 4 hours and sometimes worse than others.

Anyway, if this happens again (especially after eating a high-fat meal) I would definately get the gall bladder ruled out as it is such a common problem during pregnancy.

Since this episode I have had my gall bladder removed by keyhole surgery. This is not for everyone though as I have had intermittant toilet problems ever since. At least during this pregnancy I won't get them again!

I do hope it turns out to be the baby kicking or something similar...
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Re : Pain without elevated liver enzymes?

Postby dja » Wed Dec 08, 2004 09:58 am

Thanks ladies - this is very helpful information. I will readily admit to being paranoid, but I'm also extremely conscious of the fact that I was sick during my last pregnancy long before I had tangible symptoms show up in my labs, like proteinuria and elevated liver enzymes. By the time my labs were showing something off kilter, I was sick beyond belief. I'm not in that place now, just want to be sure I either don't get there, or if I get there I've made sure the docs know what is going on.

Does anyone recall a post that Anne did a long while back - something about those of us having prior liver issues may also just have a sensitive liver? Nothing medically determined, just something a number of us may have experienced?

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Re : Pain without elevated liver enzymes?

Postby sandy » Wed Dec 08, 2004 01:09 pm

I'm sorry you are still wondering what is going on.

To answer your question:
Originally posted by DJA

Does anyone recall a post that Anne did a long while back - something about those of us having prior liver issues may also just have a sensitive liver?

...I don't remember the e-mail, but I will say this: I recently found out that the medication Zofran that I was taking for my queasiness ended up elevating my liver enzymes to really high, dangerous levels.

My OB and Perinatologist were baffled that it was the Zofran; I do know that Zofran is not supposed to be used when one has liver issues. To the best of my knowledge, I don't have liver issues, but I did have severe PE and HELLP Syndrome, and I can't help but think that my liver is somehow either very sensitive now or that there is some sort of damage that can't be seen on liver tests from that time.

Please let us know as you figure more about the source of your pains!

~Sandy/DD born via emergency C at 35 wks/1 day June '03 due to superimposed severe PE/class III HELLP

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Re : Pain without elevated liver enzymes?

Postby jjbeck » Wed Dec 08, 2004 04:19 pm

I had terrible upper rt quad pain for quite a while...but I did have the elevated liver enzymes, both ALT and AST. However, I was told that the pain was not relevant to the up enzymes ( I question that now though ). My peri explained that it was probably muscular/skeletal and sent me to a Ostiopath. That help a little bit but the pain was pretty intense for months...<coincidently> it improved when my enzymes lowered.
Are they going to do an u/s to check the gall bladder and liver?

Good luck

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Re : Pain without elevated liver enzymes?

Postby dja » Sat Dec 11, 2004 01:27 pm

Just wanted to share one other thought on this topic - two doctors I've talked with concurred that upper right quadrant pain with no elevated liver enzymes could be heartburn, could be gallstones, could be gas, but they honestly really didn't know if it could be the start of a rumbling liver. If it happens again, I'm going to try pepcid/mylanta to see if that helps, but if it doesn't I'm going to go back to L&D while it is happening (this last week I waited until the next day).

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Re : Pain without elevated liver enzymes?

Postby specmom » Sat Dec 11, 2004 07:50 pm

Any more details on the inflamed cartilage around the rib cage theory? Would there be a reason why it would only be on the right side?

Last night, while leaning over to pick up my toddler who was lying next to me on the bed, my husband accidently leaned his hand heavily onto my abdomen to the right of my belly button thinking it was the bed (I was covered by a blanket). It really hurt, and the baby was clearly not happy about it. Moved a LOT in the hour following that and later last night.

This morning I woke up with pain in my lower right abdomen, much lower than where I felt bruised from the leaning. I drank OJ b/c the baby wasn't really moving. He moved fine after that and all day long. However, this afternoon, I started getting right upper quadrant pain just under my rib cage. I would call it moderate pain with the threat of something more. It hurt more when I sat down. It doesn't feel like heartburn and is not close to my belly button. I considered calling the doctor, but my labs have been normal lately, and a dipstick tonight showed nothing more than trace things. (BP good.) It almost feels like a pulled muscle or something. Growing pains? I don't remember this from my first pg. When I had HELLP, it was very sudden and the pain was on top of contractions, so it just felt like painful waves of non-stop contractions, and I didn't really identify it as a separate RUQ pain. I will certainly call the doctor if it gets worse. I have had transient tenderness around my liver at times during the pregnancy, but that was more achy than actively painful, which this is. Thoughts? Does this sound like what you have experienced?

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