Main reasons
The most common cause is gallstone disease. A stone blocking the outlet of the gallbladder causes an attack of intense pain after a fatty meal, often at night, radiating to the right shoulder blade. If the blockage persists, acute cholecystitis with fever develops. The liver itself hardly hurts, but stretching of its capsule as the organ enlarges causes a dull heaviness.
- Biliary colic and acute cholecystitis
- Chronic cholecystitis, biliary dyskinesia
- Fatty hepatosis, viral and alcoholic hepatitis
- Liver congestion in heart failure
- Duodenal ulcer
- Renal colic, pyelonephritis on the right
- Right-sided pneumonia, pleurisy
- Intercostal neuralgia, herpes zoster
How to distinguish causes by the nature of pain
Biliary colic is a severe, increasing pain that lasts from 30 minutes to several hours and then subsides. Cholecystitis - pain for more than 6 hours, fever, pain when pressing under the right rib while inhaling. Liver pain is dull, constant, without clear attacks. Renal colic is a very intense pain in the side and lower back, radiating to the groin and difficulty urinating. Pain when moving and turning the torso indicates the muscles and spine.
- After fatty foods and at night - gallbladder
- Dull heaviness constantly - liver
- Hunger pain in the pit of the stomach on the right - duodenum
- Lower back pain radiating to the groin - kidney
- Burning pain along the rib with a rash - herpes zoster
Pain in the right hypochondrium during pregnancy and children
In pregnant women, pain on the right may be associated with a growing uterus and displacement of organs, but cholestasis of pregnancy, pyelonephritis and severe complications - HELLP syndrome and preeclampsia, which are accompanied by increased pressure, cannot be missed. In children, abdominal pain on the right is often functional, but appendicitis must be excluded, especially if the pain moves downward.
- Pregnant women with pain on the right side and high blood pressure should immediately consult an obstetrician
- Itchy skin during pregnancy is a reason to check liver function tests
- A child has pain with vomiting and fever - see a surgeon
Diagnostics
The main primary method is ultrasound of the abdominal organs and kidneys: it shows stones, inflammation of the gallbladder, size and structure of the liver, dilation of the ducts. Blood tests evaluate inflammation and liver function. If an ulcer is suspected, gastroscopy is performed; if the picture is unclear, CT or MRI is performed.
- Ultrasound of the liver, gallbladder, pancreas and kidneys
- Complete blood count, CRP
- Bilirubin, ALT, AST, GGT, alkaline phosphatase, amylase, lipase
- General urine test
- Gastroscopy, CT or MR cholangiography as indicated
Treatment
Treatment is determined by the cause. For biliary colic, antispasmodics and painkillers are prescribed, and for repeated attacks, planned laparoscopic removal of the gallbladder is recommended. Acute cholecystitis is treated in a surgical hospital. For liver diseases, the underlying disease is treated and the causes are eliminated - excess weight, alcohol, viruses. Self-administration of choleretic drugs for pain in the right hypochondrium is dangerous: if there are stones, this can provoke an attack or jaundice.
- Do not take choleretic drugs without an ultrasound
- Limit fatty, fried foods and alcohol
- Eat regularly, don't overeat
- Lose weight gradually, without fasting
- In case of repeated attacks, do not delay consultation with a surgeon.
