Dr. Ghulam Fareed
Medical Gastroenterology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
Answered by
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Patient's Query
Hello doctor,
I had taken 50 mg hydrocodone once a day for seven years, along with 3 to 4 drinks a day. I go to the doctor twice yearly and have full blood work done. My liver function test fluctuates a little, but most of the time, they are normal. I have been clear of drugs and alcohol for two months but still worry about any damage I have already done. Kindly help.
Hello,
Welcome to icliniq.com.
I can understand your concern.
I have reviewed your case history in detail and attached laboratory investigations as well (attachment removed to protect the patient's identity). Your liver function tests are normal. All the levels are normal. The serum albumin levels are normal as well, suggestive of normal liver function, and no evidence of chronic liver disease at the moment. With these liver function test reports, your right upper abdominal pain would not be due to a liver condition. I hope you have already done your abdomen ultrasound to look for gall bladder and biliary ducts. The current medication dose is relatively safe and has nothing to do with your liver. Were you using hydrocodone because of a persistent cough? If yes, persistent cough is a risk factor for intercostal neuralgia.
Kindly revert for more queries.
Thank you.
Patient's Query
Thank you for your reply, doctor.
No, it was not for cough. I got out of hand using the hydrocodone to get high and drank alcohol with them, though not heavy drinking. But that took place for seven years. The pain is along the right ribs above the liver and sometimes upper right back pain. Pain comes and goes but worsens at night. I read that liver function tests do not always indicate liver problems. Kindly help.
Hello,
Welcome back to icliniq.com.
As you mentioned previously, I am happy that you have been off drugs and alcohol for the last two months.
1) Your liver function tests are normal; another important investigation for the right-sided upper abdominal pain is abdominal ultrasound to see the structure of the liver, any lesions, your gall bladder, biliary ducts, and a general review of other structures like spleen, etc.
If your abdominal ultrasound has already been done and it was normal, too, then the chances of this pain coming from the liver or gall bladder are less likely.
2) Chest x-ray to evaluate right-sided lung base, rib structure, or any bone deformity.
3) I hope there is no history of trauma or over-stretching of right-sided chest muscles.
4) If the above points are already covered and normal, I would go with an intercostal neuralgia diagnosis and would like to give you some simple painkillers, especially for neurological pain.
5) If your pain does not settle even with painkillers, then one should move on for further evaluation to see other possible causes (not related to the liver).
I hope this helps.
Thank you.
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Medical Gastroenterology
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