Pain in the left hypochondrium in front and side. What is on the left under the ribs? Pain under the ribs on the left, what to do? Sharp and sharp pain

Pain in the left hypochondrium in front of the place where the spleen, pancreas, intestines are concentrated, can also be given there left kidney

When something hurts, very few of us immediately run to the doctor. On the one hand, it is better not to take risks, because acute pain can indicate a serious health disorder that requires immediate medical care. However, on the other hand, depending on the localization of pain, a person can independently determine what exactly worries him, and only then make a decision to visit a doctor.

What is included in the region of the left hypochondrium?

In our today's material, the causes of pain under the ribs, which are located on the left, will be considered. The side of the abdomen just below the rib on the left is the place where the spleen, pancreas, and intestines are concentrated. Also, the left kidney or ureter can give there. By itself, the hypochondrium region is the upper quadrant on the left, which is located under the ribs.

Causes of pain in the front of the hypochondrium on the left

Now let's talk about the most common causes that entail the appearance pain:

• If the pain is stabbing and occurs during exercise.

If you ran a couple of kilometers and felt an unpleasant tingling sensation, you should not worry. Similar stabbing pains occur in most healthy people during prolonged physical activity. After some time, the pain will go away on its own.

Hence the conclusion: before any physical activity, we must do a thorough warm-up so that the body adapts to a rapid increase in blood circulation.

When the pain manifests itself during exercise, it is better not to test yourself for strength, but to stop, how to relax the whole body (shoulders, arms, legs) and breathe well. When exhaling, you can lightly press your palm on the place where it hurts the most, and then lean forward. We repeat several times - and move on.

In general, breathing during such loads should be deep. If we breathe often, small excursions of the diaphragm begin, the body does not have enough oxygen. It is also not recommended to run less than an hour and a half after a hearty meal. At this time, the body has not yet had time to adapt to physical activity.

• torments cutting pain.

It can also be called "dagger". With the appearance of such a sharp pain for no apparent reason, it makes sense to consult a doctor. Acute pain that suddenly arises in the left hypochondrium may indicate a rupture of the spleen, as well as perforation of the walls of the stomach.

• Relieves pain after an injury.

Asking for help is a must. Especially if the injury was caused by a fall. It is possible that the internal organs received serious damage.

• Observed Blunt pain.

Worried about the prolonged pain that "spills" around the hypochondrium? If she "rolls" in periods, this is already a cause for concern. Such symptoms indicate a mild disease of the stomach, intestines, etc. For example, cholecystitis or gastritis. To confirm or exclude pathologies, go to a gastroenterologist to take tests and undergo an ultrasound scan.

• The aching pain dragged on.

Is something constantly pulling at the bottom left? it characteristic symptom colitis, although duodenitis should also not be ruled out. Sometimes the pain is accompanied by nausea. Do not rule out a stomach ulcer. The most dangerous thing is that aching pains can talk about a pre-infarction condition.

To summarize, the pain different nature under the ribs can talk about such diseases:

• Coming heart attack, damage to the heart muscle.
• Disease of the gastrointestinal tract. For example, common gastritis or cholecystitis. More serious disorders are stomach ulcers or pancreatitis.
• Neuralgia.
• Rupture of the spleen due to a blow, its enlargement due to another disease.
• Diaphragm tumor or injury.

In rare cases, pain may indicate a rheumatic manifestation, pneumonia that has arisen in the left side of the lung below.

Types of pain and how to recognize them

All pains can be divided according to the mechanism of occurrence. Such an indicator is additional sign to help identify the pathology.

Reflected pain appears as radiating from an organ located relatively far from the site of pain. In other words, you may have a heart attack or left-sided pneumonia, and you will think that something happened to the stomach.

Visceral pain. Most often caused by intestinal spasms and muscle strain. Flatulence is also accompanied by aching, dull pains, cramping conditions with colic, radiating to nearby areas.

Peritoneal pain. Has a clear localization. It causes irritation of the peritoneum - for example, in the case of stomach ulcers. With deep breathing and sudden movements, the pain intensifies.

Now let's look at the types of pain by the nature of their localization. If a pulls under the ribs in front, a differential diagnosis is made between myocardial infarction, diseases of the spleen and stomach. The shift of pain closer to the central part may indicate diseases of the stomach in combination with problems of the gallbladder or duodenum 12.

Localization of pain in the hypochondrium, but more behind may indicate kidney damage. By itself, such pain is quite strong and can also signal osteochondrosis. For diagnosis, ultrasound is performed, urine and blood tests are taken. To diagnose osteochondrosis, palpation of the nerve processes is performed.

Another type of pain is its girdle character, passing to the anterior wall of the peritoneum. Such a symptom may indicate inflammation of the pancreas. At first, the pain is girdle, but then subsides a little if you lean forward.

Diseases with pain in the left hypochondrium in front

Now you understand that “just like that” nothing can hurt in the region of the left hypochondrium. Below we will consider the most common diseases that make themselves felt with such symptoms.

• Diaphragm pathology.

If the pain does not stop, they may indicate a pathology of the diaphragm. It has a special opening that separates the peritoneum from the chest. It is necessary for the esophagus to properly connect with the stomach. If the muscle tissue is weakened, the lumen begins to expand. The upper section begins to go into the chest cavity, which is unacceptable. The stomach throws the contents back into the esophagus, which causes pain on the left, sometimes with nausea.

Why does diaphragmatic hernia develop? There are several reasons - from heavy loads to pregnancy. Due to the weakness of the muscular apparatus, a hernia can occur in the elderly. But if there is a pinched stomach, the pain is cutting.

• Intercostal neuralgia.

