Liver Pain

Pain in the liver can be caused by a variety of issues. Most likely if you are experiencing liver pain you may have some sort of liver disease.

Liver diseases can include many things such as infections, genetic disorders and conditions. It is important to understand them and how to prevent them because liver issues can be fatal.  In this article, you will learn about the anatomy and physiology of the liver. Also we shall cover various types of liver diseases and their specific causes, symptoms, and treatments. ^(1,2)

Where is the liver located ?

Liver anatomical location and physiology

The liver is a very large organ compared to the others. It is in the middle of your abdomen under your rib cage. The bulk of the liver sits on the right side of the body but it is a long organ and also reaches to the left side as well. It is the largest organ in the body.

More specifically the upper lobe is found in near the middle line and is level with the body of the sternum and xiphoid process. The left lobe goes all the way down to the sixth costal cartilage. The specific location can be measured as followed:

1. 1.25 cm under right nipple
2. 1.25 cm under the end of the tenth rib
3. 2.5cm under the left nipple  (1,2,12)

 

Image 1 : The relation of the liver to the other digestive organs.
Photo Source : www.mayoclinic.org

 

Picture 2 : The location of the liver because it so clearly shows its placement behind the ribs.
Photo Source : www.newhealthguide.org

Functions of the liver:

• Food digestion
• Removing toxins ⁽¹⁾

General Liver tissue symptoms:

• Yellow color to the eyes and skin. This is called jaundice.

 

Picture 3: In this picture, you can clearly see jaundice in the patient’s eyes.
Image Source : m.patient.media

 

Figure 4: The difference in color between the baby and the arms holding it.
Picture Source : encrypted-tbn0.gstatic.com

General symptoms continued:

• Bruising
• Pain and swelling in the abdominal area
• Decrease in appetite
• Light color to the stool
• Bloody stool
• Black stool
• Swelling in the extremities
• Dark color to the urine
• Itchy skin ^(1,2)

Be sure to see a doctor if you feel any of these symptoms or if the pain or discomfort is to a point that you cannot rest comfortably.

Liver pain causes

There are many causes each of which has their specific treatments, causes, and symptoms. Some of which are explained in more detail than others. Those that are explained in detail are the most common diagnosis that causes issues.

Liver infections:

• Hepatitis A
• Hepatitis B
• Hepatitis C

Issues with the immune system may cause attacks on the liver causing:

• Primary biliary cirrhosis
• Autoimmune hepatitis
• Primary sclerosing cholangitis ^(1,2)

Fatty liver

• Alcoholic liver disease (ALD)- specific early symptoms are abdominal pain, feeling sick, fatigue, feeling unwell, and decrease in appetites. Specific late symptoms are jaundice, swelling of extremities, fever, and itchy skin. This usually does not show up until it is advanced If you misuse alcohol on a regular basis check with your doctor about any tests that may be done to check your liver function.
• Nonalcoholic fatty liver disease (NAFLD)- Usually found in middle age obese people who have diabetes or high cholesterol. Sometimes medications, autoimmune issues, fast weight loss, and malnutrition can cause this.  It has four basic stages in which the prognosis decreases with each one. The stages are simple fatty liver or steatosis, non-alcoholic steatohepatitis (NASH), fibrosis (major inflammation causing scarring), and lastly cirrhosis (discussed in detail below)
• Acute fatty liver of pregnancy- This is rare but can happen and is risky for the baby. The cause is thought to be due to pregnancy hormones.
• Some specific symptoms of the Fatty liver are tired feeling, weakness, confusion or poor judgment, loss of appetite and weight loss. ^(3,4,5)

Liver cancer

• Bile duct cancer (Cholangiocarcinoma)
• Liver adenoma
• Hepatocellular carcinoma
• Most liver cancer has metastasized from a different part of the body.
• Suspected causes are birth defects, abuse of alcohol and chronic liver infections such as hepatitis.
• Other causes could be chemicals (vinyl chloride) herbicides, arsenic, and smoking.  ^{(1,2, 6, 7)}

Liver cyst- A cyst is a pouch filled with liquid that is in an abnormal place in the body. Therefore liver cysts are liquid filled pouches on the liver.

