How to relieve acute pain in the right hypochondrium. Pain under the ribs: nature, causes, treatment. Why does pain appear at the back under the right ribs

A common reason for a visit to a gastroenterologist or general practitioner is the patient's complaints of pain in the right hypochondrium. Discomfort in this area of ​​the abdomen can sometimes occur in healthy people during physical exertion.

This symptom often occurs as a result of stagnation of bile in the biliary tract. With tension in the anterior wall of the abdominal cavity, pressure on the gallbladder occurs and, as a result, its contraction. Such an attack, as a rule, is short-lived and usually ends with loose stools and an improvement in the patient's condition. In some cases, acute, sharp pains in the right hypochondrium can be evidence in which you need to immediately consult a doctor in order to avoid serious consequences and complications.

Possible causes of pain in the right hypochondrium.

Pain in the right hypochondrium can occur as a result of inflammation of various organs: the small intestine, gallbladder, duodenum and colon, right kidney, diaphragm, pancreas.

Pain in the upper part of the abdominal cavity and in the region of the right hypochondrium can be provoked by injuries of the above organs. The strength and nature of the felt pains are determined by the localization and various features of the pathological process.

There are frequent cases when a sharp pain in the right hypochondrium occurs as a result of diseases of organs that are located in another part of the abdomen. In this case, pain is transmitted through nerve fibers.

Diseases accompanied by pain in the right hypochondrium.

Most often, acute pain in the right hypochondrium occurs when. Bile, which contains enzymes necessary for the digestion of food, is formed in the liver. Excess bile is stored in the gallbladder, and from there the bile passes into the duodenum.

The intake of a large amount of fatty foods, various infections, the formation of stones in the gallbladder provoke the occurrence of an inflammatory process -. The main symptoms of acute are vomiting, nausea, burning pain in the right hypochondrium, which can radiate under the shoulder blade or in the shoulder. In some cases, severe itching of the skin may begin or, and surgical treatment is required.

Severe pain in the right hypochondrium is possible with a disease due to the inflammatory etiology of the liver. can occur with poisoning, various chemical poisons, or as a result of infections. may be accompanied by an increase in body temperature, intoxication of the body and a sharp deterioration in the general condition.

Pulling pain in the right hypochondrium is characteristic of chronic, accompanied by an increase in the liver and intolerance to fried foods. For a long time, with chronic, the patient does not show any symptoms, since the liver usually does not hurt. However, at this time, a gradual process of replacing liver cells with connective tissue occurs, as a result of which it develops. Therefore, if you suspect liver problems, liver maintenance drugs should be included in the course of treatment - the most effective of which are drugs based on.

Dull pain in the right hypochondrium indicates chronic inflammation of the gallbladder, accompanied by nausea after eating, yellowing of the sclera and skin. In this case, treatment is carried out with the use of antispasmodics, antibiotics, and diet.

Aching pain in the right hypochondrium provokes a disorder of the biliary system - resulting from a violation of its motor function. This disorder most often has a psychosomatic origin. The patient experiences pressing pain in the right hypochondrium, bitterness in the mouth, loss of appetite, fatigue, bad mood.

A stabbing pain in the right hypochondrium can be provoked by a pathology of the right kidney, accompanied by nausea, vomiting, fever, intoxication, weakness, painful frequent urination. With urolithiasis and pyelonephritis, pain occurs in the side and back, radiating to the stomach. With the formation of a pronounced destructive process and large stones, surgical intervention is required. With conservative treatment, antispasmodics, antibiotics, detoxification are used.

Throbbing pain in the right hypochondrium worries patients, which is characterized by severe pain in the epigastric region, nausea, constant vomiting with an admixture of bile, bloating, diarrhea and fever. Chronic is accompanied by arching pain in the right hypochondrium, enzymatic deficiency, flatulence. Therapeutic therapy is carried out with the help of fasting, anti-enzymatic drugs, cytostatics and antispasmodics. In an acute process, therapy is carried out only in stationary conditions in order to avoid serious complications.

The appearance of night pains in the right hypochondrium is characteristic of a duodenal ulcer, the symptoms of which are also pain on an empty stomach or immediately after eating, flatulence, nausea, bloating, belching, and sometimes vomiting with blood. If the patient is worried, dagger pain, dizziness and weakness, you should immediately call an ambulance, as this may indicate a perforation of the ulcer.

Other causes of pain in the right hypochondrium:

• cholangitis;
• colitis;
• tumor of the liver and gallbladder;
• liver abscess;
• cardiac cirrhosis of the liver;
• helminthic invasion (giardiasis, echinococcosis, ascariasis).

So, there can be many reasons for pain in the right hypochondrium. For an accurate clarification of the problem, it is necessary to contact a qualified specialist, in this case a gastroenterologist, to undergo an examination and prescribe appropriate treatment.

Pain in the right side under the ribs indicates a malfunction of the digestive system, diseases of the gynecological sphere, discomfort can be caused by pathologies of the heart, musculoskeletal system. Unpleasant sensations are different in nature and duration, accompanied by certain signs.

The causes of pain in the right side under the ribs can be many

Causes of pain in the right side under the ribs

In the right upper zone of the abdomen is the liver, gallbladder, duodenum, kidney, part of the diaphragm. The cause of pain in this area can be female diseases osteochondrosis, heart attack, angina pectoris, pathology of the lung, pancreas, shingles.

