Pain in the right hypochondrium occurs with diseases of the hepatobiliary zone: biliary dyskinesia, acute and chronic cholecystitis, hepatitis and parasitic infections. Less commonly, a symptom occurs with cirrhosis and malignant tumors of the liver. Discomfort in the hypochondrium occurs with hemolytic anemia, heart failure, and also as a variant of radiating pain. The standard diagnostic plan includes ultrasound and X-ray examination, ERCP, duodenal sounding. For therapeutic purposes, a diet, antispasmodics, cholekinetics, antibiotics and antiviral agents, and surgical procedures are used.
With the hyperkinetic variant of dyskinesia of the biliary tract, colicky pain in the right hypochondrium predominates, developing 20-3 minutes after the end of the meal. The pain attack can be provoked by physical activity, stress. Cramping pains are accompanied by nausea, and then vomiting. Unpleasant sensations pass on their own or are removed by antispasmodics. Between attacks, the general state of health is good, there is no pain under the ribs on the right.
Hypokinetic dyskinesia is characterized by constant aching pain, a feeling of heaviness and fullness in the hypochondrium. Eating fatty foods increases the pain. When probing the right upper abdomen, a person feels a dull pain. With this form of dyskinesia, pronounced dyspeptic disorders occur. Patients complain of bitterness in the mouth, belching, loss of appetite.
Pain in the right hypochondrium is a typical symptom found in all types of hepatitis. There is a dull soreness and a feeling of pressure in the indicated area, usually not associated with eating or stress. Acute hepatitis is characterized by sharp pains, which are aggravated by palpation of the abdomen in the hypochondrium zone. The pain syndrome is supplemented by dyspeptic disorders, signs of intoxication, jaundice.
With inflammation of the gallbladder, moderate pain is felt in the hypochondrium, which persists for several days and even weeks. Typical irradiation of pain in the scapula, lower back, right shoulder girdle or shoulder. Increased pain contributes to the intake of fatty and spicy foods, carbonated drinks. The disease proceeds with periods of remission, during which the pain disappears, and patients are only concerned about discomfort or heaviness under the right costal arch.
With acalculous cholecystitis, the symptoms are less pronounced, the general condition remains satisfactory. As a rule, dyspeptic disorders come to the fore. In chronic calculous cholecystitis, in addition to dull pain, severe pain attacks can occur. In this case, the pain becomes cramping, sharp. In addition to them, severe nausea, vomiting with bile, subfebrile condition are noted.
Symptoms are due to exacerbation of gallstone disease. A person experiences excruciating pain, which can be cramping, cutting, tearing or burning. At the time of the attack, the patient lies on his side, legs tucked to his stomach, or rushes around the bed to find a comfortable position. Pathognomonic irradiation of pain in the right shoulder and shoulder blade. The clinical picture is supplemented by nausea, vomiting of bile, flatulence.
Pain in the right hypochondrium
Initially, there is a sharp pain in the right hypochondrium with irradiation to the corresponding scapula and shoulder. The patient lies motionless on his side, pulls his knees to the abdominal wall. When feeling the right parts of the abdomen, the pain intensifies. At the second stage of bile peritonitis, the pain syndrome persists, repeated vomiting opens, and intoxication increases. If a person does not seek medical help, the terminal phase begins, when the pain subsides due to the death of nerve endings.
With liver echinococcosis, the pain syndrome gradually increases. At first, the patient is worried about heaviness, discomfort, especially after eating large amounts of food. An increase in the size of an echinococcal cyst is accompanied by increased pain. The development of symptoms after physical activity is characteristic. Pain in the right hypochondrium is also found in other infections: amoebiasis, opisthorchiasis, ascariasis.
For a long time, it is asymptomatic. Patients experience intermittent dull pain in the right abdomen, provoked by diet or alcohol consumption. There are rapid satiety, heaviness under the ribs at the end of the meal. When cirrhosis is complicated by portal hypertension, pain spreads to the epigastric and paraumbilical regions.
