Pain after eating in the right subcostal region

In the right hypochondrium, that is, under the two lower ribs on the right side of the epigastric region of the abdomen, are the gallbladder, part of the liver and duodenum, and a little deeper is 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.

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• Pain in the right hypochondrium
• Pain after eating

So pain after eating in the right hypochondrium 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 noted by gastroenterologists, 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 may be a consequence of gastric ulcer or duodenal ulcer, inflammation of the liver parenchyma (hepatitis), and fatty liver disease. And each of these pathological conditions has its own characteristics.

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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.

A typical clinical picture of acute cholecystitis (calculous or non-calculous, i.e. with or without gallstones) is a cramping, sharp pain in the right hypochondrium after eating. 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 an irregular heartbeat may be observed. An 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 by spasms of the gallbladder. Spasms occur for several reasons: due to blockage (obstruction) of the bile duct by 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 (the inflammation has affected only the upper layer of the mucous membrane of the gallbladder) and is not associated with gallstones, then if you follow a diet and all the doctor's instructions, 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 phlegmonous acute cholecystitis, in which patients complain of a dull pain in the right hypochondrium after eating, chills and fever, sometimes yellowing and severe itching of the skin. If left untreated, there is a high probability of phlegmonous acute cholecystitis turning 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 tissues of the gallbladder wall occurs, and pain may no longer be felt. After a few days, the gallbladder can simply rupture, which leads to peritonitis.

With chronic cholecystitis, patients experience a nagging pain in the right hypochondrium after eating, which is not as intense as with 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 antispasmodic drugs during an attack of pain. And chronic calculous cholecystitis can only be permanently cured by surgical intervention - 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 bouts of nausea, belching with bitterness or a bitter taste in the mouth, include such factors as opportunistic bacteria and microbes (E. coli, streptococci, staphylococci), pathogenic bacteria, various viruses, intestinal invasions (ascaris, lamblia).

It should be noted that when bacteria and parasites (through blood or lymph) enter the bile ducts, they become inflamed - 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 elevated, and an enlarged liver is noticeable upon palpation. If cholangitis is not treated, the inflammatory process spreads from the bile ducts to the nearby liver, forming abscesses in it. Hospitalization of a patient with suspected cholangitis is urgent, since everything can end in obstruction of the extrahepatic bile ducts (secondary biliary cirrhosis), hepatorenal failure, or sepsis.

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

The formation of gallstones is the result of increased cholesterol entering the 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 fats or alcohol. An attack of pain - with chills, vomiting and general weakness - can last from several minutes to several hours.

Aching pain after eating in the right hypochondrium can be observed with a functional disorder of the biliary system - weakening of the contractile ability (dyskinesia) of the gallbladder and bile ducts. The presence of this pathology, in addition to pain, is indicated by bitterness in the mouth, loss of appetite, a constant feeling of fatigue and a bad mood.

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

The duodenum (the duodenum) encircles the head of the pancreas and is the initial section 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, or more precisely, its upper expanded part - the bulb (bulbus duodeni).

Most often, an 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, this disease is accompanied by dyspeptic symptoms in the form of belching, nausea, vomiting, a feeling of distension in the epigastric region, flatulence, as well as such vegetative symptoms as weakness and increased sweating. If there are complaints of severe (stabbing) pain and dizziness, urgent medical care is needed, as these are signs of perforation of the ulcer of the duodenum.

Depending on the location of the lesion in gastric ulcer (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 in the case of a deep ulcer in the antropyloroduodenal 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 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 the duodenum, alcohol, fatty and spicy foods, and long-term use of certain medications.

Pain in pancreatitis can be sudden and very strong – with nausea, vomiting (with bile), fever, increased heart rate and decreased blood pressure. Features and localization of pain: sensation of a source of pain high under the pit of the stomach; bursting pain in the right hypochondrium with the capture of the left; encircling pulsating pain, forcing the patient to bend into the "fetal position".

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 ulcer, 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 hypochondrium with hepatitis

Hepatitis – inflammation of the liver with necrosis of parts of its tissue – is caused by a number of reasons. These include hepatitis viruses, alcohol abuse, prolonged drug exposure to the liver, and impaired bile flow from the liver (cholestatic hepatitis).

In addition to a nagging pain after eating in the right hypochondrium, the list of symptoms of this disease includes yellowing of the skin and sclera, itchy skin, nausea, bitter belching, light-colored stool and dark urine, general intoxication, increased temperature and decreased overall tone of the body.

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 pains 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 parenchymatous tissue of the liver, consisting of hepatocytes, with fibrous connective tissue. Ultimately, this leads to cirrhosis of the liver.

Pain after eating in the right hypochondrium with fatty liver disease

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 endocrine-induced protein and vitamin deficiency in the body or with unbalanced nutrition. In this case, the disruption of fat formation in liver cells is often accompanied by such endocrine pathologies as diabetes mellitus and thyrotoxicosis.

In fatty hepatosis, there is a pathological loss of fat by liver cells (hepatocytes), i.e. 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 minor physical exertion), dull pain after eating in the right hypochondrium, enlargement and pain of the liver upon palpation.

If the damaging factors are not eliminated and treatment is not started in a timely manner, liver dystrophy can lead to chronic hepatitis and liver cirrhosis.

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 rely on the anamnesis, clinical picture of the disease and the results of a comprehensive examination of the patient.

Among the mandatory tests required 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 indicators.

The main methods of diagnostic examination of these pathologies are ultrasound examination (US) of the liver, gallbladder and bile ducts, plain radiograph of the abdominal organs 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, X-ray and endoscopy of all organs associated with the gallbladder and bile ducts are performed, and examination of the duodenum, pancreas and liver is prescribed using ultrasound or laparoscopy.

When diagnosing gallstone disease, the diagnosis cannot be made only on the basis of blood tests, so ultrasound and X-ray examination of the gallbladder and its duodenal intubation are mandatory. And the main endoscopic method of examination in the diagnosis of 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.

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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 syndrome. And to rid patients of their cause, a wide range of modern drugs is used, and their selection and dosage are carried out by the attending physician individually.

For example, in the treatment of cholelithiasis - if 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 gallbladder have not disappeared, their surgical removal (cholecystectomy) may be prescribed.

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

A mandatory and most important component of complex treatment of pain after eating in the right hypochondrium is diet! Doctors recommend reducing the volume and caloric 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.

Nutritionists advise, for diseases that are accompanied by pain after eating in the right hypochondrium, to consume foods that help reduce cholesterol levels in the blood and improve bile flow: buckwheat and oatmeal, bran, vegetables, fruits, berries, dried fruits, vegetable oils (corn, olive, sunflower), fermented milk products.