- Zone of the right hypochondrium
- Conditions for the onset of pain
- Can pain arise in a healthy person?
- Pathological causes of pain
- Characteristics of pain
- What causes pain?
- Related Videos
An analysis of the pain syndrome showed that the pain localized in the right upper quadrant is felt at different times to 1/3 of the adult population. 90% of people have pathological changes.
Basically, these are diseases of the gallbladder and biliary tract, liver disease and hepatomegaly caused by edema in heart failure. Let's try to highlight the peculiarities of pain taking into account the localization and characteristics of patients' complaints.
Zone of the right hypochondrium
If we talk about localization, we should clarify which place of the human body is called the "right hypochondrium". For this, there is a classical definition of topographic anatomy - the area of the anterior abdominal wall, which has:
- the upper boundary is the right dome of the diaphragm at the level V of the rib;
- lower - the inner edge of the costal arch;
- in the center - a conditional vertical line passing through the lowest edge of the rib;
- on the right side - a vertical connection of the XII rib and right iliac crest of the hip bone.
As you can see, the anatomical definition is rather complicated. In fact, we refer to the hypochondrium all that is located in the region of the right lower ribs and beneath them from the spine (from the back) and to the sternal articulation.
In the projection of the right hypochondrium fall internal organs:
- liver and gallbladder;
- bending of the ascending and transversal gut;
- the upper pole of the right kidney with the adrenal gland;
- the peritoneal side of the diaphragm dome separating the thoracic cavity from the abdominal.
Conditions for the onset of pain
Causes of pain in the right hypochondrium are formed from the structure of the walls of internal organs, peculiarities of their innervation. For the painful organ, the following conditions must be met:
- in dense parenchymal organs - this is puffiness, increase in size and stretching or destruction of the capsule, which has pain receptors;
- for the bowel and gallbladder - spasm or stretching of the muscle and layer, inflammation in the submucosa (the mucosa itself has no pain points), disruption of the wall integrity.
No less important feature of the interior of the abdomen is the general innervation from some parts of the spinal cord, so the pain under the right lower ribs can reflect local pathology in the stomach, pancreas, duodenum, inferior vena cava.
Can pain arise in a healthy person?
Pain in the right upper quadrant in the front can arise for physiological reasons and not be accompanied by pathology. With physical exertion (more often when running, pushing) in an unprepared person, stitching pains on the right under the ribs are possible.
This is explained by a decrease in tone and stretching of the bile ducts due to the release of an additional portion of adrenaline, an increase in the blood filling of the liver with the expansion of the capsule, a spastic contraction of the muscles of the diaphragm during inspiration due to untrained breathing.
Exercising after a tight dinner makes the condition worse, because the liver feels pressure from the overflowing stomach
In women, colic in the hypochondrium causes an increase in estrogen on the right side and a fall in progesterone in the period before menstruation. Hormonal imbalance affects the tone of the gallbladder and pathways, causes stagnation and overstretch, hence, short-term colic is possible.
Similarly, hormonal contraceptives work, their reception is also accompanied by a violation of the outflow of bile. In the third trimester of pregnancy, physical activity is accompanied by moderate pain in the hypochondrium or a feeling of heaviness. Symptoms stop after giving birth.
Pathological causes of pain
Diseases of the organs lying in the right hypochondrium are accompanied by pains of a different shade, by irradiation to other parts of the abdomen, into the lower back and thorax. Symptoms of pain in the right upper quadrant should be known to doctors, because they are based on differential diagnosis.
Diseases of the liver, including hepatitis of various nature, alcoholic hepatosis, cirrhosis, parasitic diseases (echinococcosis, trichinosis), abscesses, liver cancer or metastatic node from the stomach, lungs, large intestine, breast.
The pathology of the heart (ischemic disease, a common heart attack, cardiopathy, inflammatory diseases of the membranes, vices) - there is a weakness of the right ventricle. This means that the muscle loses its ability to pump blood in the required volume. Insufficiency of blood circulation is accompanied by stagnation of blood below the hollow veins.