Why does it hurt right front

In case of malfunctions in the liver, gallbladder, stomach, pathological processes in the lungs and diaphragm, heart disease, unpleasant sensations are localized in the anterior right hypochondrium region of the abdomen.

Main diseases:

• tumors and cirrhosis of the liver, various forms of hepatitis;
• cholecystitis, gallstones;
• dysfunction of the pancreas;
• diaphragmatic hernia;
• inflammation of the appendix;
• heart attack, angina pectoris;
• right-sided inflammation of the lungs - the pain syndrome manifests itself brighter during a cough, with a deep breath;
• shingles.

If the pain appears under the ribs on the right front, then this may indicate a diaphragmatic hernia.

Causes of discomfort under the ribs at the back on the right

If the pain syndrome from the right ribs spreads back, this is a sign of the presence of pathologies in the organs of the urinary system.

Why does pain appear at the back under the right ribs:

• with pyelonephritis, the pain is paroxysmal, radiates to the lumbar zone;
• urolithiasis - the severity of the pain syndrome depends on the size of the stone;
• acute attack of pancreatitis;
• lumbar osteochondrosis, intervertebral hernia - the pain is sharp or muffled, it is more intense when moving, it is difficult for a person to sit.

Dagger pain in the right rear often appears after back injuries, aggravated by walking - similar symptoms indicate the formation of a hematoma behind the peritoneum.

Pain in the right back indicates urolithiasis

Dull pain in the ribs on the right side

Pulling constant or periodic discomfort is a sign of chronic diseases of the gastrointestinal tract and organs of the genitourinary system.

Causes of pain syndrome of a pulling nature:

1. Chronic cholecystitis - against the background of cholelithiasis, the gallbladder becomes inflamed. Stones damage the tissues of the organ during movement, ulcers appear, which gradually turn into scars - stagnation occurs, the movement of bile worsens. The disease is accompanied by muffled pain, heaviness in the abdomen, discomfort is more pronounced after eating fatty foods.
2. Chronic pancreatitis - the pathology is evidenced by dull pain under the ribs on both sides, which manifests itself more strongly after eating, dyspeptic disorders.
3. Chronic pyelonephritis - the pain syndrome increases during intense exercise, the temperature often rises, diarrhea occurs, and hypertension develops.
4. Chronic hepatitis - aching pain is accompanied by flatulence, intolerance to fatty foods and alcohol.
5. Duodenitis - there is pain of a dull nature, vomiting with streaks of bile, heartburn, stool disorder.

Dull pain under the ribs is a sign of pancreatitis

Pain in the region of the right hypochondrium at night, early in the morning or immediately after eating is a sign of a duodenal ulcer. The disease is accompanied by vomiting, bloating.

Aching pain on the right

Constant aching pain in the region of the right hypochondrium is one of the main signs of hepatic pathologies.

Why pulls in the right side:

1. Viral hepatitis - the disease can proceed for a long time without any symptoms, the development of the pathology is evidenced by periodic tingling, pulling pains under the right lower rib, severe fatigue, the skin becomes yellowish, the urine becomes cloudy.
2. Cirrhosis of the liver - a pain syndrome of a aching nature occurs at a late stage in the development of pathology, indicates the death of a large number of cells.
3. Liver tumors of a malignant nature - the pain is periodic, pressing, while the person loses weight dramatically, complains of severe fatigue, low-grade fever.

Acute or dull pain without other signs of inflammation, problems with the digestive system often has a psychosomatic origin, occurs with vegetative-vascular dystonia.

Aching pain on the right indicates cirrhosis of the liver

Sharp pain in right side

Pain syndrome of intense, burning nature is a sign of a strong inflammatory process, exacerbation of chronic pathologies of the gastrointestinal tract.

What does severe pain indicate?

1. Cholecystitis - an attack begins unexpectedly, more often at night, accompanied by a burning throbbing pain, the stomach reduces. In the acute form, the pain radiates to the arm, frequent bouts of vomiting are disturbing.
2. Ulcerative duodenitis of the duodenum - the pain has a stabbing, dagger character, worsens during sleep, discomfort, burning sensation decrease after eating. The disease is accompanied by flatulence, vomiting, weakness.
3. Renal colic - occurs when stones move, the pain is acute, severe, with a change in body position, the condition does not improve.
4. Pancreatitis - shoots in the side, the pain is throbbing, girdle, rumbles in the stomach, spasms occur.
5. Herpes zoster is a viral disease, the initial stage is accompanied by a sharp constant pain on the right or left side, after a few days bubbles appear, they are located in the places where the nerve endings pass.

Acute dagger pain in the right side, a rapid rise in temperature, vomiting - a clinical picture of appendicitis, the process is located in the iliac zone, but the pain often radiates under the ribs, in the leg, and in the pubic zone.

Before the appearance of shingles, there is a sharp pain on the right side

Pain under the right rib - gynecological problems

In women, an ectopic pregnancy, problems of the pelvic organs can provoke the appearance of discomfort in the right side.

Main reasons:

1. Ectopic pregnancy - there is no menstruation, but spotting spotting appears against the background of pulling pain, colitis in the side, a sharp increase in discomfort indicates stretching or a violation of the integrity of the fallopian tube.
2. Adnexitis - with inflammation of the appendages, the stomach hurts below, discomfort occurs in the area of ​​\u200b\u200bthe right hypochondrium. There are vaginal discharge interspersed with pus, nausea, the process of urination is disturbed.
3. Torsion of an ovarian cyst is a severe pathology, which is accompanied by pain in the lower abdomen and right side, bleeding, fever, signs of intoxication.

