Right subcostal pain refers to a mild ache that occurs below the right rib cage and extends to the upper right abdomen. It can have a variety of causes, including common abdominal conditions such as cholecystitis, hepatitis, kidney stones, and abdominal tumors, as well as chest conditions such as costochondritis, chest wall trauma, and pleurisy. In addition to the dull pain, it may also be accompanied by symptoms such as nausea, vomiting, and coughing. If left untreated, it can further damage related organ function and affect quality of life.
symptom
Typical manifestations
The pain under the right ribs is usually dull or bloating, occurring primarily in the right intercostal area of the chest wall and into the right upper abdomen. This pain is generally mild and tolerated by most patients.
Associated symptoms
1. Fever
When dull pain under the right ribs is related to infection, such as lung infection, pleurisy, infectious costochondritis, hepatobiliary inflammation, etc., the patient may experience fever symptoms.
2. Respiratory symptoms
Such symptoms as coughing, sputum, shortness of breath, and difficulty breathing are common in diseases such as lung infection and pleurisy.
3. Digestive system symptoms
Such as nausea, vomiting, abdominal pain, jaundice, etc. These symptoms are more common in diseases such as cholelithiasis, cholecystitis, hepatitis, chronic pancreatitis, and hepatobiliary tumors.
complication
This symptom generally has no obvious complications.
reason
Overview
There are many reasons for dull pain under the right ribs, which may be related to various disease factors such as right abdominal cavity disease, chest wall disease, thoracic cavity disease, as well as non-disease factors such as emotional factors and physical activity.
Cause of symptoms
1. Disease factors
(1) Right abdominal cavity disease
① Gallbladder diseases: such as cholecystitis, gallstones, gallbladder cancer, etc., may cause dull pain under the right ribs.
② Liver diseases: such as viral hepatitis, cirrhosis, liver cancer, etc. Since the liver is located under the right ribs, these diseases may cause pain in this area.
③ Kidney disease: such as right kidney stones, right kidney tumors, etc., may also cause pain under the right ribs.
(2) Chest wall disease
① Rib diseases: such as rib fractures, costochondritis, intercostal muscle strain, etc. If the lesion is located on the right chest wall, dull pain under the right ribs may occur.
②Intercostal neuralgia: Intercostal neuralgia occurring on the right side may also cause pain under the right ribs.
③Other diseases: chest wall trauma, chest wall soft tissue inflammation, herpes zoster, chest wall tuberculosis, chest wall tumors, etc. may all cause dull pain under the right ribs.
(3) Chest diseases
① Lung diseases: such as pneumonia, tuberculosis, etc., if they involve the right chest wall, they may stimulate the nerves of the right chest wall and cause dull pain under the right ribs.
② Pleural diseases: such as pleural effusion, pleurisy, etc., may also cause pain under the right ribs.
③Other diseases: right pulmonary embolism, right lung cancer and other diseases may also cause dull pain under the right ribs.
2. Non-disease factors
(1) Emotional factors
If you lose control of your emotions or are always anxious or depressed, you may experience dull pain under your right ribs.
(2) Physical activity
You may experience dull pain below your ribs when you lift heavy objects, exercise too vigorously, squeeze your chest, or twist your body sharply. This is because these activities can cause muscle pulls or strains, which can cause pain.
Common diseases
Cholecystitis, gallstones, gallbladder cancer, viral hepatitis, cirrhosis, liver cancer, right kidney stones, right kidney tumor, rib fracture, costochondritis, intercostal muscle strain, intercostal neuralgia, chest wall trauma, chest wall soft tissue inflammation, herpes zoster, chest wall tuberculosis, chest wall tumor, pneumonia, pulmonary tuberculosis, pleural effusion, pleurisy, right pulmonary embolism, right lung cancer
Seeking medical treatment
Outpatient indications
1. Dull pain under the right ribs after trauma.
2. The dull pain under the right rib persists and cannot be relieved after rest, affecting daily life.
3. The intensity of the dull pain under the right rib gradually or suddenly increases.
4. Accompanied by symptoms such as chest tightness, difficulty breathing, nausea, vomiting, fever, jaundice, and abdominal pain.
5. Other severe, persistent or progressive symptoms and signs occur.
All of the above require prompt medical consultation.
Treatment department
1. If you suspect that the dull pain under the right ribs is related to the digestive system, such as cholecystitis, hepatitis, etc., it is recommended that you first visit the gastroenterology department.
2. If you suspect that the dull pain under the right ribs is related to organs such as the liver, gallbladder, and bile duct, and requires surgical treatment, it is recommended to see a general surgeon or hepatobiliary surgeon.
3. If the dull pain under the right ribs is accompanied by urinary system symptoms such as frequent urination, urgency, and pain when urinating, or if it is suspected to be related to organs such as the kidneys and ureters, it is recommended to see a urologist.
4. If the dull pain under the right rib is accompanied by respiratory symptoms such as difficulty breathing, cough, chest pain, or if it is suspected to be related to organs such as the lungs and pleura, it is recommended to see a thoracic surgeon.
