Subcostal pain

If you have pain in the hypochondrium, do not delay your visit to the doctor. It can be difficult even for a specialist to identify the cause of discomfort. In the hypochondrium area, the chest and abdominal cavities are divided by a powerful muscle - the diaphragm. The heart and lungs are located above the diaphragm, and the liver, kidneys, spleen, stomach, pancreas and gallbladder are located below. The dome-shaped diaphragm is protected by ribs on the sides. The esophagus, blood vessels, and nerve trunks communicate with the lower parts of the body, passing through openings in the diaphragm.

Any change, injury, spasms in the internal organs of the sternum or abdominal region cause painful sensations on the left or right.

[ 1 ]

What causes pain in the hypochondrium?

Dysfunctions, injuries of organs located above or below the diaphragm are common causes of pain in the hypochondrium. Bruise, spasm, pinching of the intercostal muscle, inflammatory or adhesive processes occurring in the peritoneum are also the culprits of pain of various etiologies.

The most common causes of pain on the left:

• pancreatitis;
• heart disease;
• diseases of the lungs and pleura (tuberculosis, pleurisy, pneumonia, oncology, etc.);
• gastrointestinal tract disorders;
• spleen injury (overstretching of the capsule, increase in size);
• intercostal neuralgia;
• inflammatory processes in muscles (myositis);
• soft tissue or rib injury.

Common causes of pain under the ribs on the right:

• diseases of the lungs and pleura;
• myositis, trauma, neuralgia;
• problems with the liver, bile ducts;
• hepatitis, cholecystitis, gallstone disease;
• helminthic invasions.

Regardless of which side the pain is detected on, the reason for its appearance is often hidden in the pathology of a nearby organ. Factors causing pain also include emotional disorders, banal overeating and previously suffered diseases that have caused complications in the internal organs (for example, flu).

Symptoms of pain in the hypochondrium

Pain occurs due to the impact of damaging factors as a protective reaction. The purpose of painful sensations is a warning function about malfunctions in the body, about developing diseases. Originating in pain receptors, pain is transmitted via nerves to the spinal cord and brain. Pains are multifaceted and varied by nature, so their manifestations have different degrees of painfulness, duration and localization.

By the nature of the manifestation, the symptoms of pain in the hypochondrium can be sharp, aching, dull, shooting, stabbing, burning, etc. The appearance of acute pain syndrome on the right most often indicates an inflammatory process or injury to the liver, gallbladder. Paroxysmal, severe pain on the right is a common symptom of gallstone disease, lung disease, renal colic or urolithiasis.

Severe pain on the left is associated with inflammatory processes in the pancreas (pancreatitis), stomach or spleen.

Aching symptoms indicate chronic hepatitis and cholecystitis, while it is important to exclude cirrhosis, liver tumor, and kidney dysfunction.

Post-traumatic pain symptoms on any side are observed with bruises, injuries to internal organs, and rib fractures.

Pain in the hypochondrium from behind

Pain in the hypochondrium at the back may indicate problems with the kidneys. The diagnosis is confirmed by tests.

Local pain in the right hypochondrium indicates acute cholecystitis. The pain may radiate to the right shoulder blade, shoulder, chest, and cardiac region. The disease is accompanied by characteristic symptoms – nausea, yellowish skin, vomiting, and fever.

An attack of pancreatitis may be accompanied by pain surrounding the chest, heart area, left shoulder blade and shoulder girdle.

From the respiratory system, pain in the back manifests itself in:

• pleurisy - cutting pain on the left or right side of the chest;
• pneumothorax - pain in the sternum is accompanied by pain in the scapular region;
• pneumonia - characterized by pain of varying manifestations (from moderate to severe);
• lung cancer, bronchial cancer – pain syndrome can affect the chest and shoulder.