Adnexitis - inflammation of the female appendages

Pain in the right side in men

Discomfort in the right hypochondrium in men occurs with alcohol abuse, often the cause of discomfort is urological pathologies.

Main diseases:

1. Cavernitis - the inflammatory process is localized in the cavernous body of the penis, erectile dysfunction develops intensively. The acute stage is accompanied by high fever, swelling of the inguinal lymph nodes, tingling pain in the right side. In the chronic form, discomfort is mild, manifests itself during emptying of the bladder, during sex.
2. Prostatitis - inflammation, swelling of the prostate gland, the clinical picture depends on the form of the disease. Pain from the lower abdomen can radiate to the lower back, under the ribs, in the inguinal region, erection and urination worsen.
3. Prostate adenoma is a benign hyperplasia, accompanied by a feeling of fullness, pressing pain in the lower abdomen, which radiates to the back, inguinal region, side, a bump is felt at the base of the penis.

Severe pain can be caused by the presence of stones in the prostate gland.

Pain in the right side in men may indicate prostate adenoma

Unpleasant sensations in the right hypochondrium in healthy people

Discomfort between the ribs on the right does not always indicate the presence of serious diseases; periodically, healthy people can also ache in this area.

Causes of pain below the ribs on the right:

• physical activity - it hurts and twitches in the right side, discomfort occurs in people who lead a sedentary lifestyle;
• during pregnancy - discomfort appears in the II trimester against the background of intensive growth of the fetus, which presses on the internal organs;
• PMS - discomfort occurs with high levels of estrogen, which cause spasms of the biliary tract.

Which doctor should I contact?

If the pain in the region of the ribs is of a long-term nature, it is necessary. After conducting the initial diagnosis, he can write out a direction,.

Diagnosis of pain in the right hypochondrium

The doctor makes a preliminary diagnosis after examining the patient, taking an anamnesis, studying the medical history, during the physical examination, the specialist measures pressure, temperature, and pulse rate. Then he prescribes a comprehensive examination to confirm the diagnosis.

Diagnostic methods:

• clinical, biochemical blood test;
• general urine analysis;
• coprogram;
• test for tumor markers, biopsy;
• bacteriological analysis of a smear from the vagina or urethra;
• Ultrasound of the pelvic organs and abdominal cavity:
• cardiogram;
• x-ray with or without contrast agent;
• endoscopy;
• CT, MRI.

It is necessary to immediately call an ambulance with a sharp, severe attack of pain that intensifies, with a pain syndrome of a pulling or stabbing character that lasts longer than 30–60 minutes.

To identify the causes of pain, you need to do a cardiogram

Treatment

Based on the results of the study, the doctor selects the appropriate medications, draws up a treatment regimen. If discomfort is caused by problems with the digestive system, then diet therapy is additionally prescribed.

Medical therapy

To eliminate pain in the right side, different groups of drugs are used, which are aimed at eliminating the inflammatory process, restoring the functions of damaged organs.

What drugs are used in therapy:

• antispasmodics - No-shpa, Baralgin;
• broad-spectrum antibiotics - Levofloxacin, Amoxicillin;
• anti-inflammatory drugs - Metronidazole;
• hepatoprotectors - Essentiale, Karsil;
• enzymes - Mezim, Creon;
• drugs to improve the outflow of bile - Allochol;
• sedatives - Relaxil, Deprim;
• heart drugs - Nitroglycerin, Verapamil, Concor.

Additionally, vitamin complexes, probiotics and prebiotics should be taken to strengthen immunity and restore the balance of intestinal microflora.

Pain in the right hypochondrium in front is a discomfort that every person faces throughout life, regardless of gender or age category. In most cases, such a manifestation is caused by a malfunction or damage by some pathological process to the organs located in the area under the right ribs. Less often, the factor of occurrence is the irradiation of pain in cases of the development of diseases associated with other organs. This is due to the fact that the internal organs are quite closely adjacent to each other.

Often, the soreness of this localization is the first, but not the only symptom of a particular disease. The clinical picture will be different for each person, which is explained by various sources of such a manifestation.

At the first manifestation of such a sign, especially if it is strong and persistent, you should consult a doctor as soon as possible. To confirm the diagnosis, after the initial examination, a series of laboratory and instrumental diagnostic examinations will be required. Based on the results, an individual and most effective therapy strategy will be drawn up.

Etiology

The appearance of pain in the front in the right side of the abdomen can provoke such organs:

• liver;
• right kidney;
• gallbladder and bile ducts;
• pancreas;
• a small part of the diaphragm;
• some intestinal loops.

According to the observations of gastroenterologists, diseases of the gallbladder are considered the main cause of pain in the right hypochondrium. In this case, pain can have a different character - from acute to aching, and also gradually increase the intensity of manifestation. Among the ailments of this organ, which lead to the appearance of pain in front under the right ribs, it is worth highlighting:

The second most common internal organ that causes pain in the right hypochondrium is the liver. In such cases, the pain will be bursting or dull, but it will manifest itself on an ongoing basis. Diseases of this organ include:

In addition, diaphragm diseases such as:

• inflammation of the diaphragm - diaphragmatitis;
• the appearance of a right-sided hernia;
• injury.