Irritation, strong compression of the nerve between the ribs will necessarily entail discomfort. The most common is a pulling pain, which intensifies if you sharply inhale air. The attack is accompanied by tingling in the chest area, which radiates to left hypochondrium. Twitching of individual muscle groups is observed, the skin may turn pale, sweating is increased. Painful sensations appear if you press on the points of the back, as well as between the ribs. Pain in the hypochondrium does not depend on the time of day and weather. It can be observed both in the morning and in the evening.

• Cardiac pathology.

Ischemic heart disease can remind of itself with pain in the left side. However, such pain is also accompanied by shortness of breath during exercise, nausea, heart palpitations, heaviness in the chest. Similar pains can be observed with cardiomyopathy - as in medicine they call a violation of the blood supply to the heart.

• Problems with the spleen.

The fact is that the spleen is very close to the surface of the human body. Any of its pathologies are accompanied by painful sensations. If it is infectious mononucleosis, additional symptoms may include fever and muscle pain, as well as swollen lymph nodes.

Spleen hypertrophy- this is a state when the body begins to work in an enhanced mode and perform immune, phagocytic functions. The size of the organ increases, which causes pain on the left. Particularly sharp pain can occur with injury or impact. Blueness of the skin around the navel indicates a rupture of the spleen.

• Diseases of the stomach and pancreas.

It is worth noting that these diseases are one of the most common causes of unpleasant pain in the region of the hypochondrium. The first place is occupied by gastritis, which affects the majority of citizens of our country. The spread of the disease is not due to the best state of the modern food industry. Our gastric mucosa reacts very subtly to any irritants. Something, but there are enough of them in our diet. The most characteristic signs of gastritis are aching pain in the hypochondrium and epigastric region, nausea and unpleasant belching, heartburn, a feeling of heaviness. These symptoms appear after a heavy meal.

• Ulcer disease.

Has similar symptoms. However, if the ulcer is perforated, the main symptom is a fairly sharp, cutting pain. It occurs suddenly, and a person may even lose consciousness.

• Diseases of the pancreas.

A characteristic symptom of pancreatitis is severe pain in the hypochondrium on the left. It is accompanied by vomiting with bile, severe and constant nausea, bitterness in the mouth. The temperature may rise, the urine turns dark.

• Oncological diseases.

You should be alerted by discomfort in the hypochondrium if it is accompanied by an aversion to a particular food, lack of appetite, rapid satiety, a series of diarrhea and constipation.

Now you know what pain in the left hypochondrium is and what you need to do with one or another of its manifestations.

Diagnostics this disease performed by a dermatologist. Based on the detailed clinical picture of the disease ( intercostal pain, characteristic unilateral rash), the doctor can almost accurately diagnose. Specific diagnosis is carried out only when an extremely severe or atypical form of the disease is observed, as well as when symptoms are detected in newborns or infants.

Laboratory diagnostics includes the following specific methods for detecting the herpes zoster virus:

• Linked immunosorbent assay ( ELISA) is able to determine in the body the presence of specific molecules of the immune system to this pathogen - antibodies to the herpes zoster virus. Title increase IgM antibodies indicates a recent infection or that the virus has become active again. In turn, the presence of IgG antibodies also indicates a past infection. It should be noted that sometimes the results of this laboratory study do not allow an accurate diagnosis. In this case, they resort to the most accurate method of all known - the polymerase chain reaction ( PCR) .
• polymerase chain reaction ( PCR) is a method of molecular biology that allows you to detect in the biological material of the patient ( most often it is the contents of vesicles or blood) viral DNA even in very small concentrations. In addition, this method reveals which type of herpes zoster virus has led to this infectious disease ( there are 3 types in total). In addition to the advantages, this method also has disadvantages. So, for example, PCR is not able to determine the activity of the infectious process ( whether the disease is acute or is it a reactivation).

Often ( more than 60 - 70% of cases) shingles goes away on its own even without any treatment. However, timely detection and treatment of herpes zoster is designed to alleviate the course of the disease and prevent complications.

Treatment of this viral disease involves the use of the following drugs:

• Antivirals can directly integrate into the DNA of the virus and completely inhibit its reproduction ( replication). For these purposes, as a rule, drugs such as famciclovir, acyclovir and valaciclovir are used. Already on 3 - 4 days this group medication significantly reduces the severity and duration of the disease.
• Immunostimulating drugs able to increase the production of interferons, which, in turn, effectively neutralize viruses. These drugs include viferon, cycloferon, geneferon and others.
• Pain medications allow you to relieve pain in the intercostal space. In most cases, it is prescribed to take painkillers such as analgin, ibuprofen, paracetamol and diclofenac. These drugs also have anti-inflammatory and decongestant effects.
• Glucocorticoids are adrenal hormones that have a pronounced anti-inflammatory effect. Glucocorticoids, on the one hand, eliminate inflammation, swelling, and pain, and on the other hand, suppress the immune response. That is why they can be prescribed only in the treatment of intercostal neuralgia of mild or moderate severity.

Tietze syndrome

Tietze syndrome ( costal chondritis) is an inflammation cartilage tissue ribs that are in direct contact with the sternum. This pathology most often occurs among the active population aged 20 to 35 years. Men and women suffer from this disease to the same extent. As a rule, a unilateral lesion of the cartilaginous ends of the first 5-7 ribs is detected.

The following factors can lead to Tietze's syndrome:

• increased physical load on the chest, as well as the shoulder girdle;
• chest trauma;
• autoimmune diseases ( damage to one's own tissues by cells of the immune system);
• allergic reactions;
• collagenoses ( diseases predominantly affecting the connective tissue);
• some diseases of the respiratory system ( pleurisy, bronchopneumonia);
• arthritis ( joint inflammation);
• arthrosis ( deformity of the joints with loss of mobility in them).

Costal chondritis is diagnosed by a general practitioner or orthopedist. In addition to pain, only swelling is found at the junction of the ribs with the sternum. This pathology are not classified as particularly dangerous, but it is necessary to conduct a differential diagnosis with other, more serious diseases ( angina, myocardial infarction).

