Pain under the ribs: nature, causes, treatment
Pain under the ribs that causes a person to bend and press their hands to the stomach with force, can have a very diverse nature, arise due to pathological or physiological conditions and be either really dangerous for health / life, or a short-term spasm.Table of contents: Possible causes of pain in the hypochondrium Pathology of the gastrointestinal tract Spleen pathology Differentiation of the pain syndrome Painful syndrome under the ribs requiring urgent hospitalization Perforation of the stomach or duodenum ulcers Acute pancreatitis Acute cholecystitis and hepatic colic Poddiaphragmatic abscess Liver and spleen injuries Myocardial infarctionGastralgic form Pain under the ribs for chronic diseases Pain under the ribs with neurocirculatory dystonia Treatment is advisable to read:
Possible causes of pain in the upper quadrant
on a single complaint of the patient to pain under the ribs of any one person is not diagnosed - too many factors that can provoke an unpleasant sensation.But there is a definite classification of the pain syndrome under consideration.For example, most often the pain appears for two reasons - pathological conditions in the organs of the gastrointestinal tract and problems in the work of the spleen.
Pain under the ribs can cause:
- any diseases of the duodenum and stomach - for example, gastritis of acute or chronic form, predjazvennoe condition, formed ulcer of the stomach / duodenum, malignant neoplasms;
- pathologies localized in the pancreas - inflammatory process( pancreatitis) of acute or chronic form, gland cancer;
- dysfunction of the gallbladder - the formation of stones in the pelvis, bile stasis, dyskinesia of the biliary tract, inflammation of the gallbladder( cholecystitis) of any severity;
- pathology of the liver - cirrhosis, hepatitis, malignant / benign neoplasm.
It should be noted that pain under the ribs may appear even with a slight increase in the spleen.This process can begin with:
- diagnosed with leukemia;
- hemolytic anemia;
- infectious diseases occurring in acute form;
- developing sepsis;
- infectious pathologies of a chronic type;
- disorders in the body's immune system.
Pain under the ribs may occur for other reasons - for example, doctors differentiate the following conditions:
- osteochondrosis of the spine( pathology can affect any of the parts of the spinal column);
- trauma to the spleen or liver( bumps, bruises, falls);
- some diseases of the respiratory system( pleurisy, pneumonia, localized in the lower lobe of the right lung);
- myocardial infarction, but proceeding exclusively in the gastralgic form;
- Inflammatory and / or infectious diseases of the urinary system( glomerulonephritis, pyelonephritis in acute / chronic forms, urolithiasis);
- abscess of subdiaphragmatic location;
- hematoma of the retroperitoneal location;
- is a diagnosed dystonia of the neurocirculatory type.
Differentiation of the pain syndrome
As there are a lot of reasons that provoke the appearance of pain under the ribs, it is necessary to conduct an independent differentiation of the syndrome before visiting the doctor.This will help the specialist to quickly navigate the situation and offer targeted professional assistance, which will certainly lead to an early resolution of the problem. Patients are recommended to differentiate the pain syndrome under the ribs as follows:
- Accurate localization of pain.You may experience pain under the right rib, pain under the left rib, pain under the ribs in front or pain under the ribs from behind.
- Direction of irradiation( "recoil").Pay attention: the pain under the ribs is almost never "point", it usually "gives" under the left collarbone or the right scapula, it can imitate pain in the heart and be present even in the anatomical location of the kidneys.
- The level of pain strength.Even if the pain syndrome under the ribs appeared suddenly, then it can be intense and not, blunt / cutting / pricking, paroxysmal or permanent - there are many options for characterizing the strength of pain, it is worth to be more specific.
- The nature of the syndrome.It is about what kind of pain torments: pulling, aching, "diffuse", strictly localized, constant and dull, paroxysmal and acute.
If the pain under the ribs does not occur the first time, it will be necessary to clarify:
- in which cases it acquires a greater intensity - with coughing, sharp turn of the trunk, physical exertion, fast walking, sneezing and so on;
- in which ways you can quickly remove the pain - applying a warm / cold warmer, using medicines( analgesics or antispasmodics);
- whether pain is associated with food intake - it can appear on an empty stomach, immediately after a meal or during a bout of hunger;
- at what time the pain appears - night sleep, morning or lunch period.
