Acute or recurrent pain in the right hypochondrium suffers in
one form or another about thirty percent of the adult population
the planets. Pathological changes in the internal organs cause
almost ninety percent of these pains.
Doctors estimated that most often this kind of pain
- 1 place: diseases of the gallbladder and biliary tract
- 2 in frequency: liver disease and swelling of the liver
Where is the right hypochondrium?
AT топографической анатомии под правым подреберьем понимают
section of the anterior abdominal wall, limited to:
- top – the projection of the diaphragm (5 edge)
- bottom edge of the costal arch
- from the inside – by a line running vertically through the lowest
- outside – a line running vertically from the top jutting out
pelvic bone (iliac crest)
- if the lower boundary of the area is extended backwards, then it will pass
12 edges and the third lumbar vertebra.
To practice to find the right hypochondrium, you need a palm right
hands put horizontally on the ribs so that the wrist
located in the middle of the side, and the edge of the little finger coincided with the bottom
краем ribs. If, without changing the position of the wrist, palm
back, you get the rear projection of the right hypochondrium.
Conditionally, as it were, the shadows from such internal
- liver, gallbladder
- bowing of the colon (part of the colon)
- upper right kidney
- the adrenal gland and the abdominal part of the right half of the diaphragm,
separating the chest and abdomen
- sometimes pains from the pancreas are also reflected here,
двенадцатиперстной кишки, желчных протоков, нижней полой veins.
Pain under the right hypochondrium in healthy
With ряде физиологических состояний даже здоровый человек может
experience discomfort or pain in the right side.
Pain on exertion
An untrained person who takes on hard work or
athletic stress, may experience stitching pains in the area
right hypochondrium. The fact is that on the one hand, the emission
adrenaline reduces the tone of the bile ducts and contributes to their
stretching of stagnant bile. AT это же время увеличивается
filling the liver with blood, its capsule is stretched and in the hypochondrium
starts to prick.
If we proceed to the load after a hearty lunch, then early or
late pain in the hypochondrium will occur almost certainly. Especially not
Recommended after eating long-distance running and push-ups.
Untrained breathing can also cause spasm of the diaphragm.
(мышцы, separating the chest and abdomen), что тоже может
cause short-term pain while breathing after exertion
will be leveled.
But the story about the expansion of the inferior vena cava under the action
adrenaline, which begins to put pressure on the liver during exercise,
somewhat fantastic. Although this theory and publish some sites
medical orientation, with regret has to
state that adrenaline constricts the vessels (both arteries and
veins), and the liver has no pain receptors and only
tensile capsules from the inside.
Have беременных женщин в третьем триместре матка колоссально
stretched and presses on all organs with which it is in contact, displacing
intestine, pressing down stump and gallbladder. Therefore, for healthy
stitching or pressing pains in right
hypochondrium In addition, progesterone, preserving pregnancy
late, expands the bile duct and stimulates the stagnation of bile.
And if you give a physical load with such a tum, then some
discomfort can be felt with high probability.
Pain у женщин
AT конце менструального цикла у части женщин возникает резкий
an imbalance between low progesterone and high estrogen that
leads to spasm of the biliary tract and can also cause
колик в правом hypochondrium
Withем гормональных контрацептивов может ухудшать течение
premenstrual syndrome and increase stabbing pains due to
violations of the passage of bile (see the pros and cons of oral
Causes of pain in the right hypochondrium
- Liver disease (гепатиты инфекционные и неинфекционные, цирроз,
fatty or alcoholic hepatosis, hepatocellular carcinoma,
parasitic diseases, such as echinococcosis, trichinosis,
liver metastasis of cancer of the stomach, colon, lung,
- Heart disease leading to circulatory failure
a large circle (ischemic heart disease, myocardiopathy, heart defects, myocarditis,
endocarditis), including cardiac cirrhosis and abdominal
variant of myocardial infarction.
- Colon diseases (colitis, ulcerative colitis,
Crohn’s disease, intestinal infections, dysbacteriosis, tumors of the colon
intestine, diverticulosis, irritable bowel syndrome).
- Gallbladder disease (chronic, bezkamenny and
калькулезный холециститы, tumors).
- Diseases of the right kidney (pyelonephritis, kidney abscess,
kidney tuberculosis, polycystosis, urolithiasis, echinococcosis,
tumors, metastatic lesions in melanoma, bronchogenic
- Diseases of the right adrenal gland (pheochromocytoma, other
- Pathology of the right half of the diaphragm (diaphragmatitis,
- Переломы нижних ribs.