The following symptoms of costal chondritis are distinguished:

• Pain in the sternum and intercostal space is the main manifestation of pathology. The pain syndrome has a paroxysmal character and is characterized by a gradual increase. A characteristic feature of these pains is their unilateral localization. Pain is most often exacerbated by deep breathing or by coughing or sneezing. In some cases, pain can bother for several years or even decades.
• Swelling of tissues and the presence of swelling of the ribs directly related to the inflammatory process. The fact is that inflammation produces a large amount of biologically active substances (histamine, serotonin, bradykinin), which lead to an increase in the permeability of the vascular walls and the release of plasma into the surrounding tissue ( tissue swelling occurs). This swelling has a spherical shape and is a rather dense formation, which often reaches 3-6 centimeters in diameter.

Diagnosis of this pathology is based on only two symptoms - pain at the point of attachment of the cartilaginous ends of the ribs to the sternum, as well as the presence of a volumetric painful formation ( swelling of the ribs). Electrocardiography should be done to rule out cardiac pathology.

As a diagnosis of costal chondritis use following methods:

• is not specific method diagnostics of Tietze's syndrome, however, it allows to judge the presence of an inflammatory process in dynamics. On the x-rays can detect narrowing of the intercostal space, which indicates a thickening of the cartilaginous segments of the ribs. It should be noted that radiography is not able to detect pathology at the initial stage. At later stages, deforming changes in the articulation of the ribs with the sternum are revealed ( osteoarthritis).
• Computed and magnetic resonance imaging unlike the X-ray method, it allows the doctor to detect various changes at the level of the cartilaginous tissue of the ribs already at the earliest stages of the disease. It is also possible to determine the boundary of the affected area and the condition of the surrounding tissues ( vessels, nerves, muscles). In addition, the use of tomography allows you to confirm or exclude the presence of a malignant neoplasm ( used in differential diagnosis).

Since Tietze's syndrome is not a serious disease, treatment in the vast majority of cases is carried out at home ( outpatient).

For the treatment of costal chondritis, the following medicines are used:

• Non-steroidal anti-inflammatory drugs necessary to relieve pain in the intercostal space, as well as to relieve swelling and reduce severity inflammatory response. Most often, gels and ointments based on ibuprofen, diclofenac, ketoprofen or piroxicam are used. Local ( external) the use of these medications virtually eliminates the likelihood of various complications from the gastrointestinal tract ( damage to the lining of the stomach and intestines).
• Steroid hormones of the adrenal cortex ( glucocorticoids) are used only in case of persistent and severe pain in the intercostal space. At the point of maximum pain, the doctor injects a solution of novocaine and hydrocortisone. Novocaine effectively relieves pain, and hydrocortisone ( adrenal hormone) significantly suppresses inflammation, and also has a decongestant effect.
• Physiotherapy improve the effect of drug treatment. With costal chondritis, acupuncture, magnetotherapy, electrophoresis, massotherapy. These physiotherapy procedures improve blood circulation, lymphatic drainage, tissue regeneration processes, as well as reduce pain and swelling.

In very rare cases, when drug treatment does not eliminate pain, and the disease continues to progress, they resort to surgery to resect the rib ( partial removal). This operation, depending on the indications, can be carried out both under local anesthesia and under general anesthesia.

Rib tumor

Tumor of the ribs is a fairly rare pathology. Neoplasms ( neoplasia) with this localization are found, as a rule, in children under 10-12 years old. Most of these tumors are malignant and arise from the penetration of metastases into the bone tissue from other organs ( in breast cancer, lung cancer, thyroid cancer, prostate cancer, etc.).

The following symptoms of a tumor of the ribs are distinguished:

• Pain in the chest are permanent and can be localized in any segment of the chest, including in the left hypochondrium. Rib cancer is characterized by increased pain and strong feeling discomfort at night. Pain, as a rule, is not amenable to relief and only intensifies over time.
• Hot skin over the site of the tumor is a fairly common manifestation of a tumor of the ribs. In addition, redness of the area of ​​the skin is revealed, which indicates overflow of superficial vessels with blood.
• Vegetative symptoms may occur as a result of involvement in the pathological process of the autonomic nervous system. Most often this is manifested by increased irritability, anxiety or fear.
• Heat is a nonspecific symptom and occurs in less than half of the cases. Body temperature can reach 38 - 40ºС.

In order to confirm the presence of this oncological disease, it is necessary to consult either an orthopedist or an oncologist. You should take a full history, identify all the symptoms of the disease, and then conduct a thorough physical examination of the chest and left hypochondrium. To confirm or refute the presence of a benign or malignant tumor of the ribs, some additional diagnostic methods are used.

To confirm the diagnosis, the following instrumental research methods are used:

• allow to identify the presence of a tumor, as well as to determine its localization, shape and size. In addition, tomography can detect tumor compression of nearby tissues ( muscles, pleura, lungs, mediastinal organs) and blood vessels.
• Biopsy is an invasive method with violation of the integrity of surface tissues), which involves taking a piece of tissue for its subsequent examination under a microscope. It is a biopsy that helps to determine the presence of tumor cells, and also allows you to judge the form and stage of cancer.

