Liver Pain: Causes, Symptoms, Diagnosis &Treatment

Do you know where is the liver located? Do you know how the liver functions? Have you ever suffered from liver pain? Do you know what causes liver pain, how to diagnose liver pain and how to treat it? Well, you will get answers to all these questions in this article.

The Liver is amongst the important organs of the body. We all know that the heart, brain, and kidneys are vital organs of the body, and we cannot survive if any one of these organs fails or doesn’t function at all. But, many people are not aware that liver is as important as these organs like heart and brain and kidney. The liver has many important functions in the body ranging from taking part in digestive processes to the detoxification process. We cannot survive without the proper functioning of the liver.

Liver location:

Where is the liver located?

Do you know what a gland is? A gland is an organ which secretes any type of chemical substance like hormone or enzyme. The liver also secretes bile juice, which is absolutely essential for digestion of fats in the food that we take. So, we can consider liver also to be a gland. The liver is the largest gland or glandular structure or organ in our body.

Our trunk is divided into the chest and the abdomen. Our chest has organs like heart and lungs. Our abdomen has the majority of the parts of the gastrointestinal tract like the intestines, stomach, liver, pancreas, etc. Our liver is the upper right part of our abdomen.

Our abdomen can be divided into 4 quadrants by the 4 quadrant system and into 9 quadrants by the 9 quadrants system.

Liver location according to 4 quadrant system:

In the 4 quadrant system, our abdomen is divided into upper right quadrant (RUQ), upper left quadrant (LUQ), lower right quadrant (RLQ) and the lower left quadrant (LLQ). According to the 4 quadrant system, our liver is located in the upper right quadrant. See the picture below to get a clear idea about where is liver located in 4 quadrant system of abdominal division.

liver location in 4 quadrants

Liver location according to 9 quadrant system:

According to the 9 quadrant system, our abdomen is divided into 9 quadrants, which comprises of 3 upper quadrants, 3 middle quadrants, and 3 lower quadrants. The upper 3 quadrants are the right hypochondriac, epigastric and the left hypochondriac regions.

The middle 3 quadrants are the right lateral or right lumbar, umbilical and left lateral or left lumbar regions. The lower 3 quadrants are the right iliac or right inguinal, suprapubic or hypogastric, left iliac or left inguinal regions. As per the 9 quadrant system, our liver is mainly located in the right hypochondriac and epigastric regions.

The liver also extends a little into the left hypochondriac region. Our intestines are very long and they occupy many quadrants in the abdomen. In addition t the intestines, our liver is one of the important organ which occupies multiple quadrants of the abdomen. See the picture below to get a clear idea about where is liver located in 9 quadrant system of abdominal division.

liver location in 9 quadrants

Liver location in relation to Stomach:

The liver is located on the medial side of the abdominal cavity in the uppermost right corner, while the stomach is located on the left side of the abdominal cavity in the uppermost left corner. Both liver and stomach are located just below the diaphragm. Our liver is placed just above the stomach in the medial side of the stomach. See picture below to get a clear idea about the liver location in relation to the stomach.

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liver location in relation to stomach

Liver location in relation to lungs:

Our lungs are located in the chest (Upper part of the thorax). The liver is located in the abdominal cavity. Chest and abdominal cavity are separated by a muscular structure called diaphragm. The liver is located on the right side of the abdomen below the diaphragm. It means the location of the liver is just below the right lung. But it extends towards the left side of abdomen too.

Liver functions:

We have learned about the location of the liver. Let us see the important functions by the liver in our body.

Production of bile juice:

The liver plays a vital role in the secretion of bile juice. This is absolutely essential for the digestion of food in the body, mainly fatty foods.

Detoxification:

We need to get rid of harmful and toxic substances from our body every day. Otherwise, they will damage our internal organs. The liver performs the function of detoxifying the body and getting rid of all the harmful chemicals, drugs, metals, etc from the body.

Storage of nutrients:

We need vitamins and minerals to take part in various metabolic processes of the body. The liver plays an important role in storing certain vitamins and minerals. It also serves as a storage of iron, which is essential for the formation of heme part of hemoglobin.

Storage of Glycogen:

Whenever we take an excess of glucose in the food, the liver converts it into a polysaccharide molecule called Glycogen and stores it in the liver cells. Whenever we have the deficit of energy and need energy urgently, the liver converts the Glycogen back to Glucose and releases it into the blood.