• They usually do not cause issues unless they get very large and may cause bloating and abdominal discomfort.
• If they are symptomatic they do not need to be treated. But if they start to cause issues for the patient the cyst can be drained using ultrasound guided extraction.
• In the case of infection, antibiotics may be prescribed. ^{(9, 10,11)}

Chronic alcohol abuse

Liver failure

Toxicity

• Medications
• Drugs ^(1,2)

Liver fibrosis

Genetic disorders

• Hemangioma liver
• Hemochromatosis
• Wilson’s disease
• Hyperoxaluria and oxalosis

Cirrhosis- This is basically scarring in the liver due to damage. This scarring can lead to other issues. ^(1,2)

 

Image 5: This image has a great example of how the normal liver should look and even includes how the cells look under a microscope.
Photo Source : www.mayoclinic.org

Liver pain location and intensity

Many times liver pain can be missed due to its location. It resembles other types of pain such as abdominal pain, kidney pain, and back pain. The following are words that have been used to explain liver pain:

• Dull
• Sharp
• Radiate to the shoulder or back ^(1,3,4)

Risk factors for Liver issues:

• Chronic Alcohol use
• Tattoos or piercings
• Sex while not using protections
• Obesity
• High triglycerides levels
• Needle sharing
• Any exposure to blood.
• Certain chemicals and toxins
• Diabetes

Some herbal supplements can harm the liver such as:

• Jin bu huan
• Germander
• Mistletoe
• Skullcap
• Comfrey
• Pennyroyal oil
• Ma-huang
• Valerian
• Chaparral
• kava⁽¹⁾

Differential diagnosis

A variety of testing may be done to determine the cause and true location of pain which may be considered liver pain. Some of these are basic testing such as:

• Blood tests
• Ct scans and MRIS
• liver biopsy ^(1,3,4)

Figure 6 :  The anatomical positions used to help with differential diagnosis.

Photo Source : web.duke.edu

Photo 7: The liver and its full shape and size more clearly.
Picture Source : www.bartleby.com

Diagnostic hints and methods to evaluate Liver pain

Palpitation of the liver during a routine checkup can be a great way for your doctor to decide to look more into the idea of liver issues.  ⁽³⁾

Liver biopsy what to expect

As you arrive for your biopsy and IV will be placed and most likely you will be given medication to help you relax. Your doctor will you palpitation and ultrasonic machines to help them locate the liver. After applying a numbing medication your doctor will insert a needle into the area outside of your liver.

Your doctor will ask you to hold your breath as he passes the needle in and out of your liver. Your recovery will consist of you lying still for at least a few hours after the procedure. ⁽¹²⁾

Treatment options

Depending on the diagnosis found the treatment will be issued. For example for some liver disease, all the patient will need to do is change their lifestyle habits.

These changes include and re not limited to:

• stopping alcohol consumption
• weight loss ^(3,4)

Alternative medicine may be prescribed to assist with the pain.

• Deep breathing techniques
• Music therapy
• Acupressure and acupuncture
• Massage ^(7,8)

Localized treatments may be used for some of the different diagnosis. These include and are not limited to:

• Heating, and freezing cancer cells
• Alcohol  or chemotherapy drug injection into the growth
• Radiation beads placement

These surgeries may be done for liver cancers or liver failure:

• Removal of the cancerous tumor
• Full liver transplant

FAQ:

Can you feel any pain with a fatty Liver?

If fatty liver is in its early stages there are no symptoms. At the most, you may feel abdominal discomfort.

What does Liver pain feel like?

Liver pain is usually felt in the middle high abdomen or in the right middle back. It can also radiate into the shoulder.

Why do I feel Liver pain after drinking?

The liver has to work harder when you drink alcohol because it needs to extract the toxin from your body. If you feel pain after drinking this is a strong indication of liver disease. You should seek medical attention.

What pain medication that does not affect the Liver?

It is best to not use over the counter pain medications. Most all pain medications are processed through the liver. Other options for pain relief are stated above under alternative medications.

How can I avoid Liver issues?

This is a simple answer all you need to do is control your alcohol consumption. Drinking should be done in moderation. Also, avoid tattoos or body art in risky areas. If you choose to get body art be sure the establishment has its certifications. Get vaccinated from hepatitis. Avoid contact with other blood and use all medications under medical supervision. Lastly, continue to eat healthily and maintain a healthy weight. ⁽¹⁾

References:

1. http://www.mayoclinic.org/diseases-conditions/liver-problems/basics/symptoms/con-20025300
2. http://www.newhealthguide.org/Liver-Pain-Symptoms.html
3. http://www.nhs.uk/Conditions/Liver_disease_(alcoholic)/Pages/Symptoms.aspx
4. http://www.webmd.com/hepatitis/fatty-liver-disease#1
5. http://www.nhs.uk/conditions/fatty-liver-disease/Pages/Introduction.aspx
6. http://www.webmd.com/cancer/understanding-liver-cancer-basic-information#1
7. http://www.mayoclinic.org/diseases-conditions/liver-cancer/home/ovc-20198165
8. https://www.cancer.org/cancer/liver-cancer.html
9. http://www.liverfoundation.org/abouttheliver/info/livercysts/
10. http://my.clevelandclinic.org/health/articles/liver-cysts-tumors
11. http://www.mayoclinic.org/diseases-conditions/liver-problems/expert-answers/liver-cysts/faq-20058440
12. http://www.mayoclinic.org/tests-procedures/liver-biopsy/basics/what-you-can-expect/prc-20012588