The most effective method of treating a tumor, regardless of whether it is benign or malignant, is surgery. Before surgery, chemotherapy is used to suppress the growth of tumor cells. Chemotherapy refers to the use of such drugs that completely stop the growth and division of both normal and tumor cells. Most often resort to the use of methotrexate, ifosfamide or doxorubicin. If the course of chemotherapy has a positive effect, then an operation is prescribed. During such an operation, as a rule, the tumor itself is completely excised along with the affected segment of the rib. The removed part of the rib is replaced with a metal, synthetic or bone implant. If the tumor has grown into the vessels, nerves or soft tissues of the intercostal region, then these tissues are removed along with the underlying and overlying rib. After surgery, to avoid recurrence ( re-exacerbation) and tumor metastasis ( spread of cancer cells through the vessels to other organs and tissues) resort to a second course of chemotherapy. If there are absolute contraindications to surgical treatment, then radiotherapy is used ( radiation therapy) . This method of treatment is based on the destructive effect on tumor tissues of various types of ionizing radiation ( gamma radiation, x-ray radiation, etc.). The fact is that tumor cells are much more sensitive to radiation exposure than healthy cells, which is actively used in radiotherapy. This method, however, also has serious drawbacks. For example, severe burns can occur in the irradiation zone, as well as subcutaneous hemorrhages, which are the result of damage to blood vessels.

rib fracture

A fracture of one rib, as a rule, does not lead to pain and practically does not cause discomfort, while a combined fracture of several ribs causes severe pain and can lead to serious complications. Pain occurs due to the direct impact of a traumatic factor ( bruise, sprain, squeezing, crushing) on the blood vessels, periosteum, nerves and muscles of the intercostal space, in which a fairly large number of pain endings are located. Also, the pain syndrome may indicate a violation of the integrity of the pleural cavity by bone fragments of the ribs. The pleural cavity is bounded by two pleural sheets of connective tissue that line the top of each lung. It is in the pleura, and not in lung tissue, contains nerve endings that can perceive and transmit to the central nervous system ( to the pain center) pain impulses.

The causes of rib fractures are the following types of traumatic effects:

• injury;
• squeezing;
• stretching;
• crush.

The severity of symptoms in rib fractures can vary somewhat. Symptoms mainly depend on the number of injured ribs, the type of fracture ( comminuted, oblique or transverse), as well as the presence of complications, which can join immediately at the time of injury or within a few days after it.

The following symptoms of a rib fracture are distinguished:

• Severe pain in the side occurs when the costal arch is fractured. When several ribs are broken, sudden, severe and excruciating pain occurs. Any movement, even not very sharp, a deep breath or coughing intensifies this pain and causes serious discomfort. When the body is tilted to the healthy side ( with unilateral fracture of the ribs) there is a characteristic pain in the affected hypochondrium.
• shallow breathing occurs reflexively, as deep breathing leads to pain, and also intensifies them. It is worth noting that prolonged shallow breathing can cause inflammation of the lungs. This is due to the fact that with shallow breathing there is a decrease in lung ventilation, which contributes to the growth and reproduction of certain pathogens in the tissues of the lungs.
• Chest deformity may manifest itself to varying degrees. An uncomplicated fracture of one rib usually does not lead to deformity. In the event that the integrity of several ribs is damaged at once or with a comminuted fracture, the chest loses its usual shape and deforms.
• Lagging of the affected side of the chest from the healthy side observed with unilateral complicated fracture of the ribs. This symptom is manifested due to the fact that any movement on the affected side causes pain. That is why the victim spares the affected side, which is less involved in respiratory movements.

Victims with suspected rib fractures should be examined by a traumatologist as soon as possible. This is due to the fact that in some cases this injury can lead to various complications.

Fractured ribs can cause the following dangerous complications:

• Hemothorax characterized by accumulation of blood in the pleural cavity. Hemothorax occurs due to damage to the blood vessels of the lungs, diaphragm, or mediastinum. As a result of hemothorax, blood accumulates in the cavity of the pleural sac, which causes compression of the lung and has an extremely negative effect on ventilation and gas exchange. In some cases, when a significant amount of blood accumulates in the pleural cavity ( more than 1.5 - 2 liters), then there is a displacement of the heart and great vessels, which inevitably leads to heart failure ( due to hemodynamic disturbance). In addition, there is often an accumulation of air in the subcutaneous fat of the wall of the chest cavity ( skin emphysema). Pathological mobility and pathological sounds are also observed ( crepitus) associated with the friction of bone fragments of the ribs against each other. If the integrity of the lung tissue is violated, hemoptysis may occur ( hemoptysis).
• Pneumothorax is such pathological condition, in which atmospheric air enters the pleural cavity, which leads to compression of the lung tissue. At the initial stage, there sharp pain in the area of ​​damage to the pleura, which is often reflected in the shoulder or arm, sternum or neck. Coughing, deep breathing or sudden movements increase the pain syndrome. There is also dyspnea and tachycardia ( increased breathing movements) due to respiratory failure, the skin and mucous membranes become pale. Air entering under the skin of the chest leads to the formation of skin emphysema.

When making a diagnosis, the traumatologist specifies when and how the injury was received, determines its mechanism, and also conducts a physical examination of the chest in the area of ​​the fracture. Very often, when probing the fracture site, an abnormal sound is heard in the form of a crunch ( crepitus). Various instrumental diagnostic methods allow to clarify the diagnosis.

When diagnosing a fracture of the ribs, the following methods are used:

• X-ray examination is an effective and most affordable way, which often allows you to determine the presence of a fracture of the ribs. On x-rays, you can accurately localize the place where the rib fracture occurred, as well as detect bone fragments.
• Ultrasound procedure chest has less diagnostic value than radiography, however, this method is used to detect the presence of damage to the integrity of the pleural sheets, as well as to identify the accumulation of blood or air in the pleural cavity.
• Pleural puncture helps the doctor take a small amount of the contents of the pleural cavity for examination ( diagnostic puncture). If necessary, the doctor can make an outflow of a large amount of pathological contents from the pleural cavity and, thereby, turn diagnostic puncture to the medical. In addition, antiseptic solutions can be introduced into the cavity along with antibiotics to reduce the likelihood of developing complications such as pleurisy ( inflammation of the pleura) and pneumonia.