A cardiac cirrhosis of the liver is formed, which causes permanent pain in the right hypochondrium
Thrombosis at the level of the inferior vena cava should be borne in mind in acute sudden pain. In the gallbladder and ducts, inflammation, dyskinesia, precipitation of salts with the formation of stones are possible. Distinguish chronic calculous and acalculous cholecystitis, cholangitis, cholelithiasis. Rarely detected tumors.
Diseases of the right kidney are very diverse. Inflammation (pyelonephritis, glomerulonephritis) can proceed for a long time one-sidedly, the second kidney takes on the functions of both. Kidneys suffer from abscess formation, tuberculosis, echinococcosis, tissue structure is destroyed by hydronephrosis, polycystosis.
Urolithiasis promotes obstruction of the pelvis or ureter with a stone, further stagnation of urine provokes inflammation. Tumors from the renal parenchyma, as well as frequent metastasis in cancer of other localization, are accompanied by severe permanent pain. The right adrenal gland develops pheochromocytoma and other varieties of malignant neoplasms.
Among diseases of the colon should be allocated irritable bowel syndrome, colitis caused by infection, Crohn's disease, ulcerative colitis, tumors, diverticulosis, intestinal obstruction.
In the border tissues of the diaphragm and ribs, damage is possible due to fractures of the lower ribs, intercostal neuralgia, diaphragmatitis and a tumor surrounding the lichen caused by the herpes virus.
Abdominal pain radiates to the upper right and subcostal regions with perforation of duodenal ulcer, pancreatitis, appendicitis, traumatic damage to the kidney and liver.
Patients describe pain syndrome differently. The type of pain is taken into account in differential diagnosis.
Such patients are urgently delivered to the nearest surgical department and examined by experts on emergency conditions
Characteristics of pain
Then we consider the variants of pain sensations and their features against the background of diseases.
Acute pain in the right hypochondrium - arises suddenly, enters the concept of "acute abdomen". The question of surgical treatment is being solved. Sharp pain in the hypochondrium causes the following conditions on the right.
Injuries and ruptures of the liver, kidney, intestines. Growing bruises due to internal bleeding are added by dull pressing pains, accompanied by shock, dizziness, signs of anemia from blood tests.
Acute cholecystitis, pancreatitis, appendicitis in an abnormal location at the beginning of an attack causes nausea and vomiting, fever, pain radiates to the side, back, shoulder blade. Begins to pulsate, if the inflammation passes into purulent. In this case, urgent measures are needed since the condition indicates a rupture of the organ in the near future and the spread of pus around the peritoneum.
Perforation of the intestine is caused by a ulcerative lesion of the entire depth of the wall. Characterized by a cutting pain. Occurs during perforation of the ulcer (Crohn's disease, ulcerative colitis, ulcer of the duodenum), rupture of diverticula.
Intestinal obstruction is formed gradually, usually an acute condition is preceded by a period of constipation and aching pain. Abdominal bloating in the upper parts, vomiting, gas retention is added.
With complete blockage of the bile ducts, the stone shrinks muscles. On the other hand, stagnation of bile causes an increase and inflammation of the gallbladder. Therefore, an acute attack alternates with blunt burgeoning pains in the right hypochondrium.
Thrombosis of arteries and veins, thromboembolism of feeding vessels lead to oxygen hunger (ischemia), then to tissue necrosis. The pain is very intense, painful shock is possible. Renal colic, caused by the movement of the stone on the right ureter, gives an irradiation upwards to the hypochondrium, to the back and to the inguinal organs. The pain is acute unbearable, painful.
Sudden contracting pains accompany acute myocardial infarction in the abdominal form
Fracture of the right ribs causes a shooting pain, which increases with inspiration and movement. Similarly, a patient with intercostal neuralgia, shingles.
Learn more about the causes of pain during breathing in this article.
Pain is dull
The dull pain in the right upper quadrant is described by patients as "something aching, does not allow lying on the right side, bursting." They are carried by patients, although they can be different in intensity. With moderate pain, some patients do not want to see a doctor.