Often, diseases of the pancreas can be considered a predisposing factor in the appearance of such a symptom. In such situations, the patient feels a cutting pain, the intensity of which depends on the form of the underlying disease. These diseases include:

• acute or chronic pancreatitis;
• the formation of malignant or benign tumors;
• injury.

Another of the most common causes of pain in this localization is acute inflammation of the appendix. In most cases, patients assume that a similar symptom occurs on the right side of the lower abdomen, but often the attack begins precisely from the lower region of the right hypochondrium.

Quite common is pain from below in the right hypochondrium during the period of bearing a child. This is due to an increase in the size of the uterus and the active growth of the fetus in the second and third half of pregnancy. However, it is worth noting that if the pain appears in the first trimester, then it may indicate an ectopic pregnancy. It is also not uncommon for a similar symptom to appear in this area during premenstrual syndrome.

Less common factors that cause the expression of such a syndrome include:

• peptic ulcer of the duodenum or stomach;
• pathology of the cardiovascular system;
• herpes zoster;
• inflammation of the right lung;
• osteochondrosis.

In addition, it is worth considering that not the last place in the formation of such disorders and, accordingly, in the expression of pain is occupied by:

• addiction to addictions;
• irrational nutrition;
• prolonged exposure to stressful situations;
• irregular intake of certain medications.

Classification

The nature of the expression of the pain syndrome in the right hypochondrium may indicate a lesion of one or another organ. For example:

• aching pain often indicates pathologies of the gallbladder or ducts, as well as chronic liver diseases;
• stabbing pain in the right hypochondrium indicates the presence of hepatic colic or perforated ulcer;
• arching - has the same reasons as aching;
• acute - indicates lesions of the duodenum, stomach and appendage of the caecum;
• sharp and girdle is a manifestation of pancreatitis;
• dull - is a sign of an exacerbation of a particular chronic process or the formation of a neoplasm in the liver;
• pressing and extending to the entire right side may indicate pneumonia.

Also, pain can occur in the morning or at night, after eating or during movement.

Symptoms

Against the background of the fact that in almost all cases the right hypochondrium hurts below due to the influence of pathological factors, such a symptom will not be the only manifestation of the clinical picture.

It is worth noting that the pain in some diseases can be girdle, spread throughout the front wall of the abdominal cavity or the right side of the body. Sometimes the pain is so strong that even the forced position of the body cannot relieve it. In such cases, there is a risk of developing pain shock. Against the background of pain in most cases, the following symptoms are expressed:

• yellowness of the skin and mucous membranes;
• nausea and vomiting. Often vomiting does not bring relief;
• increase in body temperature values;
• decrease in blood pressure;
• an increase in the size of the abdomen;
• decreased performance, which occurs against the background of severe weakness and fatigue;
• lack of appetite;
• aversion to fatty foods;
• alternating constipation and diarrhea;
• rapid pulse;
• heartburn and belching;
• difficulty breathing;
• the appearance of an unpleasant aftertaste in the oral cavity;
• severe headaches and dizziness;
• fainting or loss of consciousness;
• impurities of bile in vomit;
• itching of the skin;
• change in the shade of urine (darkening) and feces (discoloration);
• the appearance of plaque on the tongue.

These are just the main symptoms that may accompany pain in the right hypochondrium in front.

Diagnostics

Since, in the vast majority of cases, such a symptom is expressed against the background of a particular disease, at its first manifestation, even if it occurs periodically, you should immediately seek help from clinicians.

Performing diagnostic measures and drawing up the most effective treatment tactics is carried out by a gastroenterologist, but in some situations, consultations of other narrow specialists may be necessary.

Comprehensive diagnostics includes:

• detailed survey of the patient;
• study of the patient's medical history and anamnesis of life;
• performing a thorough physical examination, during which palpation of the abdomen is mandatory, as well as measurement of blood pressure, temperature and pulse rate;
• laboratory examinations of blood, urine and feces;
• ECG and ultrasound;
• CT and MRI;
• radiography with or without contrast;
• biopsy;
• endoscopic procedures for examining the inner surface of the organs of the digestive system.

Only after studying all the results of the above examinations, the doctor will be able to draw up the most effective treatment regimen individually for each patient.

Treatment

In cases of such a symptom, patients are strictly forbidden to take measures to relieve pain, as this can only aggravate the course of a particular disease.

To neutralize pain at the bottom of the right hypochondrium, doctors use conservative methods of treatment, namely:

• prescribing medications;
• diet therapy - only when the source of the main symptom was the ailments of the digestive system. Proper nutrition will not only relieve an acute attack of pain, but also prolong the remission phase of chronic disorders;
• use of alternative therapy prescriptions. It is worth considering that such treatment should in no case form the basis of the treatment of the disease.

Depending on the patient's condition, conservative methods are used in a medical institution or at home, but under the supervision of the attending physician.

Surgical intervention is used extremely rarely - with the ineffectiveness of the above methods of treatment, in cases of the formation of calculi or malignant tumors, as well as in a serious condition of the patient, which is expressed in.

Acute stabbing pains in the right hypochondrium are commonly called biliary (hepatic) colic. biliary colic- a sudden onset of intense pain in the right hypochondrium caused by blockage or spasm of the bile ducts. Usually such pains are caused by the ingress of a stone from the gallbladder into the bile ducts. However, there are a number of reasons that can cause such pain. In the article we will consider the most common causes.

