Pain in the left hypochondrium (upper left abdominal pain) most often develops with pathologies of the abdominal organs: acute and chronic pancreatitis, Payr’s syndrome, splenomegaly, and traumatic injuries of the spleen. Occasionally, a symptom occurs with lung damage (pneumonia and pleurisy), an atypical form of myocardial infarction, intercostal neuralgia. To diagnose the causes of pain, an instrumental examination is carried out using ultrasound, X-ray, and radioisotope methods. Treatment includes analgesics, etiopathogenetic agents (enzymes, antibiotics, drugs with an antisecretory effect), surgical interventions.
Causes of pain in the left hypochondrium (pain in upper left abdomen)
For acute pancreatitis , unbearable pain in the left hypochondrium is characteristic, which appears suddenly with errors in the diet or the presence of other provoking factors. The soreness increases when the patient lies on his back and left side. Often the pains become shingles, spreading throughout the upper abdomen. Often in the clinical picture, repeated vomiting, fever, and a sharp deterioration in well-being are noted.
In the chronic form of pancreatitis, dull pain under the ribs on the left, which is paroxysmal or persistent, worries. Discomfort is accompanied by discomfort and heaviness in the hypochondrium. The pain syndrome intensifies 30-40 minutes after eating, especially when eating fatty foods. Painfulness is accompanied by steatorrhea and creatorrhea , rumbling in the abdomen, flatulence.
Diseases of the gastroduodenal zone
With gastritis and gastric ulcer , the localization of pain is rarely observed in the epigastric region, but in the left hypochondrium. For these diseases, a combination of unpleasant symptoms with food intake is typical. The pains are of a different nature: stitching, squeezing, dull or aching. In case of peptic ulcer disease, a clear pattern is revealed: the earlier the symptoms appear at the end of the meal, the higher the defect is located in the stomach.
For ulcer duodenal primary divisions are characterized by pain in the epigastric and left upper quadrant. They occur on an empty stomach, often disturbing at night. At the end of the meal, the discomfort subsides. In addition to pain, symptoms of dyspepsia develop : nausea, sour belching, heartburn. As a rule, there are violations of the stool with alternating constipation and diarrhea.
Payr’s syndrome is characterized by improper fixation of the splenic angle of the colon, which causes chronic pain in the left hypochondrium. Sensations periodically intensify, radiate to the lower back and atrial region. Symptoms appear after eating, with intense physical exertion. Pain syndrome is accompanied by prolonged (3-5 days) constipation, and after bowel movement, the pain becomes less intense.
With an increase in the spleen, constant aching pains, heaviness in the left hypochondrium are disturbing. Exercise, torso tilts contribute to the strengthening of unpleasant sensations. Splenomegaly is secondary and is associated with the progression of the underlying disease, therefore it can be combined with various symptoms. If the spleen enlarges due to infection, the pain becomes sharp, paroxysmal. Splenomegaly is manifested by:
- Metabolic disorders : phenylketonuria , glycogenosis, Wilson-Konovalov disease .
- Autoimmune processes : systemic lupus erythematosus (SLE), periarteritis nodosa , vasculitis.
- Hereditary hemolytic anemias: thalassemia , Minkowski-Shofar microspherocytosis, sickle cell anemia .
- Neoplasms : tumors of the blood system (lymphoma, leukemia ), metastases of lung cancer, liver.
- Infectious diseases : viral ( cytomegalovirus , HIV, Epstein-Barr virus), bacterial (tuberculosis, syphilis ), protozoal ( malaria , leishmaniasis).
In case of blunt trauma to the abdomen , a fall from a height, an organ rupture occurs with a capsule (one-time) or without a capsule (two-moment). Severe pain in the left upper abdomen with irradiation to the shoulder is typical for a one-time injury. The patient takes a forced position on the left side with legs tucked in, and if you try to turn him over on his back or on the other side, he returns to the starting position (symptom of “vanka-stand up”).
A two-stage rupture of the spleen is characterized by a primary episode of severe pain in the left hypochondrium, during which the person loses consciousness. Soreness gradually decreases, there is a “light period” from several hours to 2-3 weeks, when there are no symptoms of the disease. Then, acute pains suddenly begin, accompanied by light-headedness due to severe intra-abdominal bleeding.
Surgical diseases of the spleen
Such conditions are characterized by sharp pain in the left hypochondrium, which occurs suddenly without any previous pathological symptoms. The excruciating pains force a person to take a forced posture. The patient lies bent over, pulling his knees to his stomach. The general state of health deteriorates sharply, signs of hemodynamic disorder, shock are possible. Left pain in the abdominal cavity is caused by:
- Spleen infarction . The intensity of the pain syndrome depends on the extent of the organ damage. Usually there are sharp stabbing pains under the ribs, which radiate to the left scapula and the region of the heart. With a small area of infarction, there are unpleasant aching sensations and discomfort in the left hypochondrium.
- Spleen abscess . Strong pulsating pain develops in the projection of the hypochondrium, radiating to the left half of the chest, interscapular and lumbar region. Patients complain of an increase in body temperature up to 40 ° C, chills, weakness. Dyspeptic disorders are often added.
- Splenic vein thrombosis . In acute thrombosis, there is an attack of pain in the left hypochondrium or epigastrium, which is not associated with food or exercise. Simultaneously with soreness, repeated vomiting with impurities of fresh scarlet blood opens, then the patient feels short-term relief.
Diseases of the lungs
Pain in the left hypochondrium is possible with lower lobe croupous pneumonia . The sensations are dull and are aggravated by coughing and deep breathing. The symptom is combined with febrile fever, secretion of mucopurulent sputum. Sharp pains in the left side of the chest and hypochondrium are characteristic of pleurisy . The soreness is aggravated by tilting the body in the opposite direction, when trying to take a deep breath.
