- inflammatory (hepatitis)
- sclerotic and degenerative (cirrhosis, fatty hepatosis)
- tumors (primary and metastases)
Stomach diseases:
- gastritis
- peptic ulcer (more often when ulcerative defects are located in the pylorus)
Diseases of the duodenum
- duodenitis
- peptic ulcer
- tumors and blockages of the Vater nipple - the exit point of the common bile duct, which removes bile and pancreatic secretions.
Referring pain in the right hypochondrium may reflect pain from distant organs:
- appendix (inflammation)
- right fallopian tube and ovary in women (inflammation, ectopic pregnancy, tumors)
- large intestine (tumors, ulcerative colitis).
1.General information
As you know, ribs are not only part of the musculoskeletal system, but also serve as mechanical protection for vital internal organs: heart, lungs, liver, gall bladder, etc. Therefore, any pain behind or under the ribs should alert you. If pain discomfort in the hypochondrium has become recurrent or chronic, you should definitely consult a doctor: there are simply no problems in this area that can be neglected. But it is, on the contrary, very easy to waste precious time and miss the development of a dangerous pathology, and this happens, unfortunately, all the time in clinical practice.
On the left under the ribs there are many potential sources of pain: individual parts of the intestines, stomach, spleen, pancreas. Heart pain often radiates to the left hypochondrium, but it would be wrong to assume that “any pain on the left is from the heart.” Possible causes are far from limited to cardiac problems.
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Diagnosis of pancreatic diseases
To diagnose diseases of the pancreas, the doctor examines and palpates the abdomen and prescribes laboratory and instrumental methods.
A biochemical blood test examines the level of pancreatic enzymes (amylase, lipase), blood glucose, and liver function tests.
A stool analysis is carried out to assess the deficiency of enzyme production, the presence of undigested food, fat, and certain enzymes (pancreatic elastase) is examined.
Visual instrumental examinations are carried out using transabdominal ultrasound (ultrasound of the abdominal cavity), CT, radiography, magnetic resonance cholangiopancreatography.
2. Reasons
The most common causes of pain in the left hypochondrium include:
- diseases of the stomach in their entire spectrum (from mild dyspepsia to peptic ulcer of the stomach and/or duodenum);
- enlargement (splenomegaly) or damage to the spleen (especially bruises with rupture);
- inflammatory processes in the pancreas (pancreatitis);
- malignant neoplasms that have reached a certain size;
- pyelonephritis, calculi (stones) in the left kidney;
- myocardial infarction and (less commonly) other heart diseases;
- osteochondrosis;
- pathology of the diaphragm (usually an abscessing inflammatory process);
- lung damage (pneumonia, metastatic stages of cancer, etc.).
However, this list is not complete. Some neurological and endocrine disorders can also manifest as pain in the left hypochondrium; finally, the reason may lie in damage to the ribs themselves - their bruise or fracture.
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Provoking factors
Abdominal pain on the left can cause certain conditions that are not associated with organic damage to internal organs.
- Physical overexertion - playing sports without preliminary warm-up, running. A sudden pain in the left side just below the ribs is associated with blood flow to the spleen and an increase in its volume. Unpleasant sensations disappear after a short break.
- Wearing tight trousers, bandages and corsets - compression of the abdomen disrupts the blood supply to the abdominal organs, and this is fraught with the appearance of nagging pain in the abdomen on the left/right and near the navel.
- Stress - in people with high excitability of the nervous system, pain in the left side of the abdomen is caused by increased intestinal motility. Rumbling in the stomach, diarrhea and painful cramps often occur before exams, after a conflict at work or a domestic quarrel. After some time, the pain goes away, but if it occurs frequently, it is advisable to visit a neurologist.
- Overeating - every person has experienced a feeling of heaviness, bloating and nagging pain in the stomach after overeating. Unpleasant symptoms are especially pronounced in the stomach area and lower left. Relief occurs after bowel movement, but in some cases the doctor prescribes the use of enzymatic agents to reduce the load on the digestive organs.
- Overheating - prolonged exposure to the sun, abnormally hot weather and high humidity in the summer season, long stay in the sauna often leads to abdominal pain, including pain in the left side. For some, the discomfort is minor and does not cause discomfort. Others experience painful contractions and diarrhea.
- Abdominal injuries - a fall from a height or on ice, an accident, or even a slight blow to the left side with a fist are fraught with serious consequences.