Treatment of a fracture of one rib or uncomplicated fracture of several ribs is usually carried out at home. In turn, the presence of a comminuted fracture of the ribs, in which dangerous complications serves as an indication for urgent hospitalization.

First aid and treatment of rib fractures includes:

• Taking painkillers aimed at the relief of acute pain syndrome. Often in this case, such a narcotic pain reliever as promedol is used. In the treatment of an uncomplicated fracture of one or more ribs, an alcohol-novocaine blockade is used. First, up to 10 ml of 1 or 2% solution of novocaine is injected into the fracture site, after which 1–2 ml of 70% ethyl alcohol is injected there, which allows to increase the duration of the analgesic effect of novocaine. If necessary, alcohol-novocaine blockade can be repeated.
• Applying a tight bandage to the chest carried out at the prehospital stage. This manipulation is designed to almost completely limit the mobility in the chest to avoid further traumatization of various tissues in the fracture zone.
• expectorant medicines necessary to facilitate the discharge of sputum with a dry cough. As a rule, they are prescribed to take Ambroxol, ACC, Tussin.
• The imposition of a plaster corset is a method of treatment of comminuted fracture of the ribs. For several weeks, the patient must be in this plaster corset, which limits movement in the chest and, thereby, accelerates the process of fusion of bone fragments.
• Therapeutic puncture of the pleural cavity performed in the case when one of the fragments of the rib led to the perforation of the pleural cavity, which caused pneumothorax or hemothorax.

Causes, symptoms, diagnosis and treatment of pain under the rib on the left

The pain that occurs in the left hypochondrium, as a rule, speaks of various pathological processes in which the spleen is affected. Often, pain occurs immediately after a chest injury ( in the region of the left hypochondrium) or due to some infectious diseases. In some cases, persistent pain under the rib on the left may indicate the presence of a tumor in the spleen.

Enlargement of the spleen

Enlargement of the spleen ( splenomegaly) is a pathological condition that can occur in various diseases of the infectious and non-infectious nature. We can talk about splenomegaly when an ultrasound scan shows that the size of the spleen exceeds 11 - 12 centimeters in length.

With an enlarged spleen, the following symptoms are characteristic:

• Pain in the left side occurs due to overstretching of the connective capsule of the spleen, in which pain receptors are located. An enlarged organ can compress not only nearby organs digestive system (pancreas, intestines, stomach), but also the aperture. In this case, the pain can spread to the left side of the chest or to the lumbar region. The pain is usually aching or dull.
• Earlier satiety due to compression of the stomach and small intestine leading to a decrease in their volume. As a result of compression of the digestive tract, even taking a small amount food can cause earlier satiety with food, as well as lead to feelings of nausea. In addition, there is often a decrease in appetite up to its complete absence.
• Gastroesophageal reflux is the process of getting the contents of the stomach into the esophagus. Gastroesophageal reflux is manifested by heartburn, belching, chest pain. In some cases, hoarseness and dry cough may appear.
• constipation are associated with compression of intestinal loops by the spleen, which leads to impaired passage ( intestinal patency).
• Signs of anemia. Splenomegaly is often associated with anemia ( anemia). With this pathological condition, there is a decrease in red blood cells and hemoglobin, which plays the role of a carrier of oxygen and carbon dioxide. Anemia is characterized by the appearance of headaches, nausea, tinnitus, damage to the hair and nails. In addition, pallor of the skin and mucous membranes is detected. In some cases, an abnormal heart murmur occurs.

In order to diagnose this disease, you need to consult a hematologist. The doctor collects an anamnesis, asks about recent travels to tropical countries, analyzes the symptoms of the disease. One of the important diagnostic signs of splenomegaly is the ability to palpate the spleen, since normally the spleen is not palpated ( not palpable). In addition, often with palpation of the spleen, pain occurs.

In the treatment of splenomegaly, both medical and surgical treatment can be used using the following methods:

• Antibiotics are indicated in the case when the lesion and enlargement of the spleen occurred against the background of a bacterial infection. For tuberculosis of the spleen, anti-tuberculosis drugs such as ftivazid, streptomycin, rifampicin and tubazid are used. Various regimens are used to treat brucellosis, which include different combinations antibiotics ( gentamicin, doxycycline, rifampicin, biseptol and streptomycin). Syphilis is treated with antibiotics penicillin series (benzylpenicillin and its analogues), macrolides ( erythromycin, azithromycin). In turn, tetracycline, aminoglycosides and penicillins are used for leptospirosis. It should be noted that if an infectious disease of a bacterial nature leads to the formation of a purulent cavity ( spleen abscess), then a surgical operation is performed to partially or completely remove the organ ( partial or total splenectomy).
• Chemotherapy is a method of treatment of malignant diseases, including the hematopoietic system. Chemotherapy is based on the use of cytostatics, which have a toxic effect on cancer cells, stopping their growth. Often, several cytostatics are used at once for a better effect. Most often resort to the use of alexan, rubomycin, methotrexate and cyclophosphamide. Some of these drugs should be taken constantly, while others only at the beginning of the course. It should be noted that the action of cytostatics is directed not only to cancer cells, but also to healthy ones. As a result of this treatment, such side effects like hair loss, damage to the digestive tract, liver, cardiovascular system.
• Splenectomy- an operation to remove the spleen. In fact, the spleen is not a vital organ and, if necessary, it can be removed. surgically with virtually no health risks. The indication for surgery is the detection of aplastic anemia ( inhibition of growth and differentiation of erythrocytes, platelets and leukocytes), Minkowski-Choffard disease ( increased destruction of red blood cells due to a membrane defect), Werlhof's disease ( a decrease in the number of platelets, as well as the presence of deformation of these cells), polycythemia ( disruption of the bone marrow, which leads to an increase in the synthesis of red blood cells, white blood cells and platelets). In addition, this method of treatment is also used for some other diseases of the hematopoietic system, for example, for leukemia ( rebirth of various formed elements of blood) or non-Hodgkin's lymphoma ( cancerous degeneration of lymphocytes). In some cases, for example, when cysts or such benign tumors like a lymphangioma the tumor originates from the wall of the lymphatic vessels) and hemangioma ( tumor originates from cells inner wall blood vessels), perform partial removal of the organ ( spleen resection). Most often, the operation is performed laparoscopically. During this operation, access to the spleen is achieved through several small holes in the abdominal wall, through which the surgeon inserts instruments and a laparoscope, a tube-like device that transmits an image to a monitor. In addition to low trauma, laparoscopy also allows you to take a biopsy for further research ( piece of cloth) liver or lymph nodes, if there is a suspicion of metastases to surrounding organs and tissues.