Please note: the pain syndrome under the ribs may be accompanied by nausea and / or vomiting, sudden dizziness, severe blanching of the skin, increased sweating and other symptoms - they must also be noted and memorized.It is very desirable to remember where and how pains appeared under the ribs - perhaps on the eve you strongly supercooled or took too much fatty food.
Pain under the ribs in some cases require emergency medical care - this syndrome may indicate the development of a life-threatening and even life-threatening condition.But most often the syndrome in question means the presence of any developing pathology, the treatment of which will need to be carried out in a hospital.
Pain under the ribs requiring urgent hospitalization
In medicine, a number of dangerous pathological conditions that are manifested by pain under the ribs are classified.
Perforation of a stomach or duodenal ulcer
This condition is accompanied by a dagger pain - a very sharp and severe attack with localization in front and in the middle.The intensity of pain is such that the patient takes a forced position - lies on his side, his legs are bent at the knees and pulled up to the stomach.Characteristically, with the perforation of the stomach / duodenal ulcer, the pain syndrome first arises "under the spoon", and then actively shifts to the right hypochondrium.This is due to the movement of gastric contents through the abdominal cavity.
Note: after the pain syndrome has moved to the right area under the ribs, the attack ends - a phase of imaginary well-being comes, which, in the absence of professional help, always leads to the development of peritonitis.
Differentiation of perforation of gastric / duodenal ulcers is easy - usually a patient has a history of long gastritis, a pre-ulcer and an ulcer proper.
More details on ulcer symptoms are described in this video review:
A sudden attack of acute zoster that covers the upper abdomen and gives irradiation under the shoulder blades is always associated with acute pancreatitis( inflammation of the pancreas).A characteristic feature of the pain syndrome under consideration is that its intensity is not variable and remains within the initial limits when the position of the trunk, coughing or sneezing changes.In addition to the pain syndrome, with acute pancreatitis, nausea and vomiting will be present - the latter appears suddenly and does not allow even a sip of water.
Note: An acute inflammatory process in the pancreas can cause a strong intoxication of the body - enzymes produced by the body get into the blood.This provokes cyanosis of the skin, a characteristic "marble" of the abdomen and small( pinpoint) hemorrhages with localization around the navel.
To diagnose acute pancreatitis for pain syndrome is easy - it is too pronounced.Especially since the attack happens usually after eating a lot of fatty foods or alcohol.
More information about the symptoms of acute pancreatitis - in the video review:
Acute cholecystitis and hepatic colic
An attack of acute, cutting pain in the right hypochondrium with irradiation in the scapula and neck may cause an acute inflammation of the gallbladder.The patient in this case will literally rush to find a comfortable position and reduce the intensity of pain - this, by the way, he will not be able to do. The general clinical picture will help in diagnosing:
- nausea and vomiting;
- yellowness of the skin and sclera;
In this painful syndrome, it is important to differentiate acute cholecystitis and hepatic colic.In the case of movement of the stone along the hepatic ducts, pain under the ribs will be present, but neither nausea, nor vomiting, nor fever is noted.
Note: the hepatic colic is short-lived, and pain is relieved by antispasmodics.In acute cholecystitis, the syndrome lasts for a long time and even after taking specific medications, relief does not come.
Sudden pain, sharp and paroxysmal, with localization in front under the left and right ribs simultaneously indicates the development of the abscess in the sub-diaphragmatic region.The syndrome appears only on a sigh, can be accompanied by a fever and standard symptoms of the general intoxication of an organism.
This pain has several characteristic features:
- radiates to the supraclavicular area;
- may have a false localization under the blade;
- significantly increases with sudden movements - coughing, sneezing, torso turning.
Diagnosis of sub-diaphragmatic abscess is simple - this condition often occurs during postoperative periods or when diagnosing acute cholecystitis and perforated gastric / duodenal ulcer.