Anatomy of the gallbladder and bile ducts

gallbladder
The gallbladder is a pear-shaped reservoir for the accumulation and storage of bile. It is located in the right lobe of the liver in a special bed. Holds normally up to 70 ml of bile. The length is 7 cm, the width is 3 cm. The basis of the bladder is muscle fibers that run in the longitudinal and circular direction. Allocate the bottom, body, funnel and neck of the gallbladder. The promotion of bile is regulated by special muscle sphincters, which carry out the unidirectional movement of bile towards the duodenum. However, sometimes spasm of the sphincter (usually the sphincter of Oddi) causes hepatic colic.

The innervation of the biliary tract, pancreas and duodenum has a common origin, which leads to their close relationship and explains the similarity of symptoms.

Projection of the gallbladder on the anterior wall of the abdomen
Knowing the location of the gallbladder will help you navigate the diagnosis of the disease. Since it is in this place that the maximum pain sensitivity will manifest itself. The gallbladder area is the intersection of the right costal arch and the outer edge of the rectus abdominis muscle.

Causes of hepatic colic

Diseases that may present with acute an attack of pain in the right hypochondrium:

• Cholelithiasis
• Dysfunction of the sphincter of Oddi
• Functional disorders of the gallbladder
• Acute acalculous cholecystitis
• Exacerbation of chronic acalculous cholecystitis
• Choledocholithiasis (stones in the common bile duct)
• Acute cholangitis

• Crohn's disease (Terminal ileitis)
• Colitis (inflammation of the large intestine)

Mechanisms of hepatic colic

• Spasm of the cystic duct
• Blockage of the bile duct by a stone or lump of mucus
• Violation of the excretion of bile common bile duct:
  • Spasm of the sphincter of Oddi;
  • Blockage of the sphincter of Oddi with a stone or a lump of mucus;
  • Stone passage through the common bile duct.

1. The zone accompanied by moderate pain is the funnel, the neck and the part of the body of the gallbladder adjacent to the neck.
2. The zone of sharp pain is the bile ducts.

Symptoms of hepatic colic

	Cause		Start and duration	The nature of the pain	Where does it hurt?	Associated symptoms
Pain in biliary colic	Ingress of stone, mucus into the bile ducts		Sudden onset, may last for hours. Usually the intensity of pain increases within 15-60 minutes, then almost constant for 1-6 hours. Then there is a gradual subsidence of pain. But a sudden cessation of pain is also possible. An attack lasting more than 6 hours may indicate the development of acute cholecystitis (inflammation of the gallbladder).	Acute, paroxysmal	Right hypochondrium, below the sternum (in the epigastrium). The pain may radiate to the right shoulder blade and back. In some cases, pain can also occur in the region of the heart, resembling an angina attack.	Nausea, vomiting without relief. Temperature rise, chills are not observed. The pulse may be quickened, the pressure practically does not change. With prolonged colic, the mucous membranes and skin may acquire a yellowish tint. Itching may appear. The feces become white. Urine takes on the color of beer.
Between attacks of colic, the patient feels quite well. In 30% of cases, the patient does not relapse.

Mechanism of pain
When a stone enters the duct, its reflex spasm occurs, which sharply disrupts the blood supply to this area. A clogged duct leads to a violation of the outflow of bile and causes stretching of the overlying sections of the duct, the motor activity of the duct increases, all this causes severe pain.

Pain in functional disorders of the gallbladder
Reasons for violation:

• Psycho-emotional stress
• Error in diet
• Tobacco smoking

Mechanism
The pain is associated with contraction of the muscle layer of the gallbladder. Spasm is caused by a violation of the emptying or filling of the gallbladder with bile.
General symptoms: irritability. sweating, headache, palpitations, fatigue, sleep disturbance. The temperature is not raised. Pain in the projection of the gallbladder.

Pain resulting from spasm of the bile duct or sphincter of Oddi

Very often, the cause of biliary colic is a spasm of the bile ducts or the sphincter of Oddi. In case of dysfunction of the sphincter of Oddi, there is a violation of the outflow of bile and pancreatic juice in the area of ​​\u200b\u200bthe junction of the bile duct with the pancreatic one. Most often, a spasm of the sphincter occurs, usually against the background of psycho-emotional experiences, stress, during physical exertion, poor nutrition (overeating, fasting, taking spicy, fatty fried foods, drinking alcohol). Spasm leads to a violation of the outflow of bile and pancreatic juice, which is accompanied by pain and indigestion.

Pain in the right hypochondrium or in the area below the sternum, may radiate to the back, right shoulder blade, or occur in the left hypochondrium. Sometimes the pain has a girdle character, more often such pain is associated with eating, accompanied by nausea, vomiting.

The main symptoms of dysfunction of the sphincter of Oddi are recurring attacks of severe or moderate pain lasting more than 20 minutes, occurring for 3 consecutive months.

Pain in acute acalculous cholecystitis

Acute acalculous cholecystitis is an acute inflammation of the gallbladder wall.

The reasons:
The obstructed outflow of bile from the gallbladder contributes to the attachment of infection and the development of an acute inflammatory process.

