Liver pain: possible causes and treatments

Liver pain is a very nonspecific manifestation of different conditions that require medical evaluation. The use of over-the-counter pain relievers is not recommended.

Last update: 03 February, 2022

The call liver pain manifests in the upper right part of the abdomen as a sore, throbbing or palpitation. The liver has multiple functions, among which are the metabolism of food and the detoxification of the body, in addition to the synthesis of proteins, bile and coagulation factors.

Sometimes liver pain is associated with swelling and may radiate to the back or right shoulder blade. There may also be other associated symptoms, such as yellowing of the skin and mucous membranes, fatigue, dark brown urine, and loss of appetite.

Here are some possible causes of liver pain.

1. Viral hepatitis

Viral hepatitis is a infectious disease causing liver pain. There are 5 different types of hepatitis viruses: HAV, HBV, HCV, HDV, and HEV.

They all differ in the way they are transmitted and in their clinic. Although either can cause acute hepatitis, only those of hepatitis B, D and C can lead to the chronic form.

Clinical manifestations include the following:

  • Fever.
  • Yellowish coloration of skin and mucous membranes.
  • pale stools
  • Orange urine.

Sometimes it can be an asymptomatic disease. As well as could manifest with a fulminant hepatitis (liver failure).

2. Alcoholic hepatitis

Alcoholic hepatitis refers to Acute liver damage associated with chronic consumption of high amounts of alcohol. Its manifestation varies from asymptomatic to acute liver failure.

Initial symptoms may be throbbing or heavy liver pain, fatigue and weakness, loss of appetite and weight, nausea and vomiting. When there is acute liver failure, the signs are more severe.

If there is liver failure, we find changes in coagulation times, accumulation of fluid in the abdomen and extremities due to decreased protein, confusion and behavioral changes.

Excessive alcohol consumption is associated with liver damage that could be irreversible, such as cirrhosis.

3. Non-alcoholic fatty liver

NAFLD is linked to obesity, high cholesterol and triglyceride levels, and diabetes mellitis type 2. In fatty liver there is accumulation of fatty acids in the liver parenchyma, which produces a situation of oxidative stress, with the release of free radicals and the generation of an inflammatory cascade.

It is usually an asymptomatic picture. But it can cause liver pain, malaise, fatigue, and abnormal liver function tests.

4. Cirrhosis

Although liver cirrhosis does not manifest liver pain, chronic discomfort may be felt in the upper abdomen. This situation is the final moment of liver damage. The causes are diverse, but the most frequent are alcoholism, the hepatitis C virus and non-alcoholic fatty liver.

When it starts being asymptomatic it is called compensated liver cirrhosis. The final stage is liver failure with portal hypertension. (presence of esophageal and abdominal varices with propensity for gastrointestinal bleeding).

5. Liver cancer

Liver cancer, especially hepatocellular carcinoma, It is a relatively common neoplasm related to cases of cirrhosis. In its early stages, liver cancer has no symptoms. Then appears dull and constant pain, loss of weight and appetite, vomiting, yellowing of the skin and mucous membranes.

Is it always liver pain?

Sometimes liver pain can be confused with gallbladder, pancreas, or kidney problems. That is why, in the presence of discomfort, it is important to go to the doctor as soon as possible to determine the cause.

The diagnosis is based on clinical history, physical examination and complementary tests. During the questioning, emphasis will be placed on the nature of the pain, alcohol consumption, nutritional habits and family history.

In the exams, in addition to blood tests, an ultrasound of the upper abdomen and even an MRI or computed tomography are requested. In some cases, given the specific suspicion of certain causes of liver pain, a biopsy will be requested.

A simple ultrasound could distinguish a liver pain from one coming from the gallbladder.

How should liver pain be treated?

When it is caused by excessive alcohol consumption or by the consumption of certain foods, it is recommended only to stay hydrated in the face of liver pain. The consumption of ultra-processed foods, refined sugars and fats should be avoided.

Over-the-counter pain relievers are not recommended. because most of them are metabolized in the liver, so they can be counterproductive. Only a doctor should prescribe them.

When liver pain persists for hours, is of unknown origin or there are serious associated symptoms, you should go to the emergency service. The definitive treatment will depend on the cause and will always be associated with changes in nutritional habits and lifestyle.

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