- Sex - pain in the lower left abdomen before or after sexual intercourse often indicates gynecological pathology in women and genitourinary diseases in men, including STDs (sexually transmitted diseases).
3. Symptoms, diagnosis
Pain in the left hypochondrium, given the huge number of possible causes, is so diverse that its common property can only be considered localization at the edge of the costal arch. However, options are also possible here: pain in the left hypochondrium in the front carries slightly different information than pain on the side or behind. The nagging, tolerable, but almost constant debilitating pain in chronic inflammation of the internal organs is incomparable with the sharp, dagger-like pain in renal colic, perforated gastric ulcer or myocardial infarction.
Therefore, quick and accurate diagnosis of the causes is very important. For this purpose, the most detailed anamnesis is collected, an external examination, palpation (palpation), auscultation (listening), percussion (tapping) is necessarily performed, and for an experienced doctor these “ancient” methods are sometimes as important and informative as the most modern high-tech ones devices. As the situation becomes clearer, additional tests are prescribed and/or the patient is referred to a specialized specialist.
Obviously, in the diagnosis of subcostal pain, imaging methods are of great importance: various types of radiography, ultrasound, and tomography. In some cases, the primary role is given to laboratory analyzes of biological fluids, in others, only a biopsy, endoscopy or diagnostic laparoscopy can provide decisive answers.
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Pain caused by heart and vascular diseases
With diseases of the heart and vascular system, and in particular with vegetative-vascular dystonia and angina, pain also occurs in the left hypochondrium region. In the case of dystonia, this is due to a violation of the mechanism for maintaining the tone of blood vessels, and in the case of angina pectoris, heart pain is radiated to this area.
The nature of the pain in these cases can be dull, stabbing, or aching. Patients usually find it difficult to describe such phenomena, because they can be both prolonged and paroxysmal with unclear localization. When conducting research, typical diseases of the organs located in this area of the hypochondrium are not detected and the person is sent for examination to a cardiologist or neurologist.
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4.Treatment
Of course, it would be wrong to talk about the treatment of pain in the left hypochondrium itself, or, even more so, to give some “general approaches” to their treatment. Modern medicine strictly follows the etiopathogenetic principle: at all costs, find the cause and, as far as possible, eliminate it (ideally, eliminate it completely). Considering the special importance of the left hypochondrium zone, the examination should be as thorough as possible, even if it takes a lot of time and requires significant costs, and its results should give, as far as possible, complete, evidence-based, comprehensive answers about the nature and localization of the pathology, probable prognosis options and the most effective methods of treatment ad hoc (Latin for “for a given case”). A common, fully justified and advisable practice is the above-mentioned redirection of the patient to a specialized specialist: it is wiser to entrust the treatment of the stomach to a gastroenterologist, and the lungs to a pulmonologist; and if the initial contact was made to the wrong address, or the reason could not be determined “on the fly,” this does not mean that “doctors are playing tricks on each other” or “grabbing money for examinations.”
In conclusion, we emphasize once again: the causes of pain in the left hypochondrium, as well as the pain itself, are very diverse, but this is always a reason to visit a doctor. And if you are not sure which one, i.e. If you don’t know what exactly hurts—for example, you’ve never had pain before—it’s best to start by consulting a therapist as the most universal of all doctors.
Treatment of pancreatic inflammation
Treatment of acute pancreatitis should take place in a hospital.
First aid - you need to apply an ice bag to the left hypochondrium, avoid eating any food. Drug treatment includes taking antispasmodics, painkillers (opioid analgesics), and antiemetics. In the acute phase, infusion drugs are administered intravenously. For complications, antibiotics may be prescribed. Fasting is observed for three to five days or parenteral nutrition is used.
Therapy for the chronic form of the disease is based on quitting smoking, drinking alcohol, diet therapy with a small amount of fat in the diet, using painkillers, taking enzyme preparations; antidepressants (pregabalin, gabapentin) can be prescribed to relieve pain, as well as treatment of complications.
If there are stones in the gland ducts, then it is rational to perform lithotripsy and endoscopic therapy.
Surgical treatment is performed when drug therapy is impossible or the body is tolerant to their action.
The duration of treatment depends on the form and complications of the disease, and on the body’s susceptibility to therapy.