- Intercostal neuralgia.
- Herpes zoster (herpes zoster).
- Surgical conditions united by the name acute abdomen
(perforation, penetration or perforation of duodenal ulcer,
duodenal bleeding, acute pancreatitis, acute cholecystitis,
including, calculous, intestinal obstruction at the level
colon, including intestinal intussusception, appendicitis,
penetrating wounds of the abdomen with liver damage,
colon or right kidney, blunt trauma, hematoma or
liver breaks, kidneys)
- Некоторые варианты тромбоза нижней полой veins.
If the pain in the right hypochondrium is in front
Pain in the right hypochondrium gives those organs
which most closely adjacent to this area.
They give prolonged dull or arching pains, a feeling of heaviness.
due to plethora and swelling of the body, stretching its
capsule, in which there are pain receptors. And the right hypochondrium
a large right lobe of the organ is projected.
Hepatitis вирусные, алкогольные или токсические дают картину
intoxication (weakness, lethargy, disability) and
dyspepsia (nausea, loss of appetite, vomiting). In the midst of illness
joins jaundice with lemon skin and white eyes. AT
the same period, urine becomes the color of beer, and feces – the color of clay for
expense of exchange of bile pigments.
- Cirrhosis of the liver
It is the death of its cells and the restructuring of the structure with the formation
nodes, squeezing the bile ducts and blood vessels. This
the disease may be the outcome of chronic hepatitis, also known
cardiac cirrhosis on the background of liver blood supply disorders. With
cirrhosis of pain in the right hypochondrium occurs almost at the very beginning
diseases are persistent. They are combined with an increase
liver and spleen, jaundice, skin itch, insomnia,
redness of palms. Portal vein overflow
leads to varicose veins of the esophagus, the risk of bleeding from it,
fluid accumulation in the abdominal cavity. In the later stages of the liver
decreases in size, its efficiency decreases, the patient can
die on the background of hepatic coma.
These are cysts with liquid contents that are caused by a worm.
echinococcus. Cysts are most often located in the right lobe of the liver and
as they grow, they squeeze the capillaries and the intrahepatic bile.
ducts, causing severe heaviness in the hypochondrium and uneven
enlarged liver. If the cyst fester, the cavity develops,
pus-filled liver abscess. With этом боли усиливаются,
body temperature rises and inflammation of the peritoneum may develop
or even blood poisoning.
- Hepatocellular cancer is long disguised as cirrhosis and
specified only by the study of liver tissue.
Congestive heart failure
It leads to a deterioration of blood circulation in a large circle that
leads to an increase in the liver, swelling in the legs and anterior abdominal
стенке, fluid accumulation in the abdominal cavity. With этом в правом
hypochondriac feels heavy. If heart failure
goes into an irreversible phase, the liver may change, as when
Abdominal myocardial infarction is characterized by a very
severe burning or pressing epigastric pain in the right
hypochondrium Sometimes the pain begins as a knife strike: it is sharp and
intense, can give to the right shoulder blade or behind the sternum. This
the pain variant is characteristic of heart infarction
muscle. Also these pains can be wave-like.
(decrease and increase in 30-60 minutes), may be accompanied
rhythm disturbances, pressure drop, pallor and shock.
It gives pain the stronger, the more it stretches. So,
any bowel disease accompanied by flatulence will produce
sharp, almost unbearable pain. With этом боли от воспаления кишки
or its destruction will be less pronounced until
the process does not turn on the peritoneum, irritation of which can lead to
pain shock (injured intestine). Since the bend of the intestinal intestine,
which is located in the right hypochondrium – only part of the intestine, then
the pains will extend to both the umbilical region and the whole
right side to the groin.
- Colitis gives pronounced spastic pains and stool disorders.
(constipation for spasmodic or diarrhea for infectious),
flatulence and malabsorption.
- Ulcerative colitis (in 20% of cases) and Crohn’s disease
may cause inflammation of the entire intestine, pronounced bleeding,
stool with pus and mucus and complicated by intestinal obstruction,
suppuration or necrosis of the intestine. Pain is not only characteristic of this.
for hypochondrium, but for all lower abdomen, have the character
spasms and combined with bloating.
- Tumors most often give the clinic intestinal obstruction and
a picture of acute abdominal pain spilled, symptoms of peritoneal irritation,
pallor, cold sweat, pressure drop.