Destruction of Aged RBC’s:

Our Red blood cells play a vital role in carrying oxygen to all the cells of the body. This function is carried out by the hemoglobin which is present in the RBC’s. The life span of RBC’s is 120 days or 4 months. After 120 days, the old RBC’s are destroyed and are replaced by new RBC’s. This way our RBC’s function well to maintain tissue oxygenation. Liver and spleen are the 2 important organs of our body, which play a vital role in destroying old RBC’s.

Liver Pain:liver pain

We have discussed where is liver located and about the functions of the liver. Now, let us talk in detail about the liver pain, its causes, symptoms, diagnosis, and treatment. As we have already discussed, our liver is located just below the rib cage or diaphragm in the uppermost right corner of the abdomen.

So, when you get liver pain, we get pain in the uppermost right corner of the abdomen, just below the rib cage. You can also say that we get liver pain in the right upper quadrant (As per the 4 quadrant system) or in the right hypochondriac and epigastric regions (As per the 9 quadrants system).

Liver pain is mainly produced due to the involvement of the liver capsule, which surrounds the liver. It is supplied with many nerve endings which make us sense the liver pain when the liver is involved due to any disease, inflammation, etc. Sometimes pain in the liver can also radiate to the back or rarely to the flank region also.

Liver Pain Causes:

There are innumerable causes of liver pain. They might range from mild infections or drug side effects to serious disorders which need urgent medical evaluation. So, we need to be aware of all the disorders that cause liver pain.

Hepatitis:

Hepatitis is the inflammation of the liver which is caused by Hepatitis Viruses. Hepatitis causes liver pain in addition to other symptoms like:

  • Jaundice (yellowishness of the skin and sclera or the white part of the eyes due to increased bilirubin in the blood)
  • Anorexia (Lack of appetite)
  • Tiredness or Fatigue
  • Dark yellow colored urine
  • Pale or clay colored stool
  • Liver pain or abdominal pain in RUQ (Right upper quadrant)
  • Sudden loss of weight
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There are 5 main types of Hepatitis. They are Hepatitis A, Hepatitis B, Hepatitis C, Hepatitis D and Hepatitis E. All 5 of them can cause liver pain. So, let’s learn about them:

Hepatitis A:

Hepatitis A is caused by Hepatitis A Virus or HAV. It is spread by feco-oral route. It means you can get Hepatitis A if you eat contaminated food. Eg: From roadside vendors or even in good food stalls if the food handler is suffering from Hepatitis A. You can get Hepatitis A by drinking contaminated water. You can also get it by eating fruits and vegetables which were contaminated by food handlers having Hepatitis A.

You can recover from Hepatitis A in a span of 1 or 2 months. There is no chronicity for this type of Hepatitis. So, you will not suffer from any long term complications once you are cured of Hepatitis A.

Hepatitis B:

It is spread by having Sexual relations with people suffering from Hepatitis B. It can also be spread by getting a blood transfusion from infected persons. It can also spread by getting a needle stick injury. This kind of transmission is mostly seen in medical personnel who handle the blood and injections of the infected people. It can also be spread from mother to baby during birth. Hepatitis B can persist in your body as it has chronicity. It can lead to damage of the liver when persisting for long periods of time.

Hepatitis C:

It is also spread in ways similar to Hepatitis B. It is more dangerous than Hepatitis B, as it is more chronic. When Hepatitis C virus persists for a long time in the body, it can lead to Cirrhosis or fibrosis of the liver. It can also lead to cancer of the liver.

Hepatitis D:

It infects the body only when you are infected with Hepatitis B. It is dependent of Hepatitis B to survive in your body. It doesn’t infect you independently if you don’t have Hepatitis B.

Hepatitis E:

It is also spread feco-orally, similar to Hepatitis A. It is also benign and you can cure yourself of Hepatitis E in 1 or 2 months. It also doesn’t have chronicity like Hepatitis B and Hepatitis C.

Infectious Mononucleosis:

This condition is caused by a virus called Epstein Barr virus or EBV. In infectious mononucleosis, you will suffer from symptoms similar to flu like arthralgia or joint pains, myalgia or muscle aches, fever, sore throat, etc. In this condition, there is inflammation or swelling of the liver also, called hepatitis. So, you will experience liver pain if you are suffering from infectious mononucleosis.

Cirrhosis:

Cirrhosis is the fibrosis of the liver. In this condition, the healthy liver tissue is replaced by scar tissue. Cirrhosis can be caused by many different causes like Alcohol abuse over prolonged periods of time, ingestion of toxic substances, Hepatitis infections like Hepatitis B and Hepatitis C, etc. Even certain genetic disorders can also lead to cirrhosis.