Medical preparation
1. Make an appointment in advance and bring your ID card, medical insurance card, medical card, etc.
2. A comprehensive physical examination of the chest and abdomen may be performed, and it is recommended that you wear clothing that is easy to put on and take off.
3. If you have had medical treatment recently, please bring relevant medical records, examination reports, laboratory test results, etc.
4. If you have taken some medicine to relieve symptoms recently, you can bring the medicine box with you.
5. Family members can be arranged to accompany the patient to seek medical treatment.
6. Prepare a list of questions you want to ask in advance.
7. Blood tests may be performed, and it is best to visit the doctor in the morning on an empty stomach.
What questions might a doctor ask a patient?
1. What discomforts do you currently have?
2. How long have you been experiencing this condition?
3. Are your symptoms persistent or intermittent? Is there a pattern?
4. Have your symptoms gotten worse or better since you became ill? What’s the reason?
5. Have you ever had similar symptoms before?
6. Have you ever received treatment before? How was it treated? What was the effect?
7. Are you taking any medications?
8. Do you smoke? How long have you been smoking? How many cigarettes do you smoke on average per day?
9. Do you drink alcohol? How long have you been drinking? How much do you drink on average per day?
10. Is there anyone in your family who has a similar situation?
What questions can patients ask their doctor?
1. Is my condition serious? Can it be cured?
2. Why does this happen to me?
3. What treatment do I need? Do I need to be hospitalized? How long will it take to recover?
4. What are the risks of these treatments?
5. If medication is used for treatment, what are the usage, dosage and precautions of the medication?
6. What tests do I need? Are they covered by medical insurance?
7. I have other diseases. Will this affect my treatment?
8. How should I take care of myself after returning home?
9. Do I need follow-up examinations? How often?
examine
Scheduled inspection
Doctors usually perform a physical examination on the patient first to gain a preliminary understanding of the disease; they may then recommend a blood test, blood biochemistry, viral hepatitis antibody test, tumor markers, PPD (tuberculin test) or tuberculosis antibody, chest X-ray, chest CT, chest MRI, abdominal ultrasound, abdominal CT and MRI, pathological examination, electrocardiogram, gastroscopy, bone density test, etc. to determine the specific cause of the disease.
Physical examination
1. Visual examination
Observe the patient’s right subcostal area for any swelling, bulge, trauma, lumps, blisters, or other abnormalities. Also, note whether the skin color is normal and whether there is jaundice.
2. Palpation
Gently palpate the patient’s right subcostal area to check for tenderness, liver enlargement, and tenderness in the gallbladder area (Murphy’s sign). This can help to initially determine whether there are lesions in the hepatobiliary system, digestive system, or ribs.
3. Percussion
Percussion is performed in the right subcostal area to determine whether there is percussion pain or dullness, and to further determine whether there is pleural effusion or hepatomegaly.
4. Auscultation
The doctor uses a stethoscope to check the patient’s respiratory sounds in the right subcostal area to determine whether there are pleural friction sounds, dry or wet rales, etc., in order to understand the condition of the lung and chest lesions.
Laboratory tests
1. Blood routine test
By checking indicators such as white blood cell count and neutrophil ratio, we can assess whether the patient has inflammatory conditions such as bacterial infection.
2. Blood biochemistry
It includes multiple indicators such as liver function, kidney function, electrolytes, blood sugar, etc., which help to detect liver and gallbladder diseases, kidney diseases, etc.
3. Viral hepatitis antibody test
It includes five hepatitis B tests, HAV (hepatitis A virus) antibody test or HCV (hepatitis C virus) antibody test, etc., which are mainly used to diagnose viral hepatitis and help doctors determine the cause of the disease.
4. Tumor markers
Such as AFP (alpha-fetoprotein), CEA (carcinoembryonic antigen), CA19-9, etc., have certain reference value for the diagnosis of tumor diseases.
5. PPD (tuberculin test) or tuberculosis antibody
Used to detect whether patients are infected with Mycobacterium tuberculosis, which helps to rule out tuberculosis disease.
Imaging examinations
1. Chest X-ray
Used for preliminary screening of rib fractures, pleurisy, lung lesions, etc.
2. Chest CT
Compared with X-rays, CT can more accurately display the chest structure, including ribs, lungs, pleura, etc., and has higher value in the diagnosis of diseases.
3. Chest MRI (Magnetic Resonance Imaging)
It has high sensitivity and specificity for soft tissue lesions and is suitable for further diagnosis of chest diseases.
4. Abdominal ultrasound
It is economical and convenient, and has important value in diagnosing diseases of organs such as the liver, gallbladder, and kidney.
5. Abdominal CT and MRI
It can clearly display the structure of abdominal organs and has high value in diagnosing diseases of the liver, gallbladder, pancreas, etc., especially for the diagnosis of diseases such as liver space-occupying lesions and bile duct stones.
Pathological examination
Pathological examination is the gold standard for diagnosing malignant tumors. Doctors will decide whether a pathological examination is necessary based on the patient’s specific condition and imaging test results.
