Back pain under the ribs - causes, types of pain, treatment

Pain and burning under the ribs on both sides are common symptoms that indicate diseases of the liver, pancreas, gallbladder and biliary tract.

Often these signs are the main ones, since they prevail in severity. There are additional symptoms in the form of bloating, nausea, vomiting, bitterness in the mouth, loss of appetite, weakness, depression and emotional instability.

If the right and left sides hurt at the same time, a comprehensive diagnosis is required, since many diseases of the hepatobiliary system manifest themselves in this way. Only an accurate diagnosis allows you to create an effective therapeutic strategy to help the patient.

Why it hurts under the ribs on both sides in the front - the main etiology of its occurrence, what liver pathologies are manifested by these signs - in detail in the article.

Main causes of lower back pain

Unfortunately, many people try to get rid of back pain on their own without knowing exactly its source. Erroneously assuming that the paravertebral muscles are overloaded, patients take a steam bath and rub in warming ointments. Such self-medication can be dangerous to health. Lumbar pain often indicates inflammation and tumors of the digestive, urinary, and reproductive systems. From the back, pain in the ribs can occur due to neurological disorders, spinal deformities, and heart failure. Visceral pain is carried out by sympathetic fibers that innervate the internal organs. The signal arrives along the spinal projection tracts - from the spinal cord to the central nervous system. The main triggers for the occurrence and transmission of a pain impulse are a sudden increase in pressure in hollow organs or stretching of their walls (fibrous capsules).

Shpidonov Gennady Stanislavovich

Neurologist

Rostov State Medical University (neurology)

10 years of experience

Gastrointestinal tract

Relapse of chronic diseases leads to irritation of the nerves innervating the gastrointestinal tract. Pain in the ribs appears during exacerbation of:

• Stomach ulcers. The disease develops due to damage to the mucous membrane by Helicobacter pylori bacteria, as well as against the background of alcohol abuse, stress, unhealthy diet, and advanced hyperacid gastritis. Particularly intense pain is caused by a penetrating (complicated) ulcer involving adjacent tissues.
• Pancreatitis is inflammation of the pancreas (PG). The pain covers the epigastrium, left hypochondrium, extends under the scapula, into the left arm, intensifies after eating, in a lying position, often accompanied by febrile temperature (38-39℃), stool upset, increased gas formation, nausea with the release of vomit containing bile.

Triggers for the development of inflammation can be gallstones, advanced duodenal ulcers, and alcoholism. You can get sick due to incorrect intake of steroid hormones, addiction to foods rich in animal fats.

Oncological tumor of the pancreas

Cancer of the head of the pancreas is painful. The neoplasm is localized primarily in the ducts, and as it grows, it compresses the nerves, causing intense pain in the upper half of the abdomen, radiating to the lower back.

Intestines

Sacrodynia - aching, referred pain at the lumbosacral level is initiated by colitis or enterocolitis. Both diseases are associated with inflammatory processes occurring in the intestines. Severe pain is observed during an attack of appendicitis. Especially if the inflamed appendix of the cecum (appendix) has a low or retrocecal, that is, posterior anatomical location. In addition, sacrodynia is a concern in cases of cancer and mucocele of the appendix - an abnormal expansion of the lumen of the appendix with excessive accumulation of mucus.

Intercostal neuralgia

Spinal pain (dorsalgia) begins suddenly, like a “lumbago”, spreading along the thoracic spinal nerves, encircling the body. The intensity of sensations increases sharply with any twisting of the torso, coughing, or taking a deep breath. Strong pain in the pit of the stomach, under the shoulder blades, in the lower back. The cause of back pain under the ribs is:

• neuromuscular inflammation, against the background of reactivation of the herpes virus, “dormant” in the body. Exacerbation is facilitated by decreased immunity, hypothermia, prolonged stress, and infection with ARVI.
• compression of nerve fibers. Infringement of the spinal roots occurs due to involuntary contraction of the vertebral muscles during osteochondrosis and its complications.

