<s>[INST] My 60 yr old diabetic male friend has been having intermittent episodes of RLQ pain. Negative CT/X-rays. (At the VA) . But, for the first time he had the abd pain and it radiated up into his heart region.. he described it as excruciating. It resolved eventually. I realize that this is far too limited of information to come up with anything definite..gall bladder, gallstones or liver issues come to my mind. Any further speculative ideas? [/INST] thank you for using HCM i understand your queries... if a patient like him come to my place. initially  i would give him some analgesic for pain relief temporarily which would be easier for further evaluation...1. there are a few reason for RLQ  pain like gall stones. liver infection.stomach ulcer2.i would do a few test like LFT ,to evaluate liver function.3. An usg to rule out any abnormalities in liver and gall bladder stones.4.some time it could be due to acid pain...5.you  already said that his x ray was fine so then there in no problem in lungs..i hope you got sufficient information </s>