Symptoms:
More common in men. The beginning is sudden. In the form of typical pains of biliary colic. Then the pain becomes permanent. Pain occurs more often in the right hypochondrium, less often over the navel and in the right side of the abdomen. The body temperature rises to 37.2 C and above. The abdominal muscles in the right hypochondrium are tense. When tapping with the edge of the palm along the right costal arch and the patient, the pain increases sharply. In the general blood test, the number of leukocytes and ESR increases.

Acute cholecystitis requires urgent hospitalization in the surgical department to solve the problem in a conservative way (use of antibiotics) or surgical removal of the gallbladder.

Pain in acute cholangitis
Acute cholangitis - inflammation of the bile ducts.
Causes: violation of the outflow of bile contributes to the attachment of infection (E. Coli in 50-60% of cases), which leads to inflammation of the bile ducts. Violation of the outflow of bile is often associated with the entry of a stone into the bile duct.
Symptoms:
A triad of symptoms is characteristic: 1) pain in the right hypochondrium, 2) jaundice, 3) fever with chills. In addition, it is possible: confusion, lowering blood pressure. The stool is discolored, the urine is dark.
Acute cholangitis requires urgent hospitalization and treatment in the surgical department.

Treatment of hepatic colic. Urgent care.

Is it necessary to call an ambulance?

• An increase in body temperature of 37 C and above, chills;
• The appearance of yellowness of the mucous membranes and skin;
• The appearance of diffuse pain throughout the abdomen;
• confusion;
• A sharp drop in blood pressure.

Hospitalization of patients with hepatic colic is carried out in the surgical department. Where further tactics of treatment of the patient are decided. There are 2 main ways to solve the problem. The first is conservative treatment (the use of antispasmodics and analgesics, antibiotics if necessary). The second is emergency surgery (stone and/or gallbladder removal).

How to remove hepatic colic?

What to do if there are no medicines at hand?

Technique:
Pressing should be done until pain appears that is comfortable to endure, you should not press to such an extent that the pain is unbearable, everything should be comfortable. After pressing and the appearance of "comfortable" pain, you should hold the pressure until the pain disappears. This usually happens after 1-2 minutes. After that, the pressure is deepened until the next pain sensations appear. And so on until the spasm and pain completely disappear. If this type of manipulation does not help, it is better not to overdo it and wait for qualified medical assistance.

Pressure area:

1. First, pressure is applied to the duodenum, which allows you to relax the sphincter of Oddi and the bile ducts. Projection onto the abdominal wall of the abdomen about 2 cm below the xiphoid process of the sternum.

1. After it is pressed in the region of the pancreas (left hypochondrium).

1. The region of the gallbladder, the intersection of the right costal arch and the outer edge of the rectus abdominis muscle.

Prevention of hepatic colic

1. Prevention of the formation of stones in the gallbladder, their timely detection, removal and removal.
2. Diet (especially indicated for disorders of the gallbladder and bile ducts):

• Exclude: alcohol, carbonated drinks, fatty, fried, smoked foods. Limit the use of egg yolks, strong coffee and tea, creams, muffins, nuts.
• Showing products containing magnesium, which reduces the tone of smooth muscles (buckwheat, oatmeal, millet, wheat bran). Eating small amounts of food 5-6 times a day. Avoid overeating.

1. Avoid psycho-emotional stress and heavy physical exertion with overwork of the body.
2. Lead a healthy lifestyle (moderate physical activity, healthy eating, active recreation, peace of mind and harmony).

Pain in the right hypochondrium can appear with a variety of pathologies. This complaint is the most common in therapy. But it alone is not enough to make a diagnosis. There must be other signs as well.

The causes of pain syndrome are often associated with malnutrition. One of the problems of today's man is malnutrition. Due to the accelerated pace of life, you have to do a lot on the go, including eating. Sukhomyatka and fast foods lead to obesity and malfunction of the digestive tract.

The causes of pain in this area are divided into physiological and pathological. Physiological include overeating, increased physical activity in the absence of the habit of them. Physiological ones tend to pass, but pathological ones will disturb constantly, with different intensity.

Physiological causes

Stitching pains in the side on the right occur in many when running, walking fast, increasing loads, especially after eating. The load is usually sharp, with a fast pace.

This is due to the stretched capsule of the liver due to increased blood flow to it. Pain syndrome appears reflexively. The same mechanism manifests itself with a dense meal, a feast, if it was fried, fatty, spicy food, alcohol.

There is no danger here, everything passes by itself after the restoration of breathing. Also, physiology includes flour during pregnancy. Closer to childbirth, the greatly enlarged uterus squeezes neighboring organs, and aching pain appears in the right hypochondrium.

In addition, the pregnancy hormone progesterone causes dilation of the bile ducts and cholestasis. Another reason is PMS, when a hormonal imbalance spasms the bile ducts, which causes pain.

Pathological causes

Causes of pain syndrome: pathologies of the hepatobiliary system, CVD, renal pathologies, colitis, oncology, myositis, acute abdomen.

Hepatobiliary system:

• fatty hepatic degeneration;
• liver bruises;
• hepatitis;
• liver abscesses;
• echinococcosis;
• cholecystitis;
• cholestasis;
• cholangitis.

Abdominal myocardial infarction belongs to CCC diseases with pain in the right hypochondrium. In the kidneys - nephritis, pyelonephritis, ICD; cancer, etc.