Shpidonov Gennady Stanislavovich

Neurologist

Rostov State Medical University (neurology)

10 years of experience

Osteochondrosis and intervertebral hernia

Osteochondrosis is degenerative-dystrophic changes in articular fibrocartilaginous discs and bones. The interval between adjacent vertebrae gradually decreases. They shift from their anatomical positions, pinching blood vessels, as well as nerve endings at the site of their exit from the spinal canal. Transformation occurs when the trophism of the vertebral structures is disrupted due to incorrect posture and irrational physical activity. Vertebrogenic pain syndrome is caused by compression of the spinal nerve roots. Intervertebral hernia is a complication of osteochondrosis, characterized by separation and bulging of the disc between the vertebrae, and even more severe compression of the spinal roots.

Cardiac dysfunction

Burning and pain in the chest (thoracalgia), with reflection in the solar plexus, left arm and neck - a sign of an attack of angina or myocardial infarction. The condition aggravates the patient's physical and emotional stress. At the same time, the following appear:

• dyspnea;
• cold sweat;
• nausea;
• tachycardia;
• weakness;
• dizziness;
• high anxiety, fear of death.

The vast majority of such cases are provoked by coronary atherosclerosis. Due to blockage of the coronary arteries by cholesterol plaques, the heart muscle does not receive nutrients and oxygen. Circulatory failure leads to organic and functional inferiority of the myocardium, replacement of functional tissue with connective fibers. With occlusion (absolute obstruction of the vessel), cardiac activity stops. Lack of emergency resuscitation leads to the death of the patient.

Hepatobiliary system

Visceral girdling pain in the back and in the rib area is characteristic of cholelithiasis and inflammation of the gallbladder (cholecystitis). Acute pain in the right hypochondrium with irradiation under the scapula and into the epigastrium is called hepatic colic. It occurs when the flow of bile stops and intravesical pressure increases. The cause is the movement of stones that clog the bile ducts. In cholecystitis without stone formation, pain is initiated by infection with pathogenic bacteria.

Liver pathologies are painless for a long time, since there are no nerve endings in its parenchyma. With progressive cirrhosis and hepatosis, pain appears at the stage of liver enlargement. This leads to stretching of the fibrous membrane innervated by the intercostal nerves. Before discomfort appears in the right side, you need to pay attention to symptoms such as:

• constant bitterness in the mouth;
• sudden hematomas on the body without traumatic injuries (bruise, blow);
• yellowing of the eyeballs, mucous membranes, and skin.

Hepatobiliary disorders have a multifactorial etiology - from genetic abnormalities to errors in diet.

Gynecology

In women, lower back pain is accompanied by pronounced hormonal fluctuations, especially during the premenopausal and premenstrual periods. During pregnancy, the lower back is pulled due to an increase in body weight, as well as due to compression of the abdominal organs by the uterus, which is growing in volume. Lumbodynia - aching subacute or chronic lumbar pain, is well known to women with salpingitis, salpingo-oophoritis, prolapse and uterine tumors (myoma, fibroma). Progressive pain in the projection of the fallopian tubes during an ectopic pregnancy radiates to the sacral region.

Urology

With urological problems, severe lumbodynia accompanies:

• dysfunctional disorders of urine storage, filtration and excretion;
• infectious and inflammatory lesions of the urinary tract and kidneys (pyelonephritis, glomerulonephritis, cystitis).

Unbearable pain - renal colic - appears when stones move through the ureter. As a result, the stone clogs the urinary tract, stopping the flow of urine. In this case, the intrapelvic pressure sharply increases, a spastic contraction of the ureteral muscles occurs, swelling of the parenchyma and stretching of the fibrous capsule, where the sensory receptors are concentrated.

Shpidonov Gennady Stanislavovich

Neurologist

Rostov State Medical University (neurology)

10 years of experience

Most urological pathologies develop as a result of bacterial infections, metabolic failure, and intoxication.

Lungs

Pain in the back of the ribs is one of the symptoms of pleurisy. The patient feels sharp painful injections in the back, which intensify when trying to take a full breath, and decrease when lying on the side where the damaged lung is located. Thoracalgia and nagging pain in the shoulder blade area accompany pneumonia, when severe coughing causes damage to the pulmonary vessels and muscle strain. The most common etiology of pneumonia and pleurisy is the penetration of pathogenic bacteria and viruses into the lung tissue.

Spleen

Visceral back pain is accompanied by:

• formation of an abscess, areas of necrosis;
• mechanical damage due to blunt trauma to the abdominal cavity;
• tissue rupture with profuse internal bleeding;
• splenomegaly - proliferation of parenchyma due to liver problems, infectious mononucleosis;
• thrombosis of the splenic vein.