- With аппендиците боли, начавшись в надчревье, постепенно через
right hypochondia descend into the right iliac
Diseases of the gallbladder
They give the largest percentage of intense and sharp (cutting or
stabbing pains that are characteristic of acute inflammation. With этом
blamed for inflammation can be shifted stone, closing
lumen of the bladder neck or bile duct or bacterial flora.
Pain in acute inflammation occurs at the point between the rectus muscle.
the belly on the right and costal arch. They are cramping, strong,
отдают в правое плечо или левое hypochondrium There may be bitterness in
mouth, belching air, nausea and vomiting of bile. Sometimes rises
Body temperature. For calculous cholecystitis, development is typical.
obstructive jaundice with yellow-green tinge of skin and mucous membranes.
For chronic cholecystitis, aching dull pains are more common,
occasionally shoveling, morning bitterness in the mouth, moderate
nausea, appetite disorders, bloating, intolerance
fat and fried, a light yellowish tinge of the whites of the eyes and
Pain in the right hypochondrium behind
AT этой области чаще всего болят травмы нижних ребер, межреберные
nerves, right kidney, adrenal gland, inferior vena cava.
Diseases of the right kidney and, first of all, urolithiasis
able to cause intense pain. Stone or sand started
a journey from the renal pelvis, scratching it, and then the ureter,
therefore, pain in renal colic will not only be in the projection of the lower
ribs, but also in the lower back and in the side of the abdomen. Pain
paroxysmal and strong. She gives in the thigh, genitals. With
tapping the edge of the palm at the lower back pain increases and can
give in the groin. With этом в моче могут появиться следы крови. Have
some patients with renal colic are accompanied by vomiting.
Acute infectious inflammation of the kidney — pyelonephritis is a process
in which there is pain in the kidney area, an increase
There may be pain at the end of urination, frequent urination (in
including nightly and false urges. On the face in some cases
Apostematic pyelonephritis is the formation of purulent in the kidney
inflammation, which may be limited (abscess or carbuncle)
With этом боли приобретают постоянный тянущий характер,
the temperature rises and a decrease in daily excretion can be observed
urine (up to a complete stop of urination).
Necrosis of the renal papillae
It can be the result of oxygen starvation of the kidney tissue.
in blocking the vessels that feed it (infectious agents
or diabetes mellitus). With этом боль постоянная, сочетается с
blood in the urine. Painной может погибнуть от септического шока.
Acute upper paranephritis
This is an inflammation of fatty tissue in the upper part of the kidney against the background
infection from tonsils, carious teeth or other lesions
inflammation. First, temperatures up to 38 are noted, moderate pains in
lower back on the affected side. After 2-3 days the pain moves and in
right hypochondrium, aggravated by deep breath. Low back pain
intensified with a sharp straightening of the body and when walking.
If a tumor develops in the kidney, then for a long time
manifests. In the later stages, bleeding and permanent
non-intense pain in the projection of the kidneys. If the tumor prevents the outflow
urine then acute pain and episodes of acute retention may occur
Right adrenal gland
most often gives pain for large tumors.
Pheochromocytoma is accompanied by a persistent increase in blood pressure,
myocardial dystrophy, heart rhythm disturbances. Aldosteromes
change the body’s water balance, koritkoteromy violate the exchange
substances, corticoestroms promote the feminization of men,
corticosteroids form secondary male signs of
Haveшибы задних отрезков 10, 11 и 12 ребер дают выраженные
constant aching and gnawing pains associated with fractures
characteristic crunch. Pain increases with deep breaths, coughing or
slopes in a healthy way.
AT правом подреберье сзади может проявляться межреберная
neuralgia (severe stabbing pain, limiting mobility and
aggravated by turning, bending, taking a deep breath) or
muscle inflammation (myositis).
Osteochondrosis of the lumbar spine
It gives pains of varying intensity, which are accompanied by
limitation of mobility, muscle squeezing and smptomas
tension. Pain can be from whining to shooting different
degree of intensity.
Herpetic eruptions along the nerve, in which there are a number
bubbles with turbid contents against a reddened strip of skin,
resembling a punch belt. AT месте поражения имеется сильное жжение,
skin itching and pain.