Spleen injury

The most common cause of damage to the spleen is the direct impact of a traumatic factor on the organ. This is due to the close location of the spleen near the costal arch and the abdominal wall, a high degree its blood supply, as well as the size this body. The main symptom of this pathological condition is pain, which occurs in the first seconds after damage to the spleen and is a consequence of damage to the organ capsule. It is in the connective tissue capsule of the spleen, and not in the organ itself, that a large number of pain endings are located.

It should be noted that damage to the spleen is most often understood as a rupture of the tissues of the organ, leading to the occurrence of internal bleeding.

The following conditions can lead to damage to the spleen:

• injury ( direct or indirect impact of a traumatic factor);
• bacterial infections ( typhus, leptospirosis, tuberculosis);
• viral and protozoal infections ( cytomegalovirus, mononucleosis, HIV, toxoplasmosis, malaria);
• some liver diseases liver cirrhosis and hepatitis);
• excessive exercise ( lifting very heavy weight);
• blood cancer;
• pregnancy ( due to rapid labor or due to large blood flow to the spleen).

Symptoms of damage to the spleen is directly related to the degree of involvement in the process of the organ capsule, as well as the degree of blood loss and general condition organism.

Symptoms of damage to the spleen include:

• Pain in the left side is the first and most basic manifestation of damage to the spleen ( most often occurs when an organ ruptures). Often, pain is also felt in the upper segments of the abdomen, as well as in the left shoulder, arm, or under the shoulder blade. The pain is sharp and piercing, which makes you take a forced position to reduce the severity of pain. The slightest movement, deep breath or cough significantly increase the pain. This leads to a transition to shallow breathing.
• Tension of the muscles of the abdominal wall arises reflexively and wears protective function. This is explained by the fact that the “board-shaped abdomen” in this case is able to protect the abdominal wall from new injuries. It should be noted that the severity of tension in the abdominal muscles can be different and depends on the general condition of the patient. So, for example, with a sharp decrease in blood pressure observed during collapse ( a sharp drop in blood pressure), this symptom is practically not observed.
• Symptoms acute blood loss can manifest themselves in different ways and depend on the degree of blood loss. Most often there is dizziness, darkening of the eyes, tinnitus and general weakness up to loss of consciousness. The face of the victim in this case acquires a pronounced pallor, the pulse quickens, while the pressure decreases. Also quite often there is a feeling of nausea and even vomiting. It should be noted that blood loss in case of damage to the spleen occurs in the vast majority of cases and is a characteristic symptom of this pathological condition.
• Intestinal paresis represents a complete absence of peristalsis, which leads to the retention of gases and stools. This symptom usually occurs a few hours after the rupture of the spleen.

Depending on the cause that led to the rupture of the spleen, an emergency doctor, therapist or surgeon can diagnose this pathological condition. The rupture of the spleen due to abdominal trauma is most simply confirmed. The doctor collects all information regarding the injury ( time, type and strength of traumatic impact, etc.), followed by a physical examination of the abdomen. Reveal the symptom of "plank-shaped abdomen" ( strong tension of the muscles of the abdominal wall), as well as severe pain on palpation in the spleen. Severe pallor of the skin along with tachycardia ( increase in the number of heartbeats) and hypotension ( lowering blood pressure) indirectly indicate the presence of bleeding. When these symptoms are detected, it is necessary to confirm the presence or absence of rupture of the spleen as soon as possible in order to start adequate treatment as soon as possible ( in this case, most often we are talking about the removal of the organ).

With a rupture of the spleen, the following instrumental diagnostic methods are most often resorted to:

• Chest x-ray allows you to detect a homogeneous shadow on the left under the diaphragm, which indicates the accumulation of blood in this area. In addition, the images can also reveal the limitation of mobility, as well as the high standing of the left dome of the diaphragm.
• quite often reveals a displacement of the transverse colon and descending colon downward, as well as the expansion of the stomach and its displacement downward and to the right. It should be noted that in some cases, when damage to the spleen does not lead to massive bleeding, these x-ray methods of research are uninformative.
• Ultrasound procedure used to differentiate contusion and rupture of the spleen. When bruised, areas of increased echogenicity are revealed, which indicates the presence of hematomas ( local accumulation of blood). A rupture of the spleen is indicated by the presence of a defect in the contour of the organ. Also, zones with increased echogenicity are found, in the center of which there are small areas with reduced echogenicity, which indicates the presence of destruction of the spleen tissues.
• CT scan allows even greater accuracy to judge the type and degree of damage to the spleen. This highly informative method reveals subcapsular hematomas ( accumulation of blood under the capsule) which are characterized by uneven enlargement of the spleen simultaneously with its bulging in the area of ​​hemorrhage. In violation of the integrity of the spleen, computed tomography allows you to directly visualize the line of the gap or blurred contours at the site of the gap.
• Laparoscopy is a modern diagnostic method that allows you to insert an endoscopic tube with a video camera through a small hole in the abdominal wall and directly examine the organ. The advantage of this method is the fact that the diagnostic procedure, if necessary ( when ruptured spleen is confirmed) can be converted to laparoscopic surgery.