Patients with congenital anomalies of the spleen experience constant discomfort.

Chronic liver diseases in humans

Chronic liver pathologies under the influence of factors - poor nutrition, violation of doctor's recommendations, pregnancy, etc. tend to worsen, which leads to the appearance of a characteristic clinic.

Chronic hepatitis

This is inflammation in the liver, which leads to fibrotic transformations and necrotic changes in cells and tissues, while there is no disruption of the structure of the lobules. Signs of the disease are determined by the degree of damage to the gland and the type of hepatitis.

As the disease progresses, symptoms appear:

1. Increased gas formation.
2. Decreased appetite.
3. Sleep disturbance.
4. Headache.
5. Loss of body weight.
6. Jaundice.
7. Periodic pain in the right side.
8. Pain on the left side due to the enlargement of the spleen.
9. Skin itching.

Based on palpation, the doctor diagnoses diffuse hepatomegaly or an increase in only one lobe, increased liver density.

Fatty degeneration

Fatty liver is an independent syndrome or a secondary one, as a result of which lipid compounds accumulate in the liver tissues.

According to statistics, the disease is most often diagnosed in obese women. In 60-70% of pictures there are no symptoms.

Obvious symptoms of disease progression:

• Abdominal discomfort.
• Aching pain in the right side (mild).
• Hepatomegaly, when touching the right side it hurts.

In some cases, fatty liver is accompanied by dyspeptic disorders and jaundice.

Cirrhotic lesion

Cirrhosis is a disease in which full-fledged liver tissue degenerates into fibrous connective structures. The severity of the clinic is based on the degree of damage to the gland and the activity of cirrhotic processes. At the initial stage, manifestations are minimal, there is no pain.

Over time, discomfort appears under the ribs, digestion is disrupted, and the temperature increases to the level of low-grade fever. As the pain progresses, it intensifies and radiates to different parts of the abdomen and back; jaundice is observed, characteristic signs are redness of the palms, transformation of the nail plates, spider veins on the body.

Tumor neoplasms

Neoplasms of benign (cysts, hemangiomas) and malignant nature (primary, secondary cancer) in the liver do not show symptoms in the initial stages. As the tumor grows, the capsule stretches, which leads to pain.

It can be different - the pain is dull, aching, bursting, sharp. Localization is the right side, irradiation is to the stomach, to the right side under the ribs, to the back, shoulder blade and shoulder. Painful sensations initially appear periodically, but over time they become constant.

Localization of pain under the ribs

Precise determination of the area where painful sensations are concentrated allows one to assume a particular diagnosis.

Classification of pain, pain of different localizations

The most common are acute pains radiating to the back and ribs.
They are temporary. Only in 10-20% do they develop into a chronic form. Based on localization, pain is divided into: in the lumbar region. Typical for older people. They appear after long walks or excessive stress;

radiating to the back and ribs on the right. It primarily indicates the presence of an inflammatory process;

radiating to the back and ribs on the left. Appears both under load and when stationary. Especially often after a hard day at work or a long trip.

Regardless of where the pain appears, maximum attention should be given to this problem. It is recommended to listen to your own body in order to get rid of unpleasant sensations by eliminating the true cause of the pain. And there are many of them: from banal overwork to disruption of the functioning of internal organs.

Types of back pain

The nature of referred back pain depends on the etiology. The most severe pain is caused by renal and hepatic colic. Unbearable cramping pain in the back radiates to the ribs, spreads to the mesogastric, ileal zone, as well as to the thigh and rectum.

Intense vertebrogenic pain is characteristic of intercostal neuralgia and intervertebral hernia. The patient has difficulty walking, breathing deeply, coughing, sneezing, and any change in body position causes unbearable pain.

Lumbodynia and sacrodynia in gynecological diseases, before critical days, are of a pulling nature.

When the heart malfunctions, thoracalgia is associated with a feeling of burning and constriction in the chest.

If the main pathological focus is located in the gastrointestinal tract, the pain is characterized as moderate but constant. The exception is acute conditions - appendicitis and relapse of chronic pancreatitis.

Treatment

For treatment, in addition to analgesics, antiviral agents are used to eliminate the cause of the disease.

