Originally, my hospital visit was scheduled on 12/6/22. But they called me after cancellation and I got to talk with an internal medicine doctor on 11/1/22.
"Pain in upper right abdomen" can be caused by many issues. Doctor's diagnostic work is to narrow down possibilities to a diagnosis, so that they/we can move on to therapeutic work.
In established medical practice, doctors follow guidelines and standard procedures based on patient's complaints and diagnostic tests. They are standardised to flow charts. You can find the flow charts used in major hospitals with googling like "pancreatic cancer guideline 2022".
In this case of "upper right abdominal pain or heavy sensation, migrating to back and/or stomach", possible causes and treatments are:
(a) Infection (by virus, bacteria, parasite, etc) and associated acute or chronic inflammation in GI tract.
We need to treat the infection with antiviral, antibiotic, or antiparasitic, depending on the germ. For acute infection, the pain is dragging on for too long, though.
(b) cancer (in liver, bile duct, gallbladder, pancreas or possibly stomach).
By numbers (survival curve with current therapies and 5-year survival rate), none are good. They are difficult cancers and I am not gonna like it.
Yet, as a cancer biologist, I have used carcinogens and radioisotopes in the lab before. I cannot just write them off without testing. This possibility is the reason I took this pain seriously.
(c) Gallstones or kidney stone.
Most likely prediction and common issue. About 10% of people of my age may carry stones with or without symptoms.
(d) stomach issue (GERD, ulcer)
Another common issue, although I've hardly had any issues in stomach before.
(e) Liver issue (hepatitis, liver fluke, etc)
As I work in hospital complex, I got vaccination against Hepatitis B virus and it should still be active. But these infections do happen. Good med for hepC virus came to market in this past decade, which is good news.
There are some others, but blood tests and imaging with ultrasound and/or CT scan can narrow down these possibilities.
So on 11/1/22, I talked with my new doctor. He looked very smart. Following the visit, the lab collected my blood.
A few days later, I checked out patient portal and they already had blood test results uploaded.
And actually, none of the results were out of ordinary and all were in normal range. Inflammation marker, liver enzymes/liver damage markers, blood cell count, cancer marker, diabetes marker, ... nothing.
At the time, I was relieved. Probably not metastatic cancer or ongoing infection and inflammation.
But then, what is it?
Probably the doctor wondered the same thing. The doctor's office scheduled an abdominal ultrasound on 11/7/22. So I went. Working in the same hospital complex is a good thing.
I'd never taken an ultrasound imaging before. First time for everything. 30 minutes examination went by rather soon.
Next day, radiology doctor's report was up.
No stones in gallbladder or kidney (surprise). Visible part of pancreas and spleen were normal.
They found hepatic steatosis (fatty liver). Oh, my.
In the lab, I've seen steatotic liver under microscope. Each cell carries big oil droplets inside. So the liver looks somewhat like a sponge, after slide preparation for microscope that extracts oil components. With gross examination, steatotic liver do look different from "normal" liver. Steatotic liver is, essentially, "foie gras". Might taste good.
Steatosis by itself is a benign and rather common condition. 10-30% of people may carry it without knowing. But for some people, it causes pain, and this might be the case for me. Being Asian is a risk factor for hepatic steatosis.
If steatosis progresses toward steatohepatitis (fatty liver with inflammation), pathological changes and damage accumulate, and the liver can move to fibrosis (damaged liver with scars) and cirrhosis (advanced version of fibrosis). Liver with cirrhosis is a hotbed for liver cancer. You don't want it. And that is the reason this steatosis-steatohepatitis-fibrosis-cirrhosis transition process is getting serious attention in medical practitioners and researchers.
As of 11/9/22, I have not gotten contacted by the doctor. Next he might want to order another imaging test with CT scan, or he might want to finalize the diagnosis as hepatic steatosis and want me to work on diet, exercise, and/or possibly prescribe or suggest something that can work on steatosis.
Steatosis is a reversible condition. Losing 5% of my current body weight would likely alleviate the pain and other symptoms.
Maybe I need to cut back on my ice cream. Ouch.
Fat is far better than cancer, stones, virus or parasites. At least, more manageable by myself. Lucky me. I should take this as my middle age challenge and start lifting weights or something.
[Photo of "Foie gras" in wikipedia]