Pain due to intercostal neuralgia
As neurological diseases develop, irritation or compression of the intercostal nerves may occur. When nerve cells are affected, in patients with intercostal neuralgia the pain sensations can have a very wide range: cramping, pulsating, piercing, sometimes sharp or aching, dull or burning pains develop. A person complains that there is pressure, tugging, numbness, aching, and burning in the lumbar region, under the ribs. Such sensations intensify when breathing - sighing, when inhaling, exhaling, as well as when coughing, pressing on certain points on the back, chest, spine, when tense, changing body position.
During attacks of neuralgia, there is tingling under the chest, periodic muscle twitching, pallor or redness of the skin, and severe sweating.
Patients with neuralgia often ask doctors what is on the left side of a person, since the pain often radiates under the shoulder blade, is felt under the heart, in the abdominal area from above, in the upper back under the shoulder blade, and also in other places when pressed. There is a feeling that it is cutting, “getting in the way” and twitching in different places.
Painful sensations occur at any time of the day, and numbness is noted in those places where the nerve pathways have been damaged.
Pathologies of the spleen
Another organ located on the left is the spleen. It is closest to the surface of the body, so any abnormal processes occurring in it immediately make themselves felt. Problems with the spleen often occur after or during infectious diseases, since this organ is responsible for filtering blood from dead red blood cells. It greatly increases in size, fighting the virus, which explains the discomfort.
Sometimes the spleen is damaged by the ribs as a result of injury. It breaks. In such cases, pain appears not only when sighing or moving, but also on its own. It can be very strong, difficult to bear, and it radiates to the back.
Pathologies of the spleen are often accompanied by increased body temperature, inflammation of regional lymph nodes, headaches, and enlarged liver. When an organ ruptures, the skin in the navel area turns blue. If such symptoms are present, you should immediately seek medical help.
What diseases cause pain in the heart?
Acute pain syndrome can also appear with pulmonary diseases such as bronchial asthma and pneumothorax. Asthma attacks cause pain throughout the chest cavity. An equally severe form and painful condition is characterized by pneumothorax , in which air penetrates from the outside into the chest cavity and the lungs can collapse with the appearance of pain.
Among the main causes of painful attacks in the sternum area is also pathology of the peripulmonary vessels. They intensify when inhaling with the formation of a cough with pulmonary embolism , pulmonary hypertension with increased pressure in the vascular system supplying blood to the lungs.
Painful vascular diseases include dissecting aortic aneurysm with characteristic damage to large vessels. This emergency condition can be life-threatening. In this case, the pain is initially felt in the heart area and gradually moves down the abdomen. The patient's blood pressure drops sharply, tachycardia occurs and he loses consciousness.
A classic example of the appearance of pain in the chest area is osteochondrosis , which occurs in the thoracic and cervical spine. The pain is reminiscent of angina attacks with radiation to the left shoulder blade and arm. The difference lies in the intensification when moving, raising arms, turning the head, bending the body.
Sharp stabbing pain is characteristic of intercostal neuralgia, Tietze syndrome . It occurs at the joints and spaces between the ribs and becomes more intense when inhaling. The patient cannot take a deep breath, shallow breathing is observed. In case of pathology, strong anti-inflammatory and painkillers are prescribed.
An extremely painful condition in the heart area is characterized by inflammation of the muscle fibers of the chest and back . It resembles similar acute pain in intercostal neuralgia and osteochondrosis.
Shingles , which occurs as a result of infection of the body with the herpes virus, is no less painful In this case, the nerve endings are affected, characteristic rashes appear on the skin, which becomes sensitive, and this whole clinical picture is accompanied by acute pain in the chest.
Painful attacks can occur during panic attacks, nervous disorders of various etiologies. This category of patients is often young, with an unstable nervous system, and in a depressed state after stress. In this case, pain can appear spontaneously or be systematic.
How to understand that your heart hurts?
Pressing sharp pain in the heart occurs with angina pectoris or “angina pectoris,” which is the main precursor to the development of coronary heart disease (CHD). It radiates to the shoulder, left hand and little finger, and can radiate to the jaw. The intensity increases with nervous tension and physical activity. It occurs as a result of coronary vascular spasm and insufficient oxygen supply to the heart muscle due to atherosclerosis. The pain may go away on its own with rest and rest.
Among the most dangerous heart diseases associated with the cardiovascular system of the body is myocardial infarction . It occurs as a result of blockage (thrombosis) of a coronary artery by an atherosclerotic plaque and cessation of blood supply to an area of the heart muscle. In this case, necrosis occurs and part of the muscle dies.