As already mentioned, pain in the left hypochondrium is just a symptom and not an independent disease. When it first appears, a mandatory comprehensive examination is necessary to help identify the cause of the painful condition and prevent its occurrence in the future. Otherwise, the process may become chronic, threatening constant pain, which leads to apathy, depression and other psychological disorders.

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Establishing diagnosis

First of all, you need to establish the main cause of pain. The diagnostic complex may include:

• Physical examination of the patient - palpation (palpation of soft tissues), percussion (tapping), auscultation (listening).

• Laboratory blood tests. Biochemistry will detect disturbances in the functioning of the liver, gall bladder and pancreas. Microscopy will indicate the presence of inflammatory processes.
• Three types of urine tests - clinical (general), according to Zimnitsky (portioned collection of urine every three hours), daily diuresis. The tests are designed to look for problems with the kidneys, bladder and bladder ducts.
• FGDS (fibrogastroduodenoscopy) and colonoscopy. Instrumental methods help assess the condition of the gastrointestinal mucosa.
• ECG and EchoCG. Prescribed to assess heart function.
• Chest X-ray. The images reflect pathological changes in the lung tissue and elements of the spine. A more informative modern method of radiation diagnostics is CT (computed tomography).
• Ultrasound of the abdominal cavity. Detects structural deformations of the abdominal organs. Detects formed stones.
• Transvaginal ultrasound. Determines the structure, size, density, shape of the ovaries, uterus, endometrium, as well as the presence of a cyst or tumor.
• Electroneuromyography (ENMG). Performed to make neurological diagnoses.

Shpidonov Gennady Stanislavovich

Neurologist

Rostov State Medical University (neurology)

10 years of experience

Magnetic resonance imaging is considered a universal method. In combination with laboratory tests, MRI gives the most informative results.

MRI at SmartMed MC

Diagnostics

During a physical examination, the doctor determines areas of hyperesthesia and performs superficial and deep palpation of the epigastric zone. The variety of causes of pain in the upper abdomen requires the gastroenterologist to use a whole range of laboratory and instrumental methods. The most informative tests for diagnosis are:

• Ultrasound of the abdominal cavity.
  A simple and non-invasive method that detects signs of inflammatory processes, ulcerative defects and neoplasms in the epigastrium. Using ultrasound, the doctor evaluates the anatomical and functional features of the gastrointestinal tract, confirms or excludes typical diseases (calculous cholecystitis, pancreatitis, hernia).
• X-ray methods.
  A survey radiograph is not very informative, so radiography with oral contrast is used for examination. The study is necessary to detect ulcerative defects, pyloric stenosis, and diaphragmatic hernia. Using this method, the motor function of the gastrointestinal tract is assessed.
• EFGDS.
  The most informative method that allows you to visualize inflammatory and erosive changes in the walls of the esophagus, stomach and duodenum. EGD with biopsy is used for the differential diagnosis of ulcers, benign and malignant neoplasms of the gastric zone.
• Laboratory methods
  . The standard complex includes clinical blood and urine tests, coprogram, and glucose level measurement. To identify gastritis and peptic ulcers, a study of gastric juice and a rapid urease test for H. pylori are informative. To exclude chronic bleeding from the gastrointestinal tract, the Gregersen reaction is performed.
• Additional Research
  . To confirm the diagnosis of hyperacid gastritis, intragastric pH-metry is required. The functional abilities of the stomach are assessed using electrogastrography and radionuclide scintigraphy. A CT scan is performed for detailed visualization of the abdominal organs.

In case of sharp pain reminiscent of the symptoms of an “acute abdomen”, the patient must be examined by a surgeon. If extra-abdominal processes are suspected, consultations with specialized specialists are prescribed: cardiologist, pulmonologist, neurologist. Patients with suspected psychogenic causes of epigastric pain should be examined by a psychiatrist.

Gastroscopy

How to treat referred back pain, which doctor to consult

Therapy is prescribed by a specialized specialist. To start, you can see a therapist. Treatment tactics are selected based on the underlying disease that was the source of visceral pain in the ribs. The gastrointestinal tract is examined and treated by a gastroenterologist. A hepatologist specializes in hepatobiliary pathologies. Vertebrogenic pain due to neuralgia and spinal destruction is relieved by a neurologist or vertebrologist. A urologist deals with dysfunctions of the urinary system. A gynecologist helps solve “women’s problems”.