In case of dysfunction of the cardiovascular system, pain is noted in the neck, back, and shoulder. Angina, for example, causes pain between the shoulder blades. Aortic aneurysm is associated with burning, shooting unpleasant sensations in the back and left shoulder.

Pain in the hypochondrium when inhaling

Increased pain when breathing and coughing is primarily associated with the pleura and cardiac region. Localization of dull or sharp pain is detected on the right or left.

Exacerbation of cholecystitis is accompanied by inflammatory symptoms - chills, intoxication, neutrophilic leukocytosis. Acute pain on the right side increases with inhalation.

The condition of renal colic is characterized by severe pain in the hypochondrium when inhaling on the right side, radiating to the right shoulder and shoulder blade.

Disorders of the respiratory system cause sharp pain when breathing, moving the body, and coughing.

Intercostal neuralgia is described by sharp, shooting pains that increase when inhaling.

Stiffness of movement in the chest, pain, shallow breathing are possible due to functional disorders of the rib cage, pleural tumors, pericarditis.

The reduction of the interpleural ligament as a result of the inflammatory process is accompanied by constant coughing, stabbing pain when inhaling, running and other physical activity.

Sharp pain in the hypochondrium

Acute pancreatic disease (pancreatitis) begins with girdle pain. An attack is characterized by sharp pain in the left hypochondrium. Provocateurs of painful symptoms can be alcohol, fatty foods, excessive food consumption.

A sudden, sharp, cramping pain accompanies intestinal colic. It may occur along with chills and weakness. Chronic inflammation of the gallbladder (cholecystitis) most often manifests itself as a dull and aching pain under the right rib. The condition worsens after eating fatty foods, shaking in transport. Sharp, squeezing pain often occurs. Associated symptoms include bitterness in the mouth, vomiting bile, and an increase in temperature.

The appearance of sharp pain on the right may be associated with hepatitis, cirrhosis of the liver. A cutting, burning sensation under the right rib occurs with gallbladder disease, when a stone moves along the bile ducts.

Pain in the hypochondrium when moving

Urolithiasis is accompanied by constant or periodically occurring pain under the rib on the right, which intensifies during movement, travel in transport and when drinking large amounts of liquid. The process of moving the stone along the urinary tract occurs with severe pain, in which a person cannot find a place for himself in any position.

Aching, dull, prolonged pain in the hypochondrium when moving on the right, radiating to the shoulder and shoulder blade on the right, are symptoms of liver disease. The pain syndrome increases even when changing body position, which is associated with rapid liver enlargement.

Impaired biliary motility and, as a consequence, spastic contraction of the gallbladder can be caused by physical or psycho-emotional overstrain. Increased pain is observed during palpation and body movement.

Pain in the hypochondrium when coughing

Pain in the hypochondrium when coughing, possible causes:

• an inflammatory process in the membrane that lines the sternum cavity from the inside, as a result of pneumonia - a decrease in respiratory mobility is observed; •
• dysfunction of the rib cage, pleural tumor - accompanied by stiffness of movement;
• dry pericarditis - minimal or acute pain;
• limitation of caudal displacement, reduction of the interpleural ligament - stabbing pain;
• development of intercostal neuralgia - shooting pains;
• renal colic - manifests itself as pain on the right side, under the spoon, spreading to the entire abdomen;
• rib fracture - characterized by sharp pain;
• inflammation of the trachea (tracheitis), as a consequence of influenza, acute respiratory viral infection - a “scratching” sensation behind the breastbone;
• lung cancer is characterized by a variety of pains (sharp, moderate, encircling, stabbing, etc.);
• pneumothorax (air in the pleural cavity) – often occurs with unbearable pain syndrome, but can also occur without pain.

Pain in the hypochondrium from the back

Acute pancreatitis is accompanied by nausea, vomiting, and heavy sweating. An attack of pancreatitis is characterized by pain in the hypochondrium from the back, which intensifies in the lying position. The long-awaited relief is brought by a sitting position with the body tilted forward.

The cause of pain in the area of the right shoulder and shoulder blade can be diseases of the liver and biliary tract. The pain center is located on the right under the rib and is characterized by varying intensity.

A patient suffering from urolithiasis describes a dull pain under the right rib on the back side.

Painful sensations on the right are characteristic of intercostal neuralgia and can be mild or acute in nature.

Complaints of back pain also occur with kidney pathologies, ulcer disease of the duodenum. As a rule, the ulcer will manifest itself as pain on the right, kidney diseases can have local and encircling pain.

Nagging pain in the hypochondrium

Violation of the diet, excessive physical activity can cause nagging pain in the right hypochondrium. If you experience similar sensations during fast walking or running, this may indicate existing stagnation of the biliary tract. An attack of aching pain with a spasm reaction, burning from the intestines will confirm this diagnosis. Relief comes after defecation with loose stools.

Ulcer disease of the duodenum is often accompanied by a nagging pain and bitterness in the mouth. Chronic liver problems are characterized by a nagging or dull aching pain on the right. Nagging pains also occur as a result of chronic hepatitis, cirrhosis, and liver tumors.

A dull, nagging pain on the left may indicate an enlarged spleen due to infectious lesions. The process is accompanied by fever, sore throat, and enlarged lymph nodes. We are talking about acute infectious mononucleosis, which poses a risk of rupture of the spleen with minor stress, bruise or minor injury.

[ 2 ], [ 3 ], [ 4 ], [ 5 ], [ 6 ], [ 7 ]

Pain in the right hypochondrium

Disruption of the liver, gall bladder, part of the diaphragm and intestines, injury cause pain in the right hypochondrium and upper abdomen. The pain varies in nature and intensity of manifestation.

Causes of pain under the ribs on the right:

• liver diseases – viral (types A, B, C), alcoholic or toxic hepatitis;
• gallbladder problems (infections, liver dysfunction);
• inflammation of the pancreas (pancreatitis);
• kidney pathologies – abscess, abscess, stones;
• inflammatory process in the appendix (located under the liver);
• right-sided pneumonia;
• ulcer of the duodenum;
• organ damage caused by cancer;
• attack of cholecystitis;
• hepatic colic.

Pain in the left hypochondrium

Pain on the left is observed with problems with the stomach, spleen, pancreas, part of the intestine and diaphragm.

Peptic ulcer of the stomach and duodenum are characterized by cyclic pain in the left hypochondrium. Exacerbations occur in spring or autumn, the pain occurs more often at night. The diseases reveal themselves with such symptoms as: heartburn, constipation, flatulence.

Gastritis with low acidity is characterized by pain under the left rib immediately or some time after a meal. Relief occurs with vomiting. The disease is characterized by decreased appetite, diarrhea, sour or bitter belching (less often with the taste of the food consumed).

An enlarged spleen can cause pain under the rib on the left side.

Stomach cancer manifests itself as pain under the left rib only in the advanced stage, as a rule, the onset of the disease does not reveal itself in any way. Secondary signs help to suspect oncology:

• reduction of body weight;
• changes in food preferences (aversion to meat, pickiness);
• a yellowish complexion indicates signs of anemia and early intoxication;
• decreased performance, chronic weakness;
• changes in psycho-emotional background (depression, loss of interest in life).

Pain in both hypochondria

Most acute or chronic diseases of the abdominal organs, injuries, postoperative conditions cause pain in both hypochondriums. Pain in the front, local or encircling in nature occurs with the following problems:

• stomach ulcer, duodenal ulcer - pain is like a dagger strike;
• exacerbation of pancreatitis - sudden girdle pain syndrome;
• subdiaphragmatic abscess - sharp pain in the front;
• gastralgic form of myocardial infarction – manifests itself as quite severe pain;
• renal colic - paroxysmal pain in the back below the ribs;
• retroperitoneal hematoma - manifests itself as pain in the back, the intensity depends on the amount of accumulated blood;
• gastritis with high or normal acidity - pain occurs on an empty stomach;
• chronic pancreatitis - girdle pain, spreading to both shoulder blades, is detected after eating (usually fatty, sweet);
• pancreatic cancer - symptoms are similar to chronic pancreatitis, but not related to food intake;
• pulmonary pathologies - intense, aggravated by coughing and breathing;
• kidney diseases;
• vegetative-vascular dystonia – acute or dull, encircling pain.