It should be noted that the results of a general blood test are extremely uninformative and are not used for diagnosis. The fact is that during acute blood loss in the first hours, the composition of peripheral blood practically does not change due to the inclusion of regulatory compensation mechanisms.

When the spleen ruptures, severe bleeding occurs, which disrupts hemodynamics ( movement of blood through the vessels and blood supply) and is a life-threatening condition for the patient. Since it is almost impossible to stop bleeding due to the peculiarities of the blood supply to the spleen ( high venous pressure), then in more than 95 - 98% of cases they resort to the complete removal of the organ. Symptomatic therapy is also important ( reduction in the severity of associated symptoms).

In the treatment of damage to the spleen, the following methods are used:

• Painkillers are used only after the doctor has accurately determined the diagnosis. This is due to the fact that when the pain syndrome is relieved by analgesics, the symptoms completely or almost completely disappear. Only after the diagnosis of splenic rupture has been confirmed, the doctor may prescribe painkillers such as analgin, ibuprofen, pentalgin, or other drugs from the group of non-steroidal anti-inflammatory drugs.
• Splenectomy is an operation to remove the spleen. Until recently, the most widely used laparotomy, during which access to the organ was carried out using a wide incision of the abdominal wall. As a rule, a median incision was used along the white line of the abdomen ( from the xiphoid process to the umbilicus) or an oblique incision along the left hypochondrium ( Ker, Czerny). On the this moment increasingly resorting to minimally invasive ( less traumatic) operations - laparoscopy. The essence of this method lies in the fact that access to any organ of the abdominal cavity is carried out using 3-4 small holes in the abdominal wall. One hole is needed for insertion into the cavity of the laparoscope ( rigid endoscope with a video camera at the end), while the remaining holes are necessary for inserting surgical instruments into the abdominal cavity. The operation is performed under general anesthesia ( general anesthesia ).
• Stabilization of hemodynamics necessary to eliminate the symptoms of acute blood loss and cardiovascular insufficiency. Most often resort to intravenous transfusion of blood or its components ( blood transfusion). In emergencies, when a sharp decline blood pressure ( collapse) and shock occurs, blood transfusion is carried out intra-arterially. In order to eliminate hypotension ( decrease in blood pressure below 70 - 90 mm. rt. Art.) Dobutamine or dopamine is administered intravenously. These drugs act both on the heart muscle, increasing the force of myocardial contraction, and on the arteries, improving the central and peripheral blood supply. The most common treatment for shock is norepinephrine. norepinephrine), which raises blood pressure ( including in the arteries of the heart), and also increases the force of contraction of the heart muscle ( inotropic effect).

Spleen infarction

Spleen infarction is understood as a partial or complete cessation of blood supply to any area of ​​this organ, which leads to tissue necrosis. It should be noted that small infarctions of the spleen are almost asymptomatic, which cannot be said about massive infarcts, in which there is a sudden and severe pain in the left hypochondrium. In quite rare cases, a total heart attack can occur, in which the entire spleen is affected.

Spleen infarction most often occurs due to the following pathologies:

• malignant blood diseases leukemia, polycythemia, lymphogranulomatosis);
• blockage of the vessels of the spleen by thrombotic masses or emboli ( foreign bodies, microbes, gas bubbles, etc.);
• bacterial, viral and protozoal infections ( malaria, typhoid fever, leishmaniasis, septic endocarditis).

The severity of symptoms in this pathological condition directly depends on the degree of damage to the organ. There is a direct relationship between the size of the area of ​​necrosis ( tissue necrosis) and the severity of pain in spleen infarction.

The symptoms of a splenic infarction are as follows:

• Pain in the left hypochondrium occurs due to overexcitation pain receptors in the vessels of the spleen. It is in the arteries of the spleen, and not in the parenchyma ( functional fabric spleen), contains a large number of nociceptors. These receptors are responsible for the perception and transmission of nerve impulses to the pain center located in the brain ( thalamus). In addition, pain can be significantly increased if the spleen capsule is involved in the pathological process ( it also contains nociceptors). Small foci of necrosis resulting from splenic infarction are practically not accompanied by pain, while with subtotal ( violation of the blood supply to most of the body) or total infarction, acute pain occurs in the left side, which very often radiates ( distributed by) in the lumbar spine or under the left shoulder blade. The pain is aggravated by deep breathing or coughing. It is worth noting that the pain gradually subsides and disappears during the first few days.
• Flatulence (painful bloating, which occurs due to excess accumulation of gases) appears when the peritoneum is involved in the pathological process ( connective tissue membrane that covers the abdominal organs). Except given symptom nausea may also occur.

Quite often, a splenic infarction goes unnoticed and is not diagnosed in time. Firstly, this is due to the fact that the symptoms are not particularly pronounced and unspecific. Secondly, even if a large part of the spleen is affected, the pain almost completely disappears during the first three days. Most often, splenic infarction is diagnosed only after ischemia ( decrease in blood supply) an abscess of the spleen ( accumulation of pus).

The following methods of instrumental diagnostics can help in identifying a spleen infarction:

• Ultrasound procedure can identify areas of the spleen with different densities. It is worth noting that ultrasound, as a rule, does not detect heart attacks of rather small sizes.
• CT scan is a more accurate method for diagnosing splenic infarction. On tomograms, one or more zones with reduced density are found, which most often have a wedge-shaped or round shape and are located on the periphery of the spleen.

With a spleen infarction, in most cases they resort to a conservative method of treatment. The operation is necessary only when suppuration of the organ occurs ( abscess).