Vena cava thrombosis
A rare variant of thrombosis of the inferior vena cava (when a blood clot comes
of the iliac veins and clogs the main trunk of the vein) gives pain in
lower back (right upper quadrant on the back) and a clinic similar to
late stage of kidney tumors. If the liver is thrombosed
segment, then intense pain will occur in the right hypochondrium in front
and will give under the right shoulder blade. With этом появится скопление
fluid in the abdominal cavities and jaundice.
Sharp pains in the right hypochondrium are characteristic of emergency
surgical conditions united by the notion of “acute abdomen”.
- Damage to internal organs (injured liver, kidney,
colon, liver, gallbladder or kidney rupture,
hematomas of the liver and kidneys).
- Acute inflammation of the gallbladder, acute pancreatitis,
appendicitis at the onset of inflammation.
- Perforation of the intestine (duodenal, colon), tears
- Intestinal obstruction, bile duct obstruction.
- Thrombosis of the arteries and veins that feed the internal organs and cause
to organ necrosis.
The pain is very intense, it can lead to pain.
shock, falling blood pressure, loss of consciousness, impaired kidney function and
hearts. Occlusion of hollow organs often gives spastic pain.
Bleeding is accompanied by acute anemia and can lead to
hemorrhagic shock. Patients with acute abdomen are stressed
abdominal wall, which are trying to protect the right hypochondrium. Pain
may be spilled or punctate, but in any case it is sufficient
intense and sometimes unbearable.
Acute compressive pains in the form of a prolonged attack are also characteristic.
for abdominal myocardial infarction. Mimics a sharp belly and
renal colic, sometimes intestinal infections, non-specific
ulcerative colitis. Sufficiently sharp and severe pains occur when
Dull pain in right hypochondrium
Dull aching pain is a frequent sign of chronic inflammation.
This kind of pain in the following pathologies.
- Acute and chronic hepatitis, cirrhosis, liver cancer, parasitic
lesions of the right lobe of the liver.
- Chronic acute and non-calculous cholecystitis outside
- Pyelonephritis, hydronephrosis, apostematic nephritis, kidney tumors
in advanced stages.
- Tumors of the adrenal glands.
- Mild colitis, intestinal diverticulosis.
Persistent pain is characteristic of tumors, metastatic
lesions of internal organs, parasitic cysts of the liver, fractures
Heaviness in right hypochondrium
The feeling of heaviness under the right costal arch accompanies edematous
liver against the background of congestive heart failure, hepatitis,
fatty hepatosis, hypomotor dyskinesia of the biliary tract,
part of chronic cholecystitis.
Pain after eating
Eating accelerates the secretion and promotion of bile, increases
filling the liver and stimulates intestinal peristalsis.
Therefore, food provokes pain in pathologies of the liver, gall
bladder, intestines. The nature of the pain may be different:
nausea and dull pain are characteristic of cholecystitis, sharp
pain of spastic nature accompanies colitis and dysbacteriosis
intestines, stitching pains accompany biliary dyskinesia
pathways or gallstone disease.
Pain after exercise
Stitching or pulling pain occurs after physical exertion with
congestive liver, hepatitis or cirrhosis. Calculous attack
cholecystitis can trigger both exercise or
physical education, and shaking ride.
But when hypomotor dyskinesia biliary tract load
somewhat improves the passage of bile and discomfort may even
Provoked stress and deterioration during intercostal
neuralgia, myositis, osteochondrosis, rib fractures, hollow thrombosis
What to do?
When pains in the right hypochondrium are concerned, it is worth referring to
to the doctor. Independent attempts to cope with pain with
antispasmodics such as drotaverine or no-shpy can smooth the picture
many acute conditions of internal organs, and this can lead
to delayed care and a worse prognosis for the patient.
Warmers or painkillers containing non-steroid
anti-inflammatory drugs are generally contraindicated until clarification
causes of pain, as they can be very harmful (for example,
provoke internal bleeding).
For any acute abdominal pain, it is advisable to call
station “ambulance” or independently contact the duty officer
Surgeon nearest hospital. If indications for hospitalization and
emergency treatment will not be, doctors will transfer the patient to colleagues
clinics to clarify the diagnosis and treatment selection.
Appeal to the clinic should start with a trip to the therapist,
who, if necessary, appoint a surgeon’s advice,
neuropathologist, cardiologist, endocrinologist.
Remember that pain in the abdomen is inappropriate, and often
life threatening. The earlier the patient will be examined by a specialist,
the greater is his chance to get out of the situation with pain in the hypochondrium with