Pain in the left hypochondrium most often develops with pathologies of the abdominal organs: acute and chronic pancreatitis, Payr's syndrome, splenomegaly and traumatic injuries of the spleen. Occasionally, a symptom occurs with lung damage (pneumonia and pleurisy), an atypical form of myocardial infarction, intercostal neuralgia. To diagnose the causes of pain, an instrumental examination is carried out using ultrasound, radiological and radioisotope methods. Treatment includes analgesics, etiopathogenetic agents (enzymes, antibiotics, drugs with antisecretory effect), surgical interventions.
For acute pancreatitis, unbearable pain in the left hypochondrium is characteristic, which appears suddenly with errors in the diet or the presence of other provoking factors. The pain is aggravated when the patient lies on his back and left side. Often the pain becomes girdle, spread throughout the upper abdomen. Often in the clinical picture there are repeated vomiting, fever, a sharp deterioration in well-being.
In the chronic form of pancreatitis, there is a dull pain under the ribs on the left, which is paroxysmal or permanent. Discomfort is accompanied by discomfort and heaviness in the hypochondrium area. The pain syndrome intensifies 30-4 minutes after eating, especially when eating fatty foods. Soreness is accompanied by steatorrhea and creatorrhea, rumbling in the abdomen, flatulence.
With gastritis and gastric ulcer, localization of pain is occasionally observed not in the epigastric region, but in the left hypochondrium. For these diseases, a combination of unpleasant symptoms with food intake is typical. The pains are of a different nature: stabbing, squeezing, dull or aching. With peptic ulcer, a clear pattern is revealed: the sooner symptoms appear after eating, the higher the defect is located in the stomach.
For an ulcer of the initial sections of the duodenum, pain in the epigastrium and the left hypochondrium is characteristic. They occur on an empty stomach, often disturb at night. At the end of the meal, the discomfort subsides. In addition to the pain syndrome, symptoms of dyspepsia develop: nausea, sour belching, heartburn. As a rule, there are violations of the stool with alternating constipation and diarrhea.
Payr's syndrome is characterized by improper fixation of the splenic angle of the colon, which causes chronic pain in the left hypochondrium. Sensations periodically intensify, radiate to the lower back and precordial region. The onset of symptoms after eating, with intense physical exertion is characteristic. The pain syndrome is accompanied by prolonged (3-5 days) constipation, and after emptying the intestines, the pain becomes less intense.
Pain in the left hypochondrium
With an increase in the spleen, constant aching pains, heaviness in the left hypochondrium are disturbing. Strengthening of unpleasant sensations is promoted by physical activity, inclinations of the torso. Splenomegaly is secondary and is associated with the progression of the underlying disease, so it can be combined with various symptoms. If the spleen is enlarged due to infection, the pain becomes sharp, paroxysmal. Splenomegaly is manifested by:
With a blunt injury to the abdomen, a fall from a height, the organ ruptures along with the capsule (one-stage) or without the capsule (two-stage). For a single-stage injury, severe pain in the left upper abdomen with irradiation to the shoulder is typical. The patient occupies a forced position on his left side with his legs tucked in, and if you try to turn him over on his back or on the other side, he returns to his original position (a symptom of "roll-up").
A two-stage rupture of the spleen is characterized by an initial episode of severe pain in the left hypochondrium, during which the person loses consciousness. Gradually, the pain decreases, there comes a "light period" from several hours to 2-3 weeks, when there are no symptoms of the disease. Then, sharp pains suddenly begin, accompanied by a fainting state due to severe intra-abdominal bleeding.
Such conditions are characterized by a sharp pain in the left hypochondrium, which occurs suddenly without any previous pathological symptoms. Excruciating pains force a person to take a forced posture. The patient lies, bent over, pulls his knees to his stomach. The general state of health deteriorates sharply, there may be signs of hemodynamic disorders, a state of shock. Pain on the left in the abdominal cavity causes:
Pain in the left hypochondrium is possible with lower lobar lobar pneumonia. The sensations are dull in nature, aggravated by coughing and deep breathing. The symptom is combined with febrile fever, mucopurulent sputum. Sharp pains in the left half of the chest and hypochondrium are characteristic of pleurisy. The pain is exacerbated by tilting the torso in the opposite direction, when trying to take a deep breath.
In atypical forms of the disease, pain is localized in the left hypochondrium, and not behind the sternum, as in classical cases. The pain syndrome is very intense, sometimes it leads to loss of consciousness. With necrosis of the heart muscle, pain radiates to the left arm and shoulder blade, to the neck. The skin is covered with a cold sweat, the heartbeat quickens, and blood pressure drops sharply. Sometimes, with an abdominal variant of a heart attack, pain occurs in the epigastric zone.
When nerves are involved in the pathological process, sudden burning pains are observed in the left hypochondrium, lasting several minutes. Patients describe the sensation as a "shot through" or "current flow" from the spine to the sternum. Soreness is usually provoked by sitting in an uncomfortable position, awkward turns of the torso, active sports activities. At the time of the attack, the person freezes, avoids deep breaths.
Examination of a patient with pain in the left hypochondrium is carried out by a gastroenterologist or surgeon, if necessary, a cardiologist, pulmonologist are connected to them. On examination, the abdomen is palpated, typical symptoms of pancreatitis and peptic ulcer are checked, but the results of a physical examination may be uninformative. To correctly establish the diagnosis, data from laboratory and instrumental methods are required, the main of which are:
Ultrasound of the abdominal organs
With mild pain in the left hypochondrium, due to the abuse of fatty or heavy foods, patients are advised to follow the diet selected by the doctor. In chronic gastritis or stomach ulcers, antisecretory drugs, antispasmodics can be taken to relieve pain. If the pain continues for a long time or a sudden pain syndrome occurs, you should seek medical help.
Therapeutic measures are primarily aimed at eliminating the cause of the symptom, after which the pain in the hypochondrium subsides. With a strong pain syndrome, narcotic analgesics are introduced to alleviate well-being, in rare cases, novocaine blockades are made. Etiopathogenetic drug therapy includes:
Pain in the left hypochondrium, provoked by Payr's syndrome, responds well to physiotherapy. To remove unpleasant symptoms, electrophoresis with local anesthetics is used. To increase intestinal motility and prevent constipation, iontophoresis with prozerin, UHF therapy, and diathermy are used. With intercostal neuralgia, reflexotherapy, UHF, and magnetotherapy are effective.
When acute pancreatitis is complicated by an abscess or necrosis, surgery is performed: endoscopic drainage, necrectomy, resection of the pancreas. With myocardial infarction, operations are performed to restore blood flow: coronary angioplasty, coronary artery bypass grafting. Exudative pleurisy is an indication for puncture and drainage of the pleural cavity.
A number of diseases of the spleen (heart attack, abscess, vein thrombosis) require emergency assistance from an abdominal surgeon. Taking into account the degree of damage to the organ, excision of individual sections of the parenchyma (resection) or total removal of the organ (splenectomy) is performed. With small tears, an organ-preserving operation is necessary to suture the damage, and extensive lacerations and crushed tissues are an indication for splenectomy.