Causes of pain in the right hypochondrium

In the right hypochondrium, that is, under the two lower ribs on the right side of the epigastric zone of the abdomen, there is the gallbladder, part of the liver and duodenum, and a little deeper – the pancreas (its part called the tail).

Also projected onto the right hypochondrium are 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.

So pain after eating in the right hypochondrium may be caused by pathological processes in which any of the organs located here is involved.

Causes of pain after eating in the right hypochondrium

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

In addition, pain after eating in the right hypochondrium can be a consequence of gastric or duodenal ulcers, inflammation of the liver parenchyma (hepatitis), as well as fatty liver. And each of these pathological conditions has its own characteristics.

Pain after eating in the right hypochondrium with cholecystitis

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

The typical clinical picture of acute cholecystitis (calculous or non-calculous, that is, with or without gallstones) is a cramping acute pain in the right hypochondrium after eating. In this case, the pain radiates to the area of ​​the right shoulder blade, shoulder and lower back. In addition to pain, a person suffers from nausea and vomiting, and heart rhythm disturbances may occur. An attack of pain can be so severe that it can lead to loss of consciousness.

Experts explain these symptoms pain after eating in the right hypochondrium spasms of the gallbladder. Spasms occur for several reasons: due to blockage (obstruction) of the bile duct with a stone, inflammation of the bladder wall itself or the presence of scars in its cavity, as well as due to functional disorders of motility (dyskinesia) of the neck of the gallbladder, which flows into the cystic bile duct.

If acute cholecystitis is catarrhal (inflammation affects only the upper layer of the mucous membrane of the gallbladder) and is not associated with stones in the gallbladder, then if you follow a diet and follow all the doctor’s prescriptions, everything will return to normal in a couple of weeks.

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 is phlegmatic acute cholecystitis, in which patients complain of dull pain in the right hypochondrium after eating, chills and fever, sometimes yellowing and severe itching of the skin. In the absence of treatment, there is a high probability of transformation of phlegmous acute cholecystitis into purulent (with a temperature of up to +39°C, weakness and signs of intoxication) and even gangrenous cholecystitis. With this form of the disease, necrosis (death) of the tissue of the gallbladder wall occurs, and pain may no longer be felt. After a few days, the gallbladder may simply rupture, leading to peritonitis.

With chronic cholecystitis, patients experience nagging pain in the right hypochondrium after eating, which is not as intense as in the acute form of the disease. In addition, nausea and vomiting are quite rare. The main cause of chronic inflammation of the gallbladder is the same stones, and an attack is provoked by excessive and frequent consumption of fatty, spicy and fried foods and alcohol. Doctors recommend following a diet and taking medications to relieve spasms during an attack of pain. And you can get rid of chronic calculous cholecystitis forever only through surgery – removal of the gallbladder.

The causes of chronic non-calculous cholecystitis, in which a person is bothered by aching pain after eating in the right hypochondrium, as well as attacks of nausea, bitter belching or a bitter taste in the mouth, include factors such as opportunistic bacteria and microbes (Escherichia coli, streptococci, staphylococci) , pathogenic bacteria, various viruses, intestinal invasions (roundworms, lamblia).

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

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

The formation of stones in the gallbladder is the result of an increase in the flow of cholesterol into bile, changes in its composition and stagnation in the gallbladder and its ducts.

Classic signs of gallstone disease (choletiasis) include the appearance of a bitter taste in the mouth, and paroxysmal acute pain in the right hypochondrium 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 or several hours.

Aching pain after eating in the right hypochondrium can be observed with a functional disorder of the biliary system – weakening of the contractility (dyskinesia) of the gallbladder and biliary tract. In addition to pain, the presence of this pathology is indicated by bitterness in the mouth, decreased appetite, a constant feeling of fatigue and bad mood.

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

The duodenum (duodenum) goes around the head of the pancreas and is the initial part of the small intestine. Symptoms of pain after eating in the right hypochondrium, as well as night pain and pain on an empty stomach are typical for an ulcer of the duodenum, more precisely, its upper expanded part – the bulb (bulbus duodeni).

Most often, a duodenal ulcer is preceded by inflammation – duodenitis. In the erosive form of duodenitis, the mucous membrane is first destroyed, and then an ulcer forms. In addition to aching or cutting pain, this disease causes dyspeptic symptoms in the form of belching, nausea, vomiting, a feeling of fullness in the epigastric region, flatulence, as well as vegetative symptoms such as weakness and increased sweating. If you complain of severe (stabbing) pain and dizziness, urgent medical attention is necessary, as these are signs of a perforation of a duodenal ulcer.

Depending on the location of the lesion in gastric ulcers (which, like gastritis, is caused by the bacterium Helicobacter pylori), pain appears soon after eating or one and a half to two hours after eating, and with a deep ulcer in the antropyroduodenal zone of the stomach – even at night. However, as clinical gastroenterologists 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 hypochondrium, mainly when the ulcer is localized in the pyloric part (outlet section) of the stomach.

Pain after eating in the right hypochondrium due to 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 considered to be stones, acute cholecystitis, gallbladder diseases, inflammation of the papilla between the pancreas and duodenum, alcohol, fatty and spicy foods, and long-term use of certain medications.

Pain in pancreatitis can be sudden and very severe – with nausea, vomiting (with bile), fever, rapid heartbeat and decreased blood pressure. Features and localization of pain: sensation of a source of pain high in the pit of the stomach; bursting pain in the right hypochondrium with seizure of the left; surrounding pulsating pain, forcing the patient to bend over into the “fetal position.”