This type of pain syndrome is typical for chronic chronic inflammation, the initial stage of neoplasm and is observed:
- with chronic hepatitis, liver cirrhosis;
- parasitic liver disease;
- chronic cholecystitis and pyelonephritis without exacerbation;
- colitis without ulceration of the wall;
- diverticulum of the colon;
- gradually growing hydronephrosis;
- metastases from other organs.
Feeling of "heaviness"
Patients with heart failure indicate a permanent heaviness in the right hypochondrium caused by stagnation of blood. At the same time there are swelling in the feet and legs, an increase in the abdomen (ascites) due to sweat plasma into the abdominal cavity.
With a significant increase in the organ there is a drawing pain. Similar symptoms occur with hepatitis, fatty hepatosis, bile duct dyskinesia (hypomotor type), chronic cholecystitis outside exacerbation.
What causes pain?
All organs located in the right hypochondrium do not like sharp and fatty foods, fried dishes, smoked foods, pickles. These foods cause digestion to work with increased stress.
Unsuitable food provokes hidden forms of diseases, causes the failure of the functions of the digestive system
By the nature of the pain are distinguished by stupidity, spasm (cramping, stitching), the presence of nausea, accompanied by bloating, a violation of the stool. More information about pain in the right upper quadrant after eating can be found in this article.
Physical activity activates calculous processes in the gallbladder, kidneys. A special role is attached to jolting in transport, running, jumping. Called the movement of stones, which means - an attack of renal colic, cholelithiasis.
At the same time, the filling of the liver with blood is activated, the aching pain in the hypochondrium is strengthened on the right after performing hard work, sports training. Loads provoke exacerbation of intercostal neuralgia, osteochondrosis, myositis. Contribute to thromboembolic complications of blood vessels.
If dyskinesia of the biliary tract is caused by hypotension of the muscles, then the physical load improves the passage of bile. Patients note the removal of pain. The features of the pain syndrome will be considered on the example of different pathologies.
Pain caused by liver pathology
In the hypochondrium is the right side of the liver, the left - goes into epigastrium. The pains are caused by the overgrowth of the capsule. This mechanism is suitable for both swelling of the parenchyma in inflammation, and for volumetric processes (abscess, echinococcal cyst, neoplasm).
Hepatitis is a large group of inflammation of the hepatic parenchyma of different etiologies. For reasons distinguish between viral infectious, alcoholic, toxic, autoimmune. The pain is blunt burgeoning.
In the clinical course, intoxication of the organism comes first: nausea, lack of appetite, vomiting, severe weakness. Violation of the metabolism of proteins, fats and carbohydrates, the exchange of bile pigments causes jaundice of the skin and mucous membranes. The feces become grayish, the urine darkens.
With cirrhosis of the liver - gradually the inflammation passes into the stage of scarring. Dense nodes that do not contain hepatocytes are formed. Similarly fatty hepatosis ends with alcoholic illness. Characteristic persistent aching pain at the onset of the disease, when the liver is still enlarged. Then the size of the organ decreases. Hepatic insufficiency develops.
Echinococcal cyst - manifested when the body enters the larvae of the echinococcus parasite. It is most often localized in the right lobe. As he grows he squeezes the hepatic and bile ducts, stretches the capsule.
In 12% of patients causes suppuration with the formation of a liver abscess. About abstsedirovanie says throbbing pain in the right hypochondrium. Clinically revealed by intense constant pain in the hypochondrium to the right of a dull and aching character. Irradiates to the right shoulder, scapula.
Typically, amplification in the supine position on the left side, against the background of movements, deep breathing. The pain decreases, if you lie on your right side, curled up. When examined, doctors reveal a strong soreness when pressing on the lower right ribs.
Liver abscesses with a superficial localization break through the capsule and spread into the sub-diaphragmatic space
Pain in congestive heart failure
Heart failure causes a significant increase in the liver, edema on the feet and legs, trophic ulcers, ascites. The pains are of the character of a feeling of heaviness in the hypochondrium on the right. The patient can find out the previous history, the transferred diseases of the heart muscle.