On the right hypochondrium are projected:

• hepatobiliary system;
• the corner of the colon;
• right half of the diaphragm;
• right kidney and adrenal gland.

Diseases of all these organs will cause pain in the right hypochondrium. In addition, pain can radiate from the duodenum, stomach, pancreas, port vein.

Pain in the right hypochondrium in front

Of the pathologies with right-subcostal colic in front, one can name: injuries and bruises of any abdominal organs, intercostal neuralgia, pancreatitis, hernia and inflammation of the diaphragm, pleurisy and lung oncology; ubiquitous osteochondrosis.

Pain in the right hypochondrium behind

Intense pain syndrome manifests itself with a fracture of 3 lower ribs, with neuralgia, oncology, stagnation in the portal vein. Also, the causes may be in right-sided pyelonephritis, ICD, kidney cancer. It also includes cholecystitis and cholelithiasis.

Pain radiates to the lower back

Hepatitis, intestinal wounds, cholecystitis, diaphragmatitis, vertebral hernia, pain from the back with spondylarthrosis, pancreatitis, renal abscess, DZHVP. As you can see, there is a repetition of pathologies in the list.

Characteristic symptoms

Symptoms accompanying pain in the right hypochondrium in front:

• decreased appetite; vomiting and nausea;
• fatigue;
• fluctuations in blood pressure;
• hyperthermia, chills, myalgia, diarrhea, belching and increased gas formation;
• arrhythmia; cardialgia;
• lumbar colic;
• icterus of the sclera and skin;
• difficulty urinating;
• change in color of feces and urine.

The severity of pathologies often manifests itself at night.

The nature of sensations

They are acute and chronic. Chronic ones feel like pulling, they are constant. With JVP, there are pulsating algias; the same takes place with pancreatitis and hepatitis, gastritis, tumors, intestinal pathologies.

Acute pain is characteristic of urogenital conditions requiring surgery. A sharp pain in the right side is also dangerous because it can cause pain shock with loss of consciousness, collapse, and heart rhythm disturbances.

If the pain in the right hypochondrium radiates up and back to the shoulder blade, this indicates an exacerbation of cholecystitis, a shift in gallstones, hepatosis and hepatitis. Stitching pains occur with ulcerative colitis, cholelithiasis, acute intestinal infections. Aching pains occur in all pathologies of a chronic nature without exacerbations.

Cholecystitis

Pain in the right hypochondrium is most often caused by cholecystitis. The main number of calls for right-subcostal colic falls on them. They give sharp long-term colic, often of a dagger character. In addition, the stool is disturbed - it becomes gray, shiny due to the high content of fatty acids in it, this stool is poorly washed off with water.

Acute cholecystitis - always characterized by a rapid course:

• pain in the right side under the ribs is strong, paroxysmal;
• with recoil in the back, right collarbone;
• irradiation to the left hypochondrium.
• bad feeling;
• frequent nausea and repeated vomiting;
• chills, febrile condition;
• no appetite;
• dyspeptic symptoms.

Chronic cholecystitis - pains in the right hypochondrium and epigastrium are constant, they are aching, they also radiate.

The surest signs are cephalalgia, flatulence and morning bitterness in the mouth. With exacerbations, there may sometimes be febrile condition, weakness and deterioration of well-being appear.

Cholelithiasis

If the stones are motionless, there is no clinic. If there is a movement of the stone, then bitterness in the mouth increases, heartburn and discomfort become more frequent, pain in the right hypochondrium and belching is the progression of the process.

The shift of the stone is always accompanied by hepatic colic. Most often it is night pain. It can also occur from the back. If unpleasant symptoms continue after cholecystectomy, one can think of a postoperative syndrome with an exacerbation of comorbidities. Then most often there is pain in the right hypochondrium after eating. This happens when overeating, eating ice cream, cold drinks, coffee, serving fatty foods.

Kidney pathologies

The pain is dull, mild, radiating to the right side, lower back, genitals. But the pathology of the kidneys is indicated by such symptoms as: dysuria (oliguria, polyuria); increased frequency of mictions; a characteristic sign is false urges; painful urination.

Acute pyelonephritis - it has 3 main signs:

• chills, fever;
• lumbar cramps in the area of ​​the diseased kidney;
• frequent and painful urination.

Additional signs - no appetite; weakness, fatigue; cephalgia; myalgia and arthralgia; sweating, nausea. Lumbar pain worsens when coughing.

Chronic pyelonephritis

Signs of this condition:

• temperature increase for no apparent reason in the evening up to 38 and above;
• cephalgia, fatigue;
• a feeling of always freezing lower back;
• urge to urinate becomes more frequent;
• increased pain in the lower back when walking;
• cloudy urine and the appearance of an unpleasant odor in it, which is already felt during urination.

Kidney cancer - symptoms usually appear in stages. Acute pain appears when it is difficult to excrete urine. Right-subcostal pains are also possible with oncology of the adrenal gland with a large neoplasm.

Liver disease

Characterized by aching pain in the right hypochondrium, nausea, vomiting, constant feeling of heaviness. Often bursting pain due to swelling. Feeling of constant discomfort. These are the main symptoms. They tend to get complicated. With the development of cirrhosis, telangiectasias appear on the body, itching of the skin, swelling of the abdomen, increased pain and the appearance of ascites, etc.

