Heaviness In The Hypochondrium : Causes, Symptoms, Diagnosis & Treatment

Last Updated: 26/09/2022

Heaviness in the hypochondrium on the right occurs in diseases of the hepatobiliary zone: biliary dyskinesia, hepatitis, cholecystitis. Discomfort in the left hypochondrium develops mainly with splenomegaly caused by infectious, tumor or autoimmune factors. Diagnostic search involves standard ultrasound, X-ray and endoscopic methods, as well as modern studies - scintigraphy, elastography, laparoscopy. To stop the symptom, etiotropic drugs are prescribed, physiotherapeutic methods are selected. Sometimes surgery is recommended.

Causes of heaviness in the hypochondrium

Biliary dyskinesia

Heaviness under the ribs on the right is a typical manifestation of the hypokinetic-hypotonic variant of JP. An unpleasant sensation worries a person constantly, intensifies 40-6 minutes after eating. Patients experience a feeling of fullness in the stomach, mild aching pain in the right hypochondrium. With errors in the diet, belching, bitterness in the mouth appears. Heaviness in the hypochondrium decreases with a low-fat diet, after taking choleretic drugs.


Regardless of the etiological factor, in acute inflammation of the liver, its capsule is overstretched, which is manifested by severity and moderate pain in the right hypochondrium. Symptoms are observed constantly, with no apparent connection with a violation of the diet. The discomfort is aggravated by tilting the torso to the right, when feeling the projection zone of the organ. Aching pain is aggravated by motor activity.

In addition to heaviness in the side, there are signs of dyspepsia: nausea and vomiting, poor appetite or lack of it, unstable stools. Often noticeable yellowness of the skin, mucous membranes, sclera. The disease is accompanied by fever and asthenovegetative symptoms. Such a clinical picture is determined in different types of hepatitis: viral, autoimmune, alcoholic.


Violation of the outflow of bile provokes discomfort and heaviness in the area of ​​​​the right hypochondrium, which intensifies after half an hour or an hour after the end of the meal. Such symptoms are characteristic of the chronic course of inflammation of the gallbladder, mainly for its acalculous form. With calculous cholecystitis, in addition to heaviness in the hypochondrium, patients experience intense pain like biliary colic that develops after eating fatty and heavy foods.

Heaviness in the hypochondrium


Parasitic infections

Heaviness in the projection of the right hypochondrium is noted with the invasion of helminths that affect the hepatic parenchyma. These include echinococcosis and alveococcosis. At the first stage, when the parasite invades the liver, patients feel slight discomfort, heaviness in the hypochondrium after a heavy meal. Dyspeptic disorders at this stage are not detected.

An increase in echinococcal cyst leads to an increase in symptoms. Patients complain of constant heaviness, bursting sensations, loss of appetite, nausea and vomiting. At the end of a meal or physical activity, there are dull pains in the liver area. Periodically, diarrhea occurs associated with impaired bile formation and bile secretion. With a complicated course and rupture of the cyst, acute pain appears.

Neoplasms of the liver

Benign liver tumors are manifested by a slight severity with discomfort in the right abdomen. They grow slowly, do not disrupt digestion. Large cysts cause a feeling of fullness in the hypochondrium, aggravated after eating. Liver cancer is characterized by earlier addition of dyspeptic disorders, lack of appetite, and a sharp weight loss in patients. As the tumor grows, the heaviness in the hypochondrium is replaced by constant dull pain.

Cardiac diseases

Right ventricular heart failure is accompanied by stagnation in the systemic circulation, which causes a feeling of fullness and heaviness in both hypochondria. Patients notice an increase in the abdomen, difficulty in bending the torso, fatigue when walking. Symptoms can occur with rarer cardiac pathologies - mitral tricuspid disease, tricuspid stenosis, postpericardiotomy syndrome.

Diseases of the spleen

Heaviness on the left in the hypochondrium most often develops against the background of diseases of the spleen. In this case, unpleasant symptoms are not associated with dietary errors, but are aggravated during bending and physical exertion. Severity, moderate aching pains are manifestations of splenomegaly caused by infections (malaria, leishmaniasis, mononucleosis), hemoblastoses (leukemia, lymphogranulomatosis), autoimmune processes (SLE, periarteritis, vasculitis).

Rare Causes

  • Diseases of the respiratory system : lower lobe pneumonia, exudative pleurisy.
  • Rare hepatobiliary pathologies : liver peliosis, perihepatitis, amoebic liver abscess.
  • Vascular damage : portal vein thrombosis, splenic vein thrombosis, Budd-Chiari syndrome.
  • Congenital diseases : Crigler-Najjar syndrome, Gilbert's disease, hereditary anemia (microspherocytosis, thalassemia).