Other tests
1. Electrocardiogram
Electrocardiogram (ECG) is mainly used to diagnose heart diseases. In some cases, such as radiating pain caused by myocardial infarction, ECG may also show abnormalities.
2. Gastroscopy
If the patient has dull pain under the right ribs accompanied by digestive system symptoms (such as nausea, vomiting, acid reflux, etc.), the doctor may recommend a gastroscopy to rule out stomach diseases.
3. Bone density test
If you are older or have risk factors for osteoporosis, your doctor may recommend a bone density test to assess your osteoporosis and develop an appropriate treatment plan.
diagnosis
Diagnostic principles
Doctors can usually make a preliminary diagnosis based on the patient’s medical history and symptoms, combined with a physical examination, but further confirmation of the diagnosis is required based on the results of laboratory tests, imaging tests, and pathological tests.
Differential diagnosis
1. Cholecystitis
Based on the patient’s symptoms such as severe pain and pain on pressing in the right upper abdomen, nausea, vomiting, chills and high fever, as well as increased white blood cell count, a preliminary diagnosis can be made, and then combined with imaging examinations such as ultrasound and CT, the diagnosis can be further clarified.
2. Cirrhosis
Based on the patient’s medical history of hepatitis, drinking, medication, etc., and physical examination showing typical symptoms such as jaundice of the skin and sclera, liver palms, spider nevi, etc., a preliminary diagnosis can be made, and then combined with biochemical tests of liver and kidney function, as well as imaging tests such as ultrasound, to confirm the diagnosis.
3. Liver cancer
A preliminary diagnosis can be made based on the patient’s history of alcoholism, hepatitis, family history of liver cancer, as well as symptoms such as liver pain, ascites, jaundice, and suspected space-occupying lesions in the liver found through tumor markers and ultrasound examinations. A puncture biopsy of the liver and a concurrent pathological examination can then confirm the disease. In addition, imaging examinations such as CT and MRI can be used to determine whether liver cancer has metastasized to other parts of the body.
4. Right kidney stones
Based on typical symptoms such as right abdominal pain, hematuria, and the spontaneous excretion of small stones by a few patients, combined with signs such as right kidney percussion tenderness, a preliminary diagnosis can be made. The diagnosis can then be further confirmed by detecting kidney stones through imaging examinations such as ultrasound.
5. Right costochondritis
Based on the patient’s dull pain under the right ribs, which worsens after activity, and the bulge of the costal cartilage at the painful area and obvious pain when pressed, the disease can be initially suspected. Then, combined with laboratory tests, electrocardiograms, chest imaging examinations, etc., other causes of subcostal pain should be excluded before a definitive diagnosis can be made.
treat
Expected treatment
Treatment for dull right subcostal pain depends on the specific cause and may include medication, surgery, lifestyle support, and specialized treatment tailored to the specific cause. If the cause is unknown, avoid self-medication and seek professional medical advice promptly.
General treatment
1. Rest in bed and avoid further activities on the affected area, which will help eliminate inflammation and relieve pain.
2. Avoid working at a desk for long periods of time and maintain correct sitting and standing postures.
3. Sleeping on your left side or on your back can help relieve pain.
4. Quit smoking, limit alcohol consumption, maintain a healthy weight, and eat a balanced and varied diet.
Drug treatment
1. Analgesics
Such as ibuprofen sustained-release tablets, diclofenac sodium sustained-release capsules, etc., used for anti-inflammatory and analgesic purposes.
2. Antibiotics
Such as amoxicillin capsules, cefdinir dispersible tablets, etc., are used to inhibit bacterial reproduction and are suitable for pain caused by diseases such as pleurisy and cholecystitis.
3. Antiviral drugs
For example, acyclovir capsules are suitable for intercostal neuralgia caused by viral infection.
4. Nerve nutrition drugs
Such as methylcobalamin tablets, which are used to nourish nerves and relieve neuralgia.
Related drugs
Ibuprofen sustained-release tablets, diclofenac sodium sustained-release capsules, amoxicillin capsules, cefdinir dispersible tablets, acyclovir capsules, methylcobalamin tablets
Surgical treatment
1. For tumors in the liver, lungs and other parts of the body, radical tumor resection can be performed to remove the tumor or reduce its size through surgery to reduce irritation and relieve pain.
2. For digestive system diseases such as cholecystitis, when the condition is severe, treatment methods such as laparoscopic cholecystectomy or cholecystectomy may be considered.
Other treatments
1. Closed treatment
For patients with severe pain, local anesthetics or corticosteroids can be used for pain point blocking treatment.
2. Nerve block therapy
For patients with persistent pain, nerve blocks may be used.
Treatment cycle
The treatment cycle is affected by factors such as the severity of the disease, treatment plan, treatment timing, age and physical condition, and may vary from person to person.
Estimated treatment costs
There may be significant individual differences in treatment costs, and the specific costs are related to the selected hospital, treatment plan, medical insurance policy, etc.