With abdominal myocardial infarction, the pain is characterized by a pressing and burning intense attack ("knife blow"). Give in the right shoulder blade, behind the sternum. Most typical for infarction of the posterior wall of the left ventricle. Possible a drop in blood pressure, arrhythmia, shortness of breath.
How does the gallbladder hurt?
The gallbladder and ducts belong to hollow organs. Hence, pain in them can occur with stretching (violation of the outflow of bile) or spastic reduction. Dyskinesia is called hypotonic and hypertonic, respectively.
In its pure form, it is possible in childhood, in nervous, emotional people. Most often accompanied by inflammation (cholecystitis and cholangitis). The raised tone causes a spasm at movement of a stone that is shown by an attack of hepatic colic. Irradiate in the back, right shoulder blade.
Chronic cholecystitis occurs before exacerbation with blunt, aching pains, but in the acute stage is accompanied by sharp cutting sensations. Possible vomiting of bile, yellowing of the sclera, bloating, bitterness in the mouth in the morning.
Diseases of the gallbladder
Causes of liver abscess
Diseases of the adjacent department of the colon
The right hypochondrium refers only to the flexure of the transverse colon and the ascending colon. But the intestine is characterized by the spread of pain throughout the abdomen. At first they are less pronounced and do not affect the peritoneum. The patient feels a swelling, a violation of the stool.
Inflammation of the peritoneum can lead to pain shock, peritonitis. Symptoms are observed with injuries of the intestine. Spastic colitis causes seizures of cramping pain, constipation, flatulence. The disease is often of an infectious nature.
If nonspecific ulcerative colitis and Crohn's disease affect the entire intestine, the changes also affect the colon. In fecal masses, mucus, pus, impurities of blood are detected. The pain is intense, covering the entire abdomen.
Tumors are rarely localized in the right upper corner of the transverse colon. They manifest themselves as a mechanical obstacle for the passage of contents, disintegration. Then the main sign becomes an acute intestinal obstruction with a delay of stool, swelling of the upper part of the intestine, acute pain. Upon disintegration, the contents enter the peritoneal cavity and develop peritonitis.
Pyelonephritis - inflammation of the right pelvis of the kidney. It flows in different forms. The most difficult is the apostematous form (with multiple ulcers). Pain in the hypochondrium right "go" deep into the lower back.
Carbuncle in the gates of the kidney is capable of blocking urination, causing throbbing pain
When abscesses or carbuncles have a diffuse pulsating character. The temperature rises sharply, chills are observed. Violated urination. The patient has frequent urge to urinate, rezy. In the urine find pus, blood.
Paranephritis - is caused by the transition of inflammation from the capsule of the upper pole of the kidney to the surrounding fatty tissue. The temperature is increased. Pain syndrome is first localized in the region of the back, then covers the right hypochondrium, is strengthened by inhalation, walking, straightening of the body.
Urolithiasis is manifested by severe bouts of pain. Located in the lower back, right side of the abdomen, irradiate in the groin, external genitalia. At the height of the attack, vomiting is possible. In the urine, salt and blood are found.
Kidney cancer - gives symptoms only in later stages. First, it does not have any characteristic features. With growth manifests blood in the urine, intense pain and acute urinary retention. Tumors of the right adrenal gland (pheochromocytoma, aldosteroma, corticosteroma) are known to endocrinologists, as they alter the hormonal composition of a person, secondary sexual characteristics.
Diseases of the ribs
Bruises, fractures, intercostal neuralgia are accompanied by intense pain in the back, side. Strengthened by a deep breath, with bends of the body, tilt. Clarity brings the palpation of a painful place. About the manifestation of pain in the right hypochondrium and back read in this article.
If you have pain in the right upper quadrant, you should not rely on your own knowledge. Only an expert will help to understand and find the cause. Prolonged patience has serious consequences.