Patients with complaints of heaviness in the hypochondrium are examined by a gastroenterologist, who, if necessary, gives a referral to narrow specialists (hepatologist, oncohematologist). During the initial examination, the doctor palpates the liver and spleen, determines their size, examines the skin for the presence of icterus, spider veins and dilated superficial vessels. A complete diagnostic complex is assigned, which includes:

  • Ultrasound of the liver. With an ultrasound examination, the doctor evaluates the size and structure of the parenchyma of the organ, reveals focal processes (cysts, abscesses, tumors), detects signs of hepatitis or fibrotic changes. The scan is complemented by Doppler ultrasound to check blood flow in the hepatic vessels.
  • ERCP. Endoscopic examination is recommended for a comprehensive diagnosis of the state of the biliary system, finding stones, deformities of the organ. To evaluate the contractile function of the bladder and obtain a sample of bile for analysis, fractional duodenal sounding is performed.
  • Radiography. On a survey picture of the abdominal cavity, hepatosplenomegaly, displacement of neighboring organs are possible. To exclude damage to the respiratory system as the cause of heaviness in the hypochondrium, a chest x-ray is performed in two projections.
  • Biopsy of liver tissue. According to the results of histological analysis of biopsy specimens, the doctor differentiates benign and malignant neoplasms, establishes the diagnosis of parasitic invasions. The method is informative for assessing the prevalence of fibrosis, diagnosing autoimmune hepatitis.
  • Laboratory Methods . In the biochemical analysis of blood in hepatic pathologies, accompanied by heaviness in the hypochondrium, the content of cytolysis enzymes (ALT and AST) increases, the levels of bilirubin and cholesterol increase. To confirm infectious hepatitis, ELISA and PCR are performed. Hematological problems are excluded according to the hemogram and coagulogram.

In modern hepatology, static scintigraphy is used to clarify the diagnosis and assess the functional activity of the liver. Widely used elastography is a non-invasive method for studying the degree of fibrosis of the hepatic parenchyma. To identify the tumor process of the spleen or liver, MSCT of the abdominal organs is informative. In difficult situations, doctors resort to diagnostic laparoscopy.

Ultrasound of the liver



Help before diagnosis

To reduce discomfort, patients are advised to follow a diet. Fatty and spicy foods, smoked meats, spices are excluded from the diet. The best ways to cook food are steaming, stewing, baking in the oven. The use of alcohol is prohibited. Self-medication is unacceptable, since heaviness in the hypochondrium has hundreds of reasons that a specialist must diagnose and treat.

Conservative therapy

With severity in the hypochondrium, etiotropic and pathogenetic drugs are selected for the underlying disease that caused the symptom. Treatment is carried out on an outpatient basis, but in the period of exacerbation of chronic pathology, it is recommended to undergo a course of inpatient therapy. As a rule, the following groups of drugs are used:

  • Choleretic agents . Improving the outflow of bile during its stagnation quickly eliminates heaviness and discomfort in the right side, eliminates dyspeptic disorders. Medicines of the group of choleretics and cholekinetics, therapeutic mineral waters are used.
  • Antibiotics . Shown during exacerbation of inflammatory processes in the hepatobiliary zone to prevent purulent complications. Infectious cysts require specific antiparasitic drugs.
  • Antiviral drugs . They are prescribed to patients with chronic viral hepatitis to reduce the number of copies of the pathogen in the blood and prevent complications. Long-term courses (at least 3 months) are selected for effective treatment.
  • Hepatoprotectors . They protect the liver from damage by toxins and free radicals, improve the functional activity of the organ and promote cell regeneration. Usually complement the main treatment of the pathology that caused heaviness under the right ribs.
  • Anti-inflammatory drugs . Non-steroidal anti-inflammatory drugs are used to eliminate discomfort and pain in the hypochondrium. Glucocorticoids quickly stop autoimmune conditions that led to the development of hepatomegaly or splenomegaly.

To eliminate signs of inflammation and reduce subjective symptoms, physiotherapy is performed. In chronic cholecystitis, UHF, inductothermia, and the introduction of drugs to the affected area by electrophoresis show a good effect. To reduce the manifestations of dyskinesia of the biliary tract, diadynamic therapy, pulsed low-frequency currents, and SMT therapy are effective.


In the calculous form of cholecystitis, a planned laparoscopic cholecystectomy is performed to prevent an attack of biliary colic. Violation of the outflow through the hepatic or splenic veins is an indication for the imposition of artificial anastomoses to restore blood flow. With echinococcal cysts, surgical excision of a volumetric formation or endoscopic drainage is prescribed. In case of tumor processes, the volume of intervention is determined taking into account the degree of their good quality and spread.