In atypical forms of the disease, pain is localized in the left hypochondrium, and not behind the sternum, as in classic cases. The pain syndrome is very intense, sometimes it leads to loss of consciousness. With necrosis of the heart muscle, soreness radiates to the left arm and scapula, to the neck. The skin becomes covered with cold sweat, heart rate increases, blood pressure drops sharply. Sometimes with an abdominal variant of a heart attack , pain occurs in the epigastric zone.
When the nerves are involved in the pathological process, there are sudden burning pains in the left hypochondrium (pain in stomach), lasting several minutes. Patients describe the sensation as “lumbago” or “current flow” from the spine to the sternum. Soreness is usually provoked by sitting in an uncomfortable position, awkward twists of the torso, active sports activities. During the attack, the person freezes, avoids deep breaths.
- Hereditary diseases : porphyria , histiocytosis H.
- Anomalies in the development of the spleen : accessory lobules, organ cysts , polysplenia.
- Pancreatic tumors .
Examination of a patient with pain in the left hypochondrium (pain in left side of abdomen) is carried out by a gastroenterologist or a surgeon , if necessary, a cardiologist and a pulmonologist are connected to them. On examination, palpate the abdomen, check for typical symptoms of pancreatitis and peptic ulcer disease, but the results of a physical examination may be uninformative. To correctly establish a diagnosis, data from laboratory and instrumental methods are required, the main of which are:
- Ultrasound of the abdominal organs . Spleen sonography evaluates the size and shape of the organ, reveals splenomegaly and local pathological processes – abscesses, cysts, malignant tumors. Ultrasound imaging of the gastroduodenal and pancreatic zones is mandatory.
- Radiography. An enlarged spleen, displacement of adjacent structures, signs of Payr’s syndrome, complications of peptic ulcer disease can be found on a plain x-ray . For detailed visualization of organs, MSCT of the abdominal cavity is recommended . Pleurisy and pneumonia are ruled out with a chest x-ray .
- Spleen scintigraphy. A modern radioisotope method that allows assessing the functional activity of an organ. The study shows focal changes in the parenchyma that occur with myeloproliferative or infectious diseases.
- Diagnostic laparoscopy . In case of difficulties in making a diagnosis, the doctor resorts to a visual examination of the peritoneal cavity through a laparoscope. Using the laparoscopic technique, signs of a heart attack, tumor or rupture of the spleen are confirmed, the condition of the walls of the stomach and duodenum 12 is examined.
- Laboratory Methods. The standard diagnostic package includes a hemogram, a blood glucose test, and a clinical urinalysis. To identify problems with the pancreas, a coprogram is shown. To assess the activity of inflammation, acute phase indicators are determined. For lung diseases, sputum analysis is required.
Help before diagnosis
In case of non-intense pain in the left hypochondrium (pain in abdomen) caused by the abuse of fatty or heavy foods, patients are advised to follow a diet selected by a doctor . In chronic gastritis or stomach ulcers, antisecretory agents, antispasmodics can be taken to relieve pain. If the pain persists for a long time or a sudden pain syndrome occurs, you should seek medical help.
Therapeutic measures are primarily aimed at eliminating the cause of the symptom, after which the pain in the hypochondrium subside. In case of severe pain syndrome, narcotic analgesics are administered to alleviate well-being, in rare cases, novocaine blockades are made. Etiopathogenetic drug therapy includes:
- Enzymes . In case of insufficiency of the external secretory function of the pancreas, the drugs normalize digestion, eliminate pain and discomfort, and eliminate steatorrhea. Sometimes pacnreatic enzymes are combined with probiotics to improve the microflora in the colon.
- Antisecretory drugs . They are prescribed for gastritis with high acidity, ulcers, in order to reduce the damaging effect of hydrochloric acid on the mucous membranes. They quickly relieve pain attacks caused by hyperacidity.
- Non-steroidal anti-inflammatory drugs . They have a double effect: they act pathogenetically due to the relief of inflammation, and also symptomatically – they effectively relieve abdominal pain. Not recommended for stomach ulcers, as they violate the natural defense of the mucous membrane.
- Antibacterial drugs . Used for infections that are accompanied by splenomegaly, for pain in the left hypochondrium caused by pneumonia and pleurisy. If the diagnosed enlargement of the spleen has non-bacterial causes, etiotropic antiviral or antiprotozoal agents are taken.
- Proteolysis inhibitors . They are prescribed for patients with acute pancreatitis in order to neutralize the damaging effects of enzymes and relieve pain. It is extremely rarely administered for massive bleeding and other emergency conditions.
Pain in the left hypochondrium, provoked by Payr’s syndrome, responds well to physiotherapy. To remove unpleasant symptoms, electrophoresis with local anesthetics is used. To increase intestinal motility and prevent constipation, iontophoresis with proserin, UHF therapy , and diathermy are used. With intercostal neuralgia, reflexology , UHF, magnetotherapy are effective .
In case of complication of acute pancreatitis with an abscess or necrosis, surgical intervention is performed: endoscopic drainage, necrectomy , resection of the pancreas . With myocardial infarction, operations are performed to restore blood flow: coronary angioplasty , coronary artery bypass grafting . Exudative pleurisy is an indication for puncture and drainage of the pleural cavity .
A number of diseases of the spleen (heart attack, abscess, venous thrombosis) require urgent help from an abdominal surgeon. Taking into account the degree of organ damage, individual sections of the parenchyma are excised ( resection ) or total removal of the organ ( splenectomy ). For small ruptures, organ-preserving surgery is necessary to suture the lesions , and extensive lacerations and crushing of tissues are an indication for splenectomy.
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