Hepatitis C – Confirmation tests are important here as there are usually no symptoms. The main manifestations are weakness, nausea, flatulence, abdominal pain, urine and feces change in color, jaundice appears. Characterized by constant pain and heaviness in the right hypochondrium.

Echinococcosis of the liver

Cysts are predominantly localized on the right; they can compress the bile ducts. Hepatomegaly is noted; there is pain and heaviness in the hypochondrium.

When the cyst ruptures, this place suppurates and an abscess appears. Then there is a throbbing arching pain radiating to the back. It limits the movement of the patient due to its strengthening. There is a fever, with a burst cyst after an abscess, peritonitis develops.

Heart pathologies

Pain and burning in the right hypochondrium are most often characteristic of the abdominal type of MI. In addition to the pain syndrome, there are: a feeling of lack of air, shortness of breath, pallor and cyanosis of the skin, tachycardia, arrhythmias.

Bowel disease

Severe pains appear, they are bright, sharp. They do not have a clear localization, they spill over the entire right side of the abdomen. The instability of the stool is also noted (but its color does not change); there is an increase in gas formation; often in the feces there is mucus, pus and blood.

Inflammation of the colon - there is pain in the back and lower abdomen. The pain syndrome is proportional to the stretching of the intestine.

Algia spread to the umbilical region and the right half of the abdomen. In the acute course of colitis, the nature of the pain is spastic, flatulence appears and the stool is disturbed. Complications in the form of intestinal obstruction and intestinal necrosis. Then there are signs of peritonitis. With subhepatic localization (especially often in a child) of an inflamed appendix, epigastric pains first occur, then they become right-subcostal, and gradually concentrate on the right below.

Pathologies of the ribs

Intercostal neuralgia - pulling pain under the ribs, on the back, numbness. Mobility is very limited, characterized by pain in the right hypochondrium when pressed and when inhaling.

Rib bruises - always characterized by intense pain in the right hypochondrium. They immediately increase with any touch; palpation, coughing and breathing, on movement. Bruises are more prone to the back of the ribs. Rib fractures are accompanied by the appearance of a special crunch on palpation.

Portal vein thrombosis

Obstruction of the superior vein occurs when a thrombus moves from the iliac vein. The pain is localized behind the back. If then the hepatic segment of the vein is thrombosed in the superior vein, intense pain moves forward and radiates to the scapula. Jaundice and ascites develop.

Urgent states

Among them: bruises, wounds, hematomas of internal organs; ruptures of diverticula and intestinal perforation; ICD attacks; acute pancreatitis; cholelithiasis; intestinal obstruction; appendicitis.

Pain in these cases occurs suddenly; they grow up to pain shock. There may be loss of consciousness; a sharp drop in blood pressure. All this usually ends without treatment with peritonitis, with the characteristic symptoms of Shchetkin-Blumberg. The abdomen becomes board-shaped, tense. The pain is cutting, always unbearable.

Diagnostic measures

Ultrasound is mandatory; MRI; x-ray. Rent o.a.m. and o.a.k.; blood biochemistry. With biochemistry, all indicators of liver function are many times higher than the norm. This means hepatic pathology and gallbladder disease.

What Not to Do

You can not take analgesics. The use of NSAIDs, the use of hot heating pads is excluded - this will provoke perforation and bleeding. With colic in children, analgesics should also not be given. At home, you can take an antispasmodic pill: Drotaverine, Papaverine, Spasmex, Sparex. Strong painkillers are not applicable before consulting a doctor.

Need for an ambulance

If there are symptoms: - increasing pain with the transition to unbearable;

• continuous vomiting with blood, bile; Moreover, she does not give relief after herself.
• collapse;
• sharp blanching of the skin and loss of consciousness;
• anuria;
• fever;
• bloody loose stools;
• pain with bloating and lack of stool, which is specific for bowel obstruction. The same symptoms can develop in a child.

Right-sided paroxysmal pain during pregnancy may indicate the onset of an abortion or an ectopic abortion.

Before the arrival of the ambulance, the sick person should be laid on his side, loosen his clothes, and a cold compress can be put on his forehead. The patient is not allowed to move, eat or even drink. You can not give any drugs.

Principles of treatment

Treatment depends on the diagnosis of the disease. Urgent conditions are treated only by surgical methods. Conservative therapy is based on the appointment of drugs and diet. Treatment in many cases is symptomatic, in some pathologies it is etiotropic.

The purpose of taking drugs is to stop the inflammation, and then to carry out the rehabilitation of the hepatobiliary system during its inflammation. Without stabilization and liver cells, treatment does not make sense.

Other reasons

Here are projected: the stomach and diaphragm with their left parts, the pancreas, spleen, part of the intestine, left ureter, ligaments and kidney. Pain in the left hypochondrium may be radiating here from other organs. As you can see, some organs are repeated. They can equally give bilateral pain sensations. These include peptic ulcers, duodenal ulcers, pancreatitis, inflammation of the spleen; colitis.

Pain in the left hypochondrium during inhalation appears with inflammation of the diaphragm, diaphragmatic hernia, myocardial infarction, sciatica.

There may be post-traumatic consequences of the abdominal organs; algia with increased physical effort. Pain in the left hypochondrium is also divided into dull and acute. Acute are typical for renal colic, perforated ulcers, intestines, an attack of pancreatitis. Sharp pain in the left side under the ribs can occur with rupture of the spleen, infringement of the renal cyst, fractures of the ribs.