Depending on the presence of complications, splenic infarction can be treated by the following methods:

• Conservative treatment suggests bed rest, taking painkillers, as well as antibacterial drugs. In the first hours, it is effective to apply an ice pack to the area of ​​the left hypochondrium. This allows you to reduce the severity of pain. In addition, the presence of pain syndrome involves the use of painkillers such as analgin, paracetamol, pentalgin. You can also take spasmalgon, which, in addition to its analgesic effect, also relieves spasm of smooth muscles internal organs.
• Surgery it is necessary only in the case when suppuration of the organ occurs against the background of a heart attack. In this situation, a splenectomy is performed. During the operation, the abscess is opened, and the cavity is washed with antiseptic substances, as well as antibiotics.

spleen cancer

Spleen cancer is a rather rare pathology that can occur as a result of metastases in the spleen from other organs or tissues. Another cause of this pathology may be the accumulation of degenerated lymphocytes in the lymph nodes and tissues ( lymphoma). It should be noted that the initial stage of spleen cancer is characterized by the almost complete absence of symptoms, as, indeed, with other cancer. Symptoms characteristic of spleen cancer occur only in the later stages of the pathology and indicate the progression of the tumor process.

There are the following symptoms of spleen cancer:

• Pain in the left hypochondrium, as a rule, speaks of squeezing by the tumor of the capsule of the spleen, in which pain receptors are located. At first, dull and mild pain appears, which, as the malignant disease progresses and the tumor grows in size, gradually increases, becomes unbearable and constant. Often the pain is reflected in left hand and shoulder or under the left shoulder blade. In addition, in some cases, the tumor can reach a very large size, which leads to rupture of the spleen.
• Fatigue (asthenia) is the result of exhaustion. The fact is that against the background of malignant diseases, the body experiences enormous loads that exceed the compensatory and regenerative capabilities of organs and organ systems. Ultimately, this is manifested by increased fatigue and mental lability ( changeable mood). In addition, a person is no longer able to engage in both mental and physical activity for a long time. Depletion of the reserve functions of the central nervous system often leads to insomnia.
• Anemia ( anemia) often occurs already at the earliest stages of the disease, being the first symptom of spleen cancer. Anemia may occur different reasons. First, at the level of the gastrointestinal tract, there may be malabsorption of cobalt or copper, which are necessary for the formation of hemoglobin ( a protein that transports oxygen to tissues and carbon dioxide to the lungs). Secondly, the tumor can attack the red bone marrow and thus negatively affect erythropoiesis ( the formation of red blood cells in the bone marrow). Thirdly, chronic occult blood loss can sometimes be observed, which also leads to anemia. Fourth, tumor cells can use red blood cells as a growth substrate.
• Decreased or loss of appetite occurs due to the fact that the tumor compresses nearby organs of the digestive system ( stomach and/or intestinal loops). As a result, this leads to a decrease in the capacity of the gastrointestinal tract and faster satiety during meals.
• Weight loss is a direct consequence of loss of appetite. In addition, this phenomenon is often associated with general intoxication of the body. In this case, the disintegration of the tumor under the action of antitumor immunity leads to the release of various free radicals and substances that have a toxic effect. These substances negatively affect anabolic processes ( processes for the synthesis and creation of new substances and cells) in the body, thereby depleting it. In addition, if the tumor grows too fast, special anti-tumor immunity mechanisms are activated that block the use of fats to prevent further growth of the cancerous tumor.
• Slight increase in body temperature appears due to the fact that against the background of a cancerous tumor, the formation of so-called pyrogens occurs. These substances are able to act on the temperature center in the hypothalamus and, to a certain extent, increase body temperature. As a rule, with spleen cancer, subfebrile fever is observed, in which body temperature rarely rises above 37.5 - 38ºС.

To detect spleen cancer, you should consult with a hematologist or oncologist. There are a large number of different instrumental methods for diagnosing this disease, but a biopsy helps to accurately confirm the presence or absence of spleen cancer.

The following research methods can be used in the diagnosis of spleen cancer:

• is one of the most affordable and at the same time accurate ways to detect spleen cancer in the early stages. This method allows you to detect a cancerous tumor of the spleen, even a small size. The tumor may have a heterogeneous structure and reflect ultrasound waves in different ways ( hypoechoic, hyperechoic, or isoechoic mass). Abdominal ultrasound may also detect enlarged lymph nodes near the spleen.
• Magnetic resonance and computed tomography allow not only to detect the tumor, but also to localize it and determine the size. In addition, tomography is able to detect the presence of metastases in other organs and tissues, which is of great informative value. In fact, this method of instrumental diagnostics complements the results of ultrasound examination.
• Biopsy is an invasive traumatic) procedure ( with damage to the integrity of superficial tissues), during which a piece of tissue is taken ( most often a lymph node) of an organ for subsequent microscopic examination. In turn, various atypical cells can be detected under the microscope ( Hodgkin cells, Reed-Berezovsky-Sternberg giant cells, lacunar cells), which indicates the presence of a malignant oncological disease.
• Clinical Analysis blood and its results can only suggest the presence of any disease or pathological process. However, it is this laboratory study, which is carried out periodically in without fail, allows you to detect changes characteristic of spleen cancer. In this case, a decrease in the number of lymphocytes is most often detected in the blood ( lymphopenia), hemoglobin ( anemia) and platelets ( thrombocytopenia) along with an increase in eosinophils ( cells that are involved in immediate allergic reactions).

Treatment of spleen cancer involves an integrated approach. Most often, a combination of radiation therapy and chemotherapy is used. In some cases ( according to indications) may also require surgical treatment.

The following treatments are used for spleen cancer:

• Chemotherapy is the main treatment for spleen cancer. Thanks to the use of cytostatic drugs, a significant decrease or even a complete stop of tumor growth occurs. The fact is that cytostatics have a highly toxic effect and inhibit the growth and differentiation of cancer cells. In spleen cancer, various combinations of cytostatic agents may be used ( cyclophosphamide, bleomycin, doxorubicin, