Pain after eating in the right upper quadrant

In the right upper quadrant, that is, under the two lower ribs on the right side of the abdominal zone of the abdomen, there are the gallbladder, part of the liver and duodenum, and a little deeper - the pancreas (its part called the tail).

Also, the upper part of the right kidney, part of the small intestine and the hepatic flexure of the colon, which is part of the large intestine, are projected onto the right subcostal area.

Read also:

• Pain in the right hypochondrium
• Pain after eating

So the pain after eating in the right upper quadrant can be caused by pathological processes in which any of the organs located here are involved.

Causes of pain after eating in the right hypochondrium

As doctors-gastroenterologists note , the main causes of pain after eating in the right hypochondrium are such diseases as cholecystitis, cholelithiasis, dyskinesia of the gallbladder or bile ducts. Often, the pain associated with these diseases, are accompanied by other symptoms, primarily, nausea and vomiting.

In addition, pain after eating in the right upper quadrant may be a consequence of peptic ulcer of the stomach or duodenum, inflammation of the hepatic parenchyma (hepatitis), as well as fatty liver. And each of these pathological conditions has its own characteristics.

[1], [2],

Pain after eating in the right upper quadrant with cholecystitis

Most often, pain in the right upper quadrant after eating is a sign of cholecystitis - an acute or chronic inflammatory disease that affects the walls of the gallbladder.

A typical clinical picture of acute cholecystitis (calculous or noncalcular, that is, with or without stones in the gallbladder) is a cramping acute pain in the right hypochondrium after eating. In this case, the pain irradiates into the region of the right scapula, shoulder and waist. In addition to the pain of a person, nausea and vomiting are abnormal, a violation of the heart rhythm may be observed. The attack of pain can be so strong that it can lead to loss of consciousness.

Experts explain these symptoms of pain after eating in the right hypochondrium with spasms of the gallbladder. Spasms occur for several reasons: because of a blockage (obstruction) of the bile duct by the stone, actually inflammation of the wall of the bladder or the presence of scars in its cavity, and also due to functional disorders of the motor (dyskinesia) of the cervix of the gallbladder, which empties into the gallbladder.

If acute cholecystitis is catarrhal (inflammation has affected only the upper layer of the gallbladder's mucosa) and is not associated with gallstones, then with a diet and all the prescriptions of the doctor in a couple of weeks, everything is normalized.

But if acute cholecystitis is calculous, then a stone stuck in the bile duct can lead to infection of the gallbladder wall with the formation of pus. This phlegmous acute cholecystitis, in which patients complain of dull pain in the right upper quadrant after eating, chills and fever, sometimes there is yellowing and severe itching of the skin. In the absence of treatment, the probability of conversion of phlegmous acute cholecystitis into purulent (with a temperature of up to + 39 ° C, weakness and signs of intoxication) and even gangrenous cholecystitis is great. With this form of the disease, necrosis (necrosis) occurs in the walls of the gallbladder, and pain can no longer be felt. After a few days, the gallbladder can simply rupture, which leads to peritonitis.

With chronic cholecystitis, patients have pain in the right upper quadrant after eating, which is not as intense as in the acute form of the disease. In addition, nausea and vomiting are rare. The main cause of chronic inflammation of the gallbladder - all the same stones, but provoke an attack of excessive and frequent consumption of fatty, spicy and fried foods and alcohol. Doctors recommend to follow a diet and during an attack of pain take medications to relieve spasms. And for ever to get rid of chronic calculous cholecystitis it is possible only with the help of surgical intervention - removal of the gallbladder.

Among the causes of chronic non-calculous cholecystitis, in which a person is concerned about aching pain after eating in the right hypochondrium, as well as attacks of nausea, bitterness or taste of bitterness in the mouth, such factors as conditionally pathogenic bacteria and microbes (E. Coli, streptococci, staphylococci) , pathogenic bacteria, various viruses, intestinal invasions (ascarids, lamblia).

It should be noted that when bacteria and parasites enter (through blood or lymph) into the bile ducts, their inflammation occurs - cholangitis, in which pain in the right hypochondrium resembles a hepatic colic, the skin turns yellow and itches, the tongue is covered, the body temperature is increased, and with palpation markedly enlarged liver. If the cholangitis is not treated, then from the bile duct inflammation spreads to the nearby liver with the formation of abscesses in it. Hospitalization of a patient with suspicion of cholangitis is urgent, as everything can result in obstruction of the extrahepatic biliary tract (secondary biliary cirrhosis), hepatic renal failure or sepsis.

Pain after eating in the right hypochondrium with cholelithiasis and dyskinesia of the gallbladder

Education in the gall bladder stones is the result of increased cholesterol intake into the bile, changes in its composition and stagnation in the gallbladder and its ducts.

Classic symptoms of cholelithiasis (choletiasis) include the appearance in the mouth of a bitter taste, and paroxysmal acute pain in the right upper quadrant after eating occurs a little later and mainly after eating fat or alcohol. An attack of pain - with chills, vomiting and general weakness - can last several minutes, and several hours.

Aching pain after eating in the right hypochondrium can be observed with functional disorder of the bile excretory system - weakening of the contractility (dyskinesia) of the gallbladder and bile ducts. The presence of this pathology, in addition to pain, indicates bitterness in the mouth, a decrease in appetite, a constant sense of fatigue and a bad mood.

Pain after eating in the right hypochondrium with ulcers of the stomach and duodenum

The duodenum (duodenum) rounds the head of the pancreas and is the initial section of the small intestine. Symptoms of pain after eating in the right upper quadrant, as well as nocturnal pains and pains on an empty stomach are typical of duodenal ulcers, more precisely, of its bulbous duodeni bulb.

Most often the ulcer of the duodenum is preceded by its inflammation - duodenitis. In the erosive form of duodenitis, the mucous membrane is first destroyed, and then an ulcer is formed. In addition to aching or cutting pain in this disease, there are diarrheal events in the form of belching, nausea, vomiting, feelings of bursting in the epigastric region, flatulence, and also vegetative symptoms such as weakness and excessive sweating. With complaints of severe (dagger) pain and dizziness, urgent medical attention is needed, as these are signs of perforation of the duodenal ulcer.

Depending on the localization of the lesion in peptic ulcer disease (which, like gastritis, is caused by the Helicobacter pylori bacterium), pain occurs shortly after eating or one and a half to two hours after ingestion, and with a deep ulcer in the anthropyloroduodenal zone of the stomach - even at night. However, as gastroenterologists and clinicians emphasize, pain in this disease is not a specific symptom, and its main characteristics (strength, frequency, localization) depend on many factors. In particular, patients feel pain after eating in the right upper quadrant, mainly in the localization of ulcers in the pylorus part (outlet) of the stomach.

Pain after eating in the right hypochondrium with inflammation of the pancreas

The pancreas is the second largest digestive gland, and pancreatic juice is an active participant in the digestion of food. The causes of inflammation of this gland (pancreatitis) are stones, acute cholecystitis, gallbladder disease, inflammation of the papilla between the pancreas and duodenum, alcohol, fatty and spicy food, long-term use of certain medicines.

Pain in pancreatitis is sudden and very strong - with nausea, vomiting (with bile), fever, palpitations and lower blood pressure. Features and localization of pain: sensation of the focus of pain high in the pit of the stomach; Stretching pain in the right hypochondrium with seizure of the left; They encircle the pulsating pains that force the patient to bend into the "embryo pose".

A qualified medical examination in this situation is necessary, since the symptoms of pain after eating in the right hypochondrium with this disease can be confused with signs of acute food poisoning, perforated ulcers, as well as with an attack of cholecystitis or appendicitis. The main distinguishing feature of pancreatitis is an increased content of the digestive enzyme amylase, detected in the serum during a biochemical blood test.

Pain after eating in the right upper quadrant with hepatitis

Hepatitis - inflammation of the liver with necrosis of areas of its tissue - is caused by a number of reasons. These are hepatitis viruses, and alcohol abuse, and prolonged medicamentous effects on the liver, as well as a violation of the outflow of bile from the liver (cholestatic hepatitis).

In addition to the drawing pain after eating in the right upper quadrant, the list of signs of this disease includes jaundice of the skin and sclera, itchy skin, nausea, bitter belching, light feces and dark urine, general intoxication, fever and a decrease in overall body tone.

A characteristic feature of chronic hepatitis is a prolonged absence of obvious symptoms. But in the course of the disease, they are manifested by pains of a pulling species in the right hypochondrium, an increase in the size of the liver, full intolerance to fatty foods. In the chronic form of hepatitis, a gradual and irreversible replacement of the liver parenchymal tissue consisting of hepatocytes with a fibrous connective tissue takes place. In the end result, this leads to cirrhosis of the liver.

Pain after eating in the right hypochondrium with fatty liver dystrophy

Fatty hepatosis or toxic dystrophy of the liver is a chronic disease. In most cases, chronic fatty hepatosis is the inevitable consequence of alcoholism or poisoning by certain toxic substances. This disease can also develop with an endocrine deficiency in the body of protein and vitamins or with an unbalanced diet. At the same time, abnormalities in the formation of fats in liver cells are often accompanied by pathology of the endocrine system, such as diabetes mellitus and thyrotoxicosis.

With fat hepatosis, a pathological loss of fat takes place by liver cells (hepatocytes), that is, a dystrophy that leads to necrosis of hepatocytes. Symptoms of this disease are disorders of the whole digestive system, general weakness and headache, increased fatigue (even with little physical exertion), dull pain after eating in the right upper quadrant, an increase and soreness of the liver during palpation.

If you do not exclude the effect of damaging factors and do not start treatment in a timely manner, liver dystrophy can lead to chronic hepatitis and cirrhosis of the liver.

Diagnosis of pain after eating in the right hypochondrium

Since pain is a symptom of a particular disease, the diagnosis of pain after eating in the right upper quadrant is to identify this disease. When making a diagnosis, doctors are based on an anamnesis, the clinical picture of the disease and the results of a comprehensive examination of the patient.

Among the compulsory assays required for diagnostics of the presented spectrum of diseases are the clinical and biochemical blood test, as well as the detection of the presence of hepatitis viruses, cholesterol level and other important blood parameters.

The main methods of diagnostic studies of these pathologies are ultrasound (ultrasound) of the liver, gallbladder and bile ducts, an overview radiograph of the abdominal and intestinal organs, a radiographic study with contrast agents (which helps to identify ulcers), computed tomography of the stomach and pancreas, gallbladder and liver.

So, for the diagnosis of chronic cholecystitis, most often doctors use ultrasound, cholecystography and cholangiography, which enable to identify stones, differentiate calculous and noncalcular forms of the disease and see the condition of the gallbladder wall, the thickness of which is the main criterion for determining the degree of inflammatory process.

In addition, fluoroscopy and endoscopy of all organs associated with the gallbladder and bile ducts are performed, and examination of the duodenum, pancreas and liver using echography or laparoscopy is prescribed.

In the diagnosis of cholelithiasis, the diagnosis can not be made only on the basis of blood tests, so ultrasound and x-ray studies of the gallbladder and its duodenal sounding are necessarily performed. And the main endoscopic method of research in the diagnosis of pain after eating in the right hypochondrium with gastritis and peptic ulcer is fibrogastroscopy, with which gastroenterologists can determine the state of the mucosa and take a sample (biopsy) for examination.

[3]

Treatment of pain after eating in the right hypochondrium

It is clear that with such an extensive list of causes of pain after eating in the right upper quadrant, even symptomatic treatment can not be the same for everyone. Therapy will depend on the disease that causes pain, and the goal of comprehensive treatment is to eliminate the root cause of pain after eating in the right hypochondrium - taking into account the nature of the manifestation of a particular disease, the individual characteristics of each patient, his condition and accompanying pathologies.

So the use of spasmolytic analgesic medications is used only to relieve spasm and pain syndrome. And to get rid of patients from their cause, a wide range of modern medicines is used, and their selection and dosage are carried out individually by the attending physician.

For example, in the treatment of cholelithiasis - with a stone size of not more than 2 cm in diameter - special drugs are prescribed to facilitate their dissolution. If after a year or one and a half gallstones did not disappear, surgical removal can be prescribed (cholecystectomy).

Treatment of dyskinesia of the gallbladder and bile ducts is carried out with the help of a doctor prescribed cholagogue and antispasmodic medicines, as well as a special diet. In the treatment of pancreatitis (inflammation of the pancreas), antifermental medicines, antispasmodics, preparations with cytostatic action, and medical starvation are used. And chronic hepatitis therapy presupposes the widespread use of detoxification methods, the use of antiviral drugs and hepatoprotectors - drugs that positively influence liver function.

A mandatory and essential component of the complex treatment of pain after eating in the right upper quadrant is diet! Doctors recommend to reduce the amount and calorie content of food and completely eliminate from the diet fatty, smoked, hot and fried, to refuse spices, canned food, alcohol and carbonated drinks.

Prevention of pain after eating in the right hypochondrium

Preventive measures aimed at preventing pain after eating in the right upper quadrant include:

• reduction of excess body weight,
• the correct diet (in small portions 4-5 times a day),
• low-calorie diet,
• sufficient intake of liquid (1.5-2 liters per day),
• daily morning exercises and physical exercise,
• refusal of alcoholic beverages.

Specialists in the field of therapeutic nutrition are advised in diseases that are accompanied by pain after eating in the right hypochondrium, eating foods that contribute to lowering cholesterol in the blood and improving the outflow of bile: buckwheat and oatmeal, bran, vegetables, fruits, berries, dried fruits, vegetable oils (corn, olive, sunflower), sour-milk products.