ANSWER TO QUESTION OF THE WEEK: (12/11/05) NO. Most people with liver disease expect to feel pain over their liver.  This type of pain is known as right upper quadrant pain or tenderness (RUQT). However, RUQT is rarely due to chronic liver disease or chronic hepatitis. RUQT may occur during the acute stages of liver disease (liver disease or hepatitis that has occured within the last 6 months). It may occasionally occur when one experiences a flare-up of a chronic liver disease, although these flare-ups are very uncommon. It is most often caused by acute inflammation, irritation, and distention of the liver’s surface. Otherwise, the liver is rarely tender. If pain in the region of the liver is experienced, other causes must be considered. For example, it may indicate gallstones, which happen to be associated with many liver diseases. Or it may indicate liver cancer—also known as hepatoma or hepatocellular carcinoma (HCC). Scar tissue from prior abdominal surgery- known as adhesions, is also a cause of abdominal pain. Intestinal pain must also be considered, as the right side of the large intestine lies in close vicinity to the liver. Many people claim that although they do not actually feel pain in the liver region, they experience a rather vague sense of “fullness” or an “awareness” of the liver. The cause for this is unclear. If a person experiences abdominal pain associated with swelling of the abdomen, ascites—the accumulation of fluid in the abdomen—must be considered. Ascites is associated with advanced liver disease. Other causes of abdominal pain include those related to the stomach, such as peptic ulcer disease and gastritis, which are not necessarily indicative of liver disease and are readily treatable when -discovered. The sphincter of oddi is a muscle that is also located on the RUQ. This sphincter functions as a one-way valve that allows pancreatic and biliary secretions and enzymes to enter the small intestine to aide in the digestion of food, while preventing secretions to back-up into the rest of the body. When this sphincter does not function properly, it becomes very tight and does not allow drainage of the pancreatic and bile ducts. This can result in RUQ pain. A sphincterotomy - cutting the sphincter of oddi is the treatment of choice.

Dr. Palmer is an internationally renowned hepatologist who has been practicing medicine since 1985. She maintains perhaps the largest private medical practice devoted to liver disease in the United States. Dr. Palmer graduated from Columbia University with a B.A. and was trained in hepatology (as well as medical school) at the Mount Sinai School of Medicine in New York City. She has authored numerous scientific publications in the field of hepatology in such peer-reviewed journals as Hepatology, Gastroenterology, Seminars of Liver Disease, Transplantation and Archives of Internal Medicine.

She is frequently called upon by the media for her opinion on various topics related to liver disease. Dr. Palmer has appeared many times on television as a liver disease expert and has been quoted in such publications as TIME magazine, Cosmopolitan magazine, Prevention magazine, the Los Angeles Times, and Newsday. She also has appeared in numerous videos and CD-Roms aimed at educating doctors and the public about hepatitis C and other liver diseases, such as primary biliary cirrhosis.Dr. Palmer lectures to the medical and general public on liver disease-related topics on a regular basis. She also serves as a liver consultant to five major pharmaceutical companies.

Dr. Palmer is a board member of the New York chapter of the American Liver Foundation, and she sits on the nutrition subcommittee of the national chapter of the American Liver Foundation, the medical advisory board of the Latino Organization for Liver Awareness (LOLA) and the medical advisory board of the Primary Biliary Cirrhosis Organization (PBCers). She has also been a member of the practice guidelines committee of the American Association for the Study of Liver Disease(AASLD) and currently sits on the enduring educational materials committee of AASLD.

Dr. Palmer has performed trials on various experimental medication for the treatment of hepatitis. She is currently conducting research on new therapies for liver disease, specifically in the area of hepatitis C.

Her practice is located on Long Island, New York. (Main office located at: 1097 Old Country Road, Suite 104, Plainview, N.Y. 11803.

Satellite office located at 500 Portion Rd. Lake Ronkonkoma, N.Y. 11779)

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If you are interested in arranging an appointment with Melissa Palmer, M.D., please call (516) 939-2626.

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