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

Pain after eating in the right hypochondrium with hepatitis

Hepatitis – inflammation of the liver with necrosis of areas of its tissue – is caused by a number of reasons. These include hepatitis viruses, alcohol abuse, long-term drug effects on the liver, as well as impaired flow of bile from the liver (cholestatic hepatitis).

In addition to nagging pain after eating in the right hypochondrium, the list of signs of this disease includes jaundice of the skin and sclera, itching, nausea, bitter belching, light feces and dark urine, general intoxication, increased temperature and decreased overall body tone.

A characteristic feature of chronic hepatitis is the long absence of obvious symptoms. But during the course of the disease, they manifest themselves as nagging pain in the right hypochondrium, an increase in the size of the liver, and complete intolerance to fatty foods. In the chronic form of hepatitis, there is a gradual and irreversible replacement of the parenchymal liver tissue, consisting of hepatocytes, with fibrous connective tissue. This ultimately leads to liver cirrhosis.

Pain after eating in the right hypochondrium with fatty liver

Fatty hepatosis or toxic liver dystrophy is a chronic disease. In most cases, chronic fatty hepatosis is an inevitable consequence of alcoholism or poisoning with certain toxic substances. This disease can also develop with an endocrine-related lack of protein and vitamins in the body or with an unbalanced diet. In this case, disruption of the formation of fats in liver cells is often accompanied by pathologies of the endocrine system such as diabetes mellitus and thyrotoxicosis.

With fatty hepatosis, pathological loss of fat by liver cells (hepatocytes) occurs, that is, dystrophy, which leads to necrosis of hepatocytes. Symptoms of this disease are disorders of the entire digestive system, general weakness and headache, increased fatigue (even with little physical activity), dull pain after eating in the right hypochondrium, enlargement and tenderness of the liver on palpation.

If the effect of damaging factors is not excluded and treatment is not started 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 certain disease, the diagnosis of pain after eating in the right hypochondrium consists of identifying this disease. When making a diagnosis, doctors are based on the medical history, clinical picture of the disease and the results of a comprehensive examination of the patient.

Among the mandatory tests necessary for diagnosing the presented spectrum of diseases are clinical and biochemical blood tests, as well as determination of the presence of hepatitis viruses, cholesterol levels and other important blood parameters.

The main methods of diagnostic studies of these pathologies are ultrasound examination of the liver, gallbladder and biliary tract, plain x-ray of the abdominal cavity and intestines, x-ray examination with contrast agents (which helps to identify ulcers), computed tomography of the stomach and pancreas, gallbladder and liver.

Thus, to diagnose chronic cholecystitis, doctors most often use ultrasound, cholecystography and cholangiography, which make it possible to identify stones, differentiate calculous and non-calculous forms of this disease and see the condition of the gallbladder wall, the thickness of which is the main criterion for determining the severity of the inflammatory process.

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

When diagnosing cholelithiasis, the diagnosis cannot be made only on the basis of blood tests, therefore ultrasound and x-ray examinations of the gallbladder and its duodenal intubation are required. And the main endoscopic research method in diagnosing pain after eating in the right hypochondrium with gastritis and peptic ulcer disease is fibrogastroscopy, with the help of which gastroenterologists can determine the condition of the mucous membrane and take a sample (biopsy) for examination.

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 hypochondrium, even symptomatic treatment cannot be the same for everyone. Therapy will depend on the disease that causes pain, and the goal of complex 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 concomitant pathologies.

So taking antispasmodic painkillers is used only to relieve spasms and pain. And to rid patients of their cause, a wide range of modern medicines is used, and their selection and dosage is carried out individually by the attending physician.

For example, when treating cholelithiasis – when the stones are no more than 2 cm in diameter – special drugs are prescribed to help dissolve them. If after a year and a half the stones in the gall bladder have not disappeared, their surgical removal (cholecystectomy) may be prescribed.

Treatment of dyskinesia of the gallbladder and biliary tract is carried out by taking choleretic and antispasmodic medications prescribed by a doctor, as well as a special diet. In the treatment of pancreatitis (inflammation of the pancreas), anti-enzyme drugs, antispasmodics, drugs with a cytostatic effect, as well as therapeutic fasting are used. And therapy for chronic hepatitis involves the widespread use of detoxification techniques, the use of antiviral drugs and hepatoprotectors – drugs that have a positive effect on liver function.

A mandatory and most important component of the complex treatment of pain after eating in the right hypochondrium is diet! Doctors recommend reducing the volume and calorie content of food consumed and completely eliminating fatty, smoked, spicy and fried foods from the diet, giving up spices, canned food, alcohol and carbonated drinks.

Prevention of pain after eating in the right hypochondrium

Preventive measures aimed at preventing the occurrence of pain after eating in the right hypochondrium include:

• reduction of excess body weight,
• proper diet (small portions 4-5 times a day),
• low calorie diet
• sufficient fluid intake (1,5-2 liters per day),
• daily morning exercises and feasible physical activity,
• refusal of alcoholic beverages.

Specialists in the field of therapeutic nutrition advise that for diseases that are accompanied by pain after eating in the right hypochondrium, eat foods that help reduce cholesterol levels in the blood and improve the outflow of bile: buckwheat and oatmeal, bran, vegetables, fruits, berries, dried fruits, vegetable oils (corn, olive, sunflower), fermented milk products.