Pain in the right hypochondrium is due to an increase in the size of the tumor and stretching of the liver capsule. They disturb a person constantly, are not associated with external provoking factors. For oncological pathology, dull pain, a feeling of fullness and heaviness in the right side are typical. With malignant degeneration of the liver tissues, progressive weight loss, symptoms of dyspepsia, anemia and hemorrhagic syndrome are observed.
Constant dull pains on the right under the ribs are characteristic of toxic anemia caused by the action of toxic substances or drugs. Less often, pain in the abdomen under the costal arch on the right is a sign of paroxysmal nocturnal hemoglobinuria, autoimmune damage to erythrocytes. Severe pain in the liver area is possible with exacerbations of hereditary anemia - membranopathies, fermentopathies, hemoglobinopathies.
Discomfort and pain in the right hypochondrium are typical for dysfunction of the right ventricle of the heart, when blood stagnation occurs in the venous bed. Patients complain of distension in the abdomen, aggravated by active movements, after eating. In addition to the pain syndrome, edema of the lower extremities, shortness of breath and fatigue during physical exertion, swelling of the jugular veins are determined.
Often, when the pathological process is localized in the right iliac region, irradiation of pain in the hypochondrium is observed, which is due to the peculiarities of innervation. The pains are sharp, stabbing, dull or compressive. If the symptom is caused by a surgical pathology, unbearable pain develops, which sharply increases with pressure on the abdominal wall. The most common causes of radiating pain:
The primary examination is carried out by a gastroenterologist or a highly specialized hepatologist. Physical examination assesses bladder symptoms, liver size, signs of peritoneal irritation, and local tension in the abdominal muscles. If necessary, a consultation of an infectious disease specialist, a gynecologist, a surgical oncologist is appointed. The diagnostic plan includes:
Of the laboratory methods, a biochemical blood test with liver tests is of diagnostic value, in which they look at the level of bilirubin, cytolysis enzymes, cholesterol and alkaline phosphatase. To diagnose parasitic diseases, feces are analyzed for helminth eggs. To exclude the viral nature of pain in the right hypochondrium, serological tests for hepatitis A, B, C are done.
Ultrasound of the hepatobiliary zone
To reduce pain in the right hypochondrium, it is recommended to follow a diet with a restriction of fried, fatty, smoked foods, conservation and spices. The use of alcohol is prohibited. The diet should be dominated by fruits and vegetables, low-fat varieties of fish and meat. With increased pain syndrome, it is necessary to reduce physical activity, adhere to a sparing or half-bed regimen.
To stop an attack of spastic pain, you can use a warm (not hot!) Heating pad, which is applied to the right hypochondrium. Cramping pains are well stopped by antispasmodics. Persistent soreness is a reason to see a doctor, since a symptom can be caused by dozens of different diseases that, if left untreated, lead to serious complications.
Moderate pain in the right hypochondrium, which occurs in chronic diseases of the hepatobiliary tract, is treated on an outpatient basis. Hospitalization is required for patients with a severe pain attack and a severe general condition. In the hospital, narcotic analgesics are used to relieve unbearable pain, and detoxification therapy is carried out. To eliminate the causes of pain, several groups of medicines are used:
In chronic diseases of the gallbladder, courses of therapeutic mineral waters are prescribed. Hepatobiliary pathologies in remission are an indication for physiotherapy: reflexology, electrophoresis, SMT therapy. Phytotherapy methods are recommended to improve digestion. Spa treatment is widespread.
In cholelithiasis, minimally invasive methods of stone destruction (remote or contact lithotripsy) are used, operative methods are laparoscopic or classical laparotomic cholecystectomy. For liver cancer, a lobectomy or hemihepatectomy is performed, and chemoembolization is used. A radical method of treating cancer and cirrhosis is liver transplantation, which is performed in specialized centers.