Sharp pain in the hypochondrium

The nature of the pain manifestation can help to understand which organ requires special examination. For example, acute pain in the right hypochondrium accompanied by bloody diarrhea, tachycardia, hyperthermia, manifests itself as a result of portal vein thrombosis.

Acute pain localized on the left with hyperthermia, tachycardia and enlargement of the spleen is a sign of splenic vein thrombosis.

Sharp and severe pain accompanies perforation (through hole) of a hollow organ of the peritoneum. Acute, cutting pain is observed with perforation of the stomach, gall bladder and duodenum.

Acute pain syndrome accompanies gastric torsion, peptic ulcer, and many chronic diseases. They occur in the presence of other symptoms: nausea, vomiting, chills, increased sweating, bowel disorders, bloating, etc.

In case of acute pain, you should immediately seek advice from a specialist if the following symptoms are observed: •

• rectal bleeding;
• vomiting blood or contents similar to coffee liquid;
• dizziness, increased heart rate;
• the skin becomes sticky and cold to the touch.

Diagnosis of pain in the hypochondrium

To identify the causes, diagnostics of pain in the hypochondrium is used, which is carried out in stages:

• collection of information about the disease based on complaints, described patient conditions, and pain characteristics;
• palpation of the abdomen, rib area;
• performing an electrocardiogram (ECG) to rule out ischemic heart disease;
• use of ultrasound examination (ultrasound) of the kidneys and abdominal organs;
• urine and blood tests for a more accurate diagnosis.

The above methods are sufficient for an accurate medical conclusion in most situations. In some cases, additional examinations are necessary:

• X-ray diagnostics of abdominal organs, lungs;
• endoscopic examination of the gastrointestinal tract;
• radiocontrast diagnostics.

The appropriateness of using one or another type of examination falls on the shoulders of an experienced doctor. Only on the basis of a carefully studied anamnesis, physical, instrumental, laboratory research can a correct diagnosis be made and adequate treatment applied.

[ 8 ]

Treatment of pain in the hypochondrium

To relieve pain under the ribs, do not take painkillers or use a heating pad, which can worsen the pathological process. You can use ice on the site of pain.

Based on the analysis of the symptoms of the pain syndrome, the conducted studies, the treatment of pain in the hypochondrium is prescribed by a doctor. In case of pain, it is best to consult a specialist. Self-lowering of the temperature, reducing pain with medications leads to difficulty in making the correct diagnosis.

Acute, paroxysmal pain is especially dangerous. For example, an enlarged spleen can lead to its rupture, so to avoid a fatal outcome, you should immediately seek emergency medical care.

How to prevent pain in the hypochondrium?

Prevention of pain in the hypochondrium:

• moderate physical activity;
• proper nutrition, rich in essential vitamins, micro- and macroelements;
• full rest, adherence to the daily routine;
• walks in the fresh air, trips to nature;
• balance of mental and emotional state;
• ability to cope with stress;
• good mood;
• it is useful to have one or two fasting days a week (for example, on juices, herbal infusions, fermented milk products);
• timely referral to a specialist;
• limitation or complete abstinence from alcohol consumption;
• Do not self-medicate for any illnesses by taking medications that may have a negative impact on the liver and other internal organs;
• compliance with all medical orders.

Pain in the hypochondrium is the first signal of internal disorders. It is very important to note all the nuances of its appearance, nature, intensity, which will help a specialist diagnose the disease.