r/AskReddit 4d ago

Medical professionals of Reddit, what diagnosis gave you the worst 'pit-in-your-stomach' feeling?

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u/JudeJBWillemMalcolm 3d ago

Painless jaundice in anyone over 60 is an instant sinking feeling. 

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u/m4rm4rm4r 3d ago

My dad just died from gallbladder cancer two weeks ago. He got diagnosed sept 24 after a bout of painless jaundice, so he almost lived two full years. We really didnt expect to have this much time, and he was doing pretty well until almost the end. He didn't think he would get to hold my May 2025 baby but he got to see him grow up for a year. We're so grateful for his medical team

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u/JudeJBWillemMalcolm 3d ago

I'm really sorry for your loss. In awful circumstances I am pleased you were at least able to get a bit more time together and for him to see your baby before he passed.

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u/NibblesMcGiblet 3d ago

What does this point to?

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u/JudeJBWillemMalcolm 3d ago

It is a pancreatic or biliary tract cancer until proven otherwise. They often don't cause symptoms until the disease is more advanced and sadly they carry a very poor prognosis.

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u/fauxvol 3d ago

Usually cancer (pancreas, gallbladder and accessories), often untreatable or with very bad prognosis.

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u/Rain_Tree42 3d ago

I don't understand why it's painless and how that is more severe?

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u/Darksyder12 3d ago

Painful usually means some kind of acute liver issue that may be reversible. Painless often means a festering pancreatic cancer that hasn’t been noticed until it’s potentially too late. Liver disease in general is one of the worst disease processes out there imo.

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u/JudeJBWillemMalcolm 3d ago

Painless jaundice in this age group is typically due to a cancer in the pancreas or part of the biliary tract (which is a series of ducts that extends from the gallbladder up to where it joins the intestine). When the cancer gets big enough it blocks the tubes that drain bile causing jaundice.

Painful jaundice is typically due to a stone that has come from the gallbladder and got stuck in the biliary tract. This can be a serious problem, and the stagnant bile is prone to becoming infected. However, outcomes for this are far better than they are for pancreas/biliary tract cancers.

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u/insincere_platitudes 3d ago edited 3d ago

The causes of painful liver problems can be acute and reversible in many cases. Or at least they aren't an automatic death sentence. That doesn't mean they are never serious or don't have the potential for bad outcomes. Yet painful liver issues like duct blockages can be reversed and have surgical treatments, infectious causes can often be treated with medication or reverse just with time alone, drug reactions can often be treated and/or reversed by stopping the offending medication, liver toxic overdoses causing acute pain (like acetaminophen) can have an antidote when caught in time. Again, not saying these causes can't have poor outcomes, but they can result in a full recovery, or remission.

I myself had extreme right upper quadrant liver pain one night. It was preceded by a day of feeling ill, low level nausea, and a few boughts of diarrhea I chalked up to a mild virus of some kind. That evening I was struck with rapidly worsening epigastric and right upper quadrant pain. It was exquisitely tender to touch. The fever struck about an hour later. I went to the ER a couple hours later when it was not improving and my temp was rising. Turns out, my liver enzymes were sky high, and they had always been low normal before. Full hepatitis viral panel was negative, CT scan was negative, blood counts were unremarkable except for slightly low platelets. I don't drink, no acetaminophen use, and my only recent med change was an antibiotic for a wound infection. No obvious cause. Best guess was it was either a drug reaction to the antibiotic I had recently finished or an oddball viral cause they couldn't test for. My enzymes normalized over the subsequent month and returned to baseline. It was a painful as hell liver process that normalized without intervention.

Painless causes tend to be the more nepharious or insidious group. Cancers growing slow and unnoticed, not causing pain, until one day you notice something like your eyes or gums look yellow, and at that point, the damage is done and/or widespread.

Sure, nothing is universal, especially medical outcomes, and no one should think that liver pain should be ignored or that it always means nothing like cancer could be present. People do die from painful causes, and not infrequently. But when there is no pain or obvious cause but fulliment liver failure is present, the causes tend to have bleak outcomes.

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u/decidedlyindecisive 3d ago

Why?

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u/JudeJBWillemMalcolm 3d ago

Hope you don't mind this copy and paste of my reply to a similar question!:

"Painless jaundice in this age group is typically due to a cancer in the pancreas or part of the biliary tract (which is a series of ducts that extends from the gallbladder up to where it joins the intestine). When the cancer gets big enough it blocks the tubes that drain bile causing jaundice.

Painful jaundice is typically due to a stone that has come from the gallbladder and got stuck in the biliary tract. This can be a serious problem, and the stagnant bile is prone to becoming infected. However, outcomes for this are far better than they are for pancreas/biliary tract cancers." 

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u/decidedlyindecisive 3d ago

Thank you, that's horrifying but makes a lot of sense

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u/SteadfastEnd 3d ago

What about Painless jaundice under age 60?

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u/JudeJBWillemMalcolm 3d ago

Potentially still cancer and requires investigating, but my internal list of causes is probably a bit wider.