In cirrhosis, our liver is damaged. So, you will surely suffer from liver pain. But, there are many other symptoms of liver failure. Initially, in the early stages of cirrhosis, there are only mild symptoms. But, as cirrhosis progresses, you will develop ascites or swell up of your abdomen, hematemesis or blood vomiting, nose bleeding, swelling of hands, legs, feet, etc.

Drugs:

The liver plays a vital role in the metabolism of drugs. We need to take the drugs only in limited doses as per your physician’s prescription. If you exceed the dosage of drugs, it can have detrimental effects on your liver.

Some examples of drugs which can damage the liver when taken in excess doses are paracetamol or acetaminophen, antiepileptic drugs (Drugs used to treat seizures) like Phenytoin, Sodium Valproate, and Drugs used to lower cholesterol like Atorvastatin, Rosuvastatin, etc.

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Other causes of liver pain:

We have discussed some of the most common causes of liver pain that a physician encounters. Let us talk about some of the other conditions which can also cause liver pain.

Liver cancer:

It is also called Hepatocellular carcinoma. It occurs secondary to cirrhosis or after the development of cirrhosis.

Hemochromatosis:

It is the deposition of excessive amounts of iron in the liver and other organs of the body like joints, eyes, etc. It leads to liver pain due to the iron deposits in the liver.

CMV infection:

It also leads to flu symptoms similar to the Infectious mononucleosis caused by the EBV virus. It also leads to hepatitis and causes liver pain.

Primary sclerosing cholangitis:

It is the inflammation or swelling of the bile ducts in the liver.

Primary biliary cirrhosis:

It is also a type of cirrhosis which affects the bile ducts in the liver. In this condition, the bile ducts are damaged due to permanent cirrhosis. It persists throughout the life of the person.

Injury to the abdomen:

You can get injured in any motor vehicle accident or fall from height or tree, etc. In such cases, if your liver is injured, you can develop liver pain.

Hydatid cyst:

In this condition, there is formation of cysts in the liver by Echinococcus granulosus (Dog Tapeworm). It produces pain in the liver area.

Cholelithiasis:

Cholelithiasis is the other name of gallstones. If you are suffering from gallstones, you can get pain in the RUQ area or liver pain. This pain is more prominent after eating fatty meals.

Liver pain Symptoms (Symptoms of liver disorders):

  • Pain which can range from dull ache to sharp stabbing pain
  • Extreme fatigue or tiredness
  • Malaise or uneasiness
  • Pruritus or itching
  • Nausea and vomiting
  • Yellowishness of skin (due to jaundice)
  • Yellowishness of the sclera or white part of eyes (due to jaundice)
  • Sudden Weight loss or loss of weight
  • Dark yellow urine
  • Pale or clay colored stools
  • Low levels of hemoglobin

Liver pain Diagnosis:

Do you know how your physician diagnoses the cause of your liver pain? They will take a detailed History of your pain, its onset, duration, location, frequency, severity, radiation, etc. Your physician will also ask about all the other associated symptoms you have apart from liver pain.

You will also be asked about any thing that aggravates the pain and anything that relieves the pain. They will also take a note of your family history, social habits like drinking, smoking, etc. Then your physician will order certain investigations to come to a conclusion. The investigations that your physician orders depend on your symptoms  and they may include:

  • Liver functions tests:

They include measurement of bilirubin (Direct bilirubin and indirect bilirubin), ALT (Alanine transaminase), AST (Aspartate transaminase), ALP (Alkaline phosphatase), etc. These tests help to know if you have jaundice and about the functioning of your liver.

  • Hepatitis A tests
  • Hepatitis B tests
  • Hepatitis C tests
  • Coagulation tests like PT (prothrombin time) and ApTT (Activated partial thromboplastin time)
  • USG abdomen or Ultrasound abdomen
  • CT scan (Computerized tomography of abdomen)

Liver pain Treatment:

The treatment of liver pain is mainly aimed at curing the underlying disorder causing liver pain. If you are suffering from Hepatitis, you will be given antiviral medicines. If you are suffering from Hepatitis A, you can also take Ayurvedic medicines by consulting an Ayurvedic physician, as they are very effective in treating Hepatitis A.

If you are suffering from Ascites, you might need a procedure called paracentesis in which fluid is drained out from the abdomen. If you are suffering from any condition which damaged the liver to a major extent, you might even need a liver transplant.

References:
  1. http://www.nhs.uk
  2. http://www.webmd.com/
  3. http://www.mayoclinic.org/

 

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