This word is composed of the preposition “π” which means under and “χνδρος” for cartilage, ie “cartilagini subjacens”, which is below the cartilage.

The hypochondrium is in fact the space which is located on each side of the epigastric region, that is to say of the upper part of the lower abdomen. 

The human body has two hypochondria on each side, the right hypochondrium and the left hypochondrium. Both make up the upper part of the epigastrium: space between the ensiform cartilage, the lower rib cartilages and the tip of the stomach.

In the right hypochondrium, we find the liver and gallbladder.

The left hypochondrium contains the spleen and a large part of the stomach.

Hippocrates (Greek physician of the century of Pericles, but also a philosopher, traditionally considered the “father of medicine and recognized as the founder of ethical rules for physicians, through the Hippocratic Oath) sometimes gives the name of the hypochondrium to the whole lower belly.

The emergencies register many complaints related to pain in the right hypochondrium. In this case, patients should indeed consult because these pains are not trivial and can be the symptom of an infection or an abscess.

Pain in the right hypochondrium

The right hypochondrium is therefore the area located to the right and at the top of the belly. Among the infectious pathologies of the right hypochondrium, the most common hepatobiliary causes can be noted:

• cholecystitis;
• l’angiocholite;
• liver abscesses;
• hepatic colic (only 1/3 of hepatic colic is localized in the right hypochondrium);
• tumors.

An area close to the liver

The main organ located in this area is the liver. But other organs like the kidney, lung, ribs, intestines and pancreas may be affected by the pain described. It may also be due to:

• gallstones;
• hepatitis (affections of the liver, heart);
• pancreatitis;
• problems with the pleura (pneumothorax, pleurisy);
• pulmonary infections (pulmonary embolism, right basal pneumonia, pleurisy, pneumothorax);
• rib contusions or fractures;
• kidney problems: stones (pyonephrosis or renal colic), infections (pyelonephritis);
• constipation, intestinal obstruction

There is no particular organ in this territory, mainly occupied by the intestine. In the majority of cases, stress is the main cause, this stress causing gas, at the origin of the painful sensation. Heat in the form of a hot water bottle and a mild pain reliever can help reduce the pain.

Organs near the left hypochondrium

But be careful because other organs can be linked to this pain including the kidney, spleen, lung, ribs, stomach and pancreas. According to health professionals, the spleen is an organ often “forgotten” during abdominal pain. These pains may indeed indicate a rupture of the spleen with sub-capsular hemorrhage or hemoperitoneum, a splenic abscess or the formation of pseudocysts.

The main causes of pain

Main causes of pain in the left hypochondrium:

• Constipation, intestinal obstruction;
• Problems of the pleura (pneumothorax, pleurisy);
• Lung infections;
• Rib contusions or fractures;
• Kidney problems: stones (renal colic), infections (pyelonephritis);
• Lesions of the spleen

Rarer cases

Relatively rare, it can be:

• a condition affecting the tail of the pancreas (cancer, pseudocyst, caudal pancreatitis);
• gastric ulcer, acute gastritis;
• diverticulitis of the left colic angle;
• a splenic disorder (tumor, infarction, splenomegaly, abscess).

Splenic infarction 

Rare, splenic infarction can be the cause of pain radiating into the left hypochondrium. This infarction can have severe consequences such as abscesses, rupture or loss of function, which should call for a certain vigilance.

As the rate of complications from splenic infarction is high and pain or irradiation of pain in the left hypochondrium is frequent, splenic pathologies must be part of the differential diagnosis of abdominal pain ”. (Extract from the article in Forum Med Suisse 2008; 8 (7): 131–132). 

Diagnosis of pain in the left hypochondrium

In the differential diagnosis of pain in the left hypochondrium, we will retain:

• left pleural and pulmonary pathologies;
• pyelonephritis or renal lithiasis on the left;
• and the costal origin.

Apart from these extra digestive disorders, the differential diagnosis of digestive disorders includes gastric ulcer, gastritis, constipation, diverticulitis and pancreatitis.

The first step following a patient’s complaint of pain in one of the hypochondria is palpation by his attending physician. Depending on the level of pain and the appearance of the hypochondrium, the latter will direct his patient for more in-depth radiological examinations which may be:

An abdominal ultrasound, an injected abdominal CT scan or an angiogram, which can be useful to visualize the anatomy of the splenic vessels if one is looking for a vascular etiology to the infarction.

To establish a diagnosis, these examinations will be supplemented by a blood or urine test.