Pain during myocardial infarction causes severe weakness, lack of air, radiates to the left arm, encircles the shoulder and spreads under the left shoulder blade, sometimes to the neck, jaw, and can form far from the heart area. Sometimes the temperature rises. The person breaks into a cold sweat, shortness of breath, and in some cases nausea.
Chest pain occurs in the case of cardiac pathologies of inflammatory etiology, these include endocarditis , myocarditis , pericarditis. They appear after illnesses caused by viral and bacterial infections.
Which doctor should I consult for pain on the left under the scapula?
At the first painful sensation in the area of the shoulder blade, you should consult a specialist and undergo diagnostics. Since the nature of back pain is often neurological, you should make an appointment with a neurologist.
The doctor will conduct a visual examination, study the patient’s complaints, draw up a clinical picture: the nature and conditions of the pain syndrome (in a lying position, during movement), its intensity, accompanying symptoms.
With glenohumeral arthritis, pain worsens at night, when lying down
To understand exactly why your back hurts, your doctor will prescribe an additional examination:
- laboratory - clinical analysis of blood and urine, which will show the inflammatory process;
- instrumental, necessarily including MRI, since this diagnostic method provides the most accurate information about the condition of the spine, muscle tissue, nerve endings and blood vessels.
You can undergo magnetic resonance imaging using the new 2021 Siemens Symphony 1.5 Tesla device at the SmartMed clinic. Immediately after the examination, the doctor will interpret the results obtained, make a final diagnosis and prescribe effective treatment.
If instrumental diagnostics reveals a pathology that is not within the competence of a neurologist, the doctor will refer the patient to a therapist, pulmonologist, cardiologist, gastroenterologist, traumatologist or other specialists.
Osteochondrosis of the thoracic spine
This disease is very common today.
People who have sedentary jobs are especially susceptible to it. With this pathology, the nerve endings extending from the spine are compressed, which causes pain under the left rib. It often radiates to the back, buttock, and even thigh; it can be encircling in nature, accompanied by numbness and tingling. The fact that the cause of pain is osteochondrosis may also be indicated by a decrease in the mobility of the thoracic region. “Shots” occur not only when inhaling, but also during movements and sudden turns of the body. In most cases, they overtake a person after being in an uncomfortable position for a long time. They often happen during sleep.
Acute abdominal pain
Acute unbearable abdominal pain can be a sign of very serious diseases that require surgery: appendicitis, ectopic pregnancy, perforation of a stomach ulcer, thrombosis of blood vessels in the abdominal cavity and others.
Therefore, in some cases it is necessary to call an ambulance as quickly as possible. This must be done if you can answer affirmatively to any of the two questions listed:
- Is the pain severe and unbearable?
- Did the pain occur for the first time and is gradually increasing?
In such a situation, you cannot hesitate. In this case, it is forbidden to place a warm heating pad on your stomach and take painkillers before being examined by a doctor. You should also not take laxatives or give enemas. If you have severe abdominal pain, you should refrain from eating and drinking.
Keep in mind that in addition to the reasons listed, abdominal pain can be caused by kidney disease, cystitis, angina pectoris and a number of rarer diseases. Therefore, in case of unclear pain, it is best to immediately see a gastroenterologist to clarify the diagnosis.
How is differential diagnosis carried out?
If chest pain occurs, you should immediately call an emergency doctor. Before the specialist arrives, if possible, relieve emotional and physical stress, calm down, lie down and understand the nature of the pain in order to properly notify the doctors.
The doctor's examination includes consultations with specialized specialists, instrumental studies, and an electrocardiogram. It shows how the heart works, detecting signs of a heart attack depending on the stage and location.
Medical care and consultations can be prescribed by various specialists, a neurologist, cardiac surgeon, infectious disease specialist, pulmonologist, surgeon, gastroenterologist, psychiatrist. In case of nervous experiences, you may need the help of a psychologist.
How to relieve pain under the left shoulder blade
Pain sensations below the shoulder blade on the left, especially if they are quite intense, interfere with movement and breathing freely, require qualified help, since they pose a threat to human health and life. You cannot ignore them and self-medicate. Taking analgesics, antispasmodics and other painkillers can relieve pain, but will not eliminate the cause, which must be discovered by a doctor.
Important! Emergency care will be required in case of severe pain with increasing intensity and rapid deterioration in well-being.
