Symptom >> Surgical >> Hepatobiliary Surgery

Right upper quadrant pain

Introduction
Cause
Examine
Diagnosis

Introduction

Introduction It refers to the lesions of the internal and external organs caused by various reasons, and it is manifested as pain in the abdomen. Abdominal pain can be divided into acute and chronic. The right upper quadrant is usually a disease of the liver, gallbladder, biliary tract, pancreas, duodenum, right kidney, and right colon. Right upper quadrant pain, it is probably due to liver problems, inflammation of the liver will cause upper right abdominal pain, it is best to check the two most half of the hepatitis B, whether it has hepatitis B, accompanied by diarrhea may be intestinal inflammation; constipation may be obstruction of feces; vomiting It is necessary to consider intestinal obstruction or inflammation; changes in bowel habits may be lesions in the large intestine; there are symptoms such as jaundice and fever, which may be bile duct or liver lesions; frequent urination, difficulty in urinating, nocturia, etc., should be considered bladder, urethra, etc. The problem, these accompanying different symptoms, helps to distinguish the real cause of abdominal pain.

Cause

Cause

1, liver enlargement: such as hepatitis, liver abscess, liver tumor, liver cyst and so on.

2, gallbladder enlargement: such as acute cholecystitis, gallbladder hydrocephalus, gallbladder hemorrhage, silicified cystic cyst, primary gallbladder cancer, gallbladder torsion and so on.

3, changes in the tension of the hollow organs: such as gastrointestinal spasm or gastrointestinal, biliary dyskinesia.

4, tumor compression: tumor compression and infiltration with malignant tumors, may be associated with tumor growth, compression and infiltration of sensory nerves.

Examine

an examination

Related inspection

Liver surface state and marginal abdominal percussion liver tenderness liver area and gallbladder fistula percutaneous transhepatic cholangiography

The right upper quadrant pain was paroxysmal cramps and radiated to the right shoulder, mostly cholecystitis and cholelithiasis.

1, routine examination of blood, urine, feces: the total number of white blood cells and neutrophil increased suggesting inflammatory lesions, almost every patient with abdominal pain need to be examined. A large number of red blood cells in the urine suggest urinary stones, tumors or trauma. Proteinuria and white blood cells suggest a urinary system infection. Pus and blood will prompt intestinal infection, bloody stools suggest strangulated intestinal obstruction, mesenteric thromboembolism, hemorrhagic enteritis and so on.

2, blood biochemical examination: serum amylase increased suggestive of pancreatitis, is the most commonly used blood biochemical examination in the differential diagnosis of abdominal pain. Determination of blood sugar and blood ketone can be used to line up abdominal pain caused by diabetic ketosis. Increased serum bilirubin suggests biliary fatigue. Examination of liver and kidney function and electrolytes is also helpful in judging the condition.

3. Routine and biochemical examination of abdominal puncture fluid: When the diagnosis of abdominal pain is unknown and abdominal fluid is found, abdominal puncture must be performed. The liquid obtained by puncture should be sent for routine and biochemical examination, and if necessary, bacterial culture is required. However, the visual observation of the puncture fluid has been helpful in the diagnosis of intra-abdominal hemorrhage and infection.

4, X-ray examination: abdominal X-ray film examination is the most widely used in the diagnosis of abdominal pain. The gastrointestinal perforation of free gas found in the armpit can be determined. Intestinal gas expansion, most fluid in the intestine can diagnose intestinal obstruction. Calcification of the sputum can prompt ureteral stones. Lumbar muscle shadows are blurred or disappeared, suggesting peritoneal inflammation or bleeding. X-ray barium meal imaging, or barium enema examination can find gastroduodenal ulcers, tumors and so on. Only in case of suspected intestinal obstruction, taboo meal should be contraindicated. Gallbladder, cholangiography, endoscopic retrograde cholangiopancreatography and percutaneous cholangiography are helpful for the differential diagnosis of biliary and pancreatic diseases.

5, real-time ultrasound and CT examination: the differential diagnosis of liver, gallbladder, pancreatic disease has an important role, if necessary, according to ultrasound examination and positioning for liver puncture and other liver abscess, liver cancer, etc. can be confirmed.

6, endoscopy: can be used for the differential diagnosis of gastrointestinal diseases, often in patients with chronic abdominal pain.

7, B-ultrasound: mainly used to check biliary and urinary calculi, bile duct dilatation, pancreas and hepatosplenomegaly. It also has a good diagnostic value for a small amount of effusion, intra-abdominal cysts and inflammatory masses in the abdominal cavity.

8, ECG examination: for older people, should be an electrocardiogram to understand myocardial blood supply, to exclude myocardial infarction and angina.

Diagnosis

Differential diagnosis

Differential diagnosis:

The liver itself is not sensitive to pain. The main cause of pain in the liver area is the pain caused by stimulation of the intrahepatic bile duct and the pain caused by the pulling of the liver cell membrane. Pain in the liver area refers to a painful feeling in the area under the right rib or under the xiphoid process. The pain is intermittent or persistent. Dull pain or tingling, the patient may feel discomfort in the right upper quadrant for a period of time before the pain. Pain can be relieved when it is light or heavy.

Right lower abdominal pain is a disease of the cecum, appendix, right ovary and fallopian tube, right ureter.

Left upper abdominal pain may be a problem in the stomach, spleen, pancreas, left kidney, and left colon.