Liver and spleen injuries
Trauma to the spleen or liver is always accompanied by pain under the ribs - this is the main symptom of this condition.Moreover, the localization of the syndrome will depend on which organ is damaged - on the right is the liver, and on the left - the spleen.A characteristic symptom for the rupture of these organs is the "Vanka-Vstanka": the patient can not be in a prone position, since it experiences more intense pain due to the spillage of blood under the diaphragm.
Note: injuries to the spleen and / or liver are always accompanied by internal bleeding, so the patient will be too pale, may lose consciousness, his blood pressure drops sharply.
Especially when the spleen and liver breakdown occurs two times: the parenchyma( membrane) of the organ is damaged, the blood accumulates in the capsule, and then, even with a slight physical strain, the capsule breaks, the blood accumulating in it in the abdominal cavity is spreadingLeads to almost instantaneous death of the patient.The difficulty of this condition lies in the short-term pain syndrome under the ribs - in a few hours it passes and the patients continue to lead a habitual way of life without seeking medical help.
Myastardial infarction of the gastralgic form
Myocardial infarction is usually diagnosed easily enough - the patient makes complaints of shortness of breath and pressing pain under the heart. But in the case of the gastralgic form of this pathological condition there will be several other symptoms:
- pain in the left hypochondrium;
- nausea and uncontrollable vomiting;
- resistant hiccup;
- stool disorders.
Differentiate myocardial infarction of a gastralgic form from diseases of the gastrointestinal tract. Two distinctive features will help:
- inspiratory dyspnea;
- cyanosis and face puffiness.
Note: after administration of drugs with analgesic effect, the patient's condition is normalized to the classic symptoms of myocardial infarction.
Doctors distinguish between pain under the ribs and from the back - it occurs with renal colic( stone movement) and retroperitoneal hematoma.These two conditions are characterized by a strict localization of the pain syndrome and the absence of irradiation.In this case, the patient will complain of general weakness, increased sweating, lack of appetite.
All the above pathological conditions require immediate hospitalization of the patient and the provision of professional medical care.Otherwise, the risk of death is increased to 99%.
Pain under the ribs for chronic diseases
Chronic diseases can manifest as periodic bouts of pain under the ribs.Usually they do not pose any danger to the health and life of the patient, but they show that some pathological processes occur in the diseased organ.
For example, chronic gastritis will show non-intensive pain in the left hypochondrium, which are directly related to eating.This means that the time has come for seasonal exacerbation of the chronic inflammatory process and requires the passage of another course of curative / maintenance therapy.And for chronic pancreatitis( inflammation of the pancreas) is characterized not only by periodic pain under the ribs, but also by strengthening the syndrome in the prone position.
Note: knowing about the previously diagnosed chronic diseases, you can control the pain under the ribs and quickly remove it with various medications.
Pain under the ribs with neurocirculatory dystonia
Neurocirculatory dystonia is a disease that gives the most unpredictable in its localization, irradiation and pain intensity in the hypochondrium. There are two main features on which the physician can differentiate the pain syndrome in question, as a consequence of neurocirculatory dystonia:
- an undefined characteristic of pain: the patient can not literally describe his feelings, because the syndrome can be constant and paroxysmal, abrupt and gradually increasing,Sharp and blunt;
- no additional symptoms that appear at the time of the pain.
It is strictly forbidden to take any pain medication yourself if the pain under the ribs is sudden, acute, and there was no diagnosis of any of the above diseases!
With the usual pain in the hypochondrium, you can take any antispasmodics - No-shpa, Baralgin, Spazmalgon: usually after the first admission, the intensity of the painful syndrome begins to subside and the condition returns to normal.But this does not mean that you can ignore this syndrome - doctors should conduct a survey and identify the cause of exacerbation of chronic pathology, prescribe a course of therapy.
To combine traditional medicine recipes to reduce pain under the ribs with medicines, it is possible only after making an accurate diagnosis and receiving recommendations / permissions from the attending physician.
Pain under the ribs may indicate a dangerous condition for the patient, so it is better to seek medical help immediately - emergency surgical intervention will save life and make a prediction even of complex pathology favorable.
More information on possible causes of pain in the hypochondrium is obtained by viewing this video:
Tsygankova Yana Aleksandrovna, medical reviewer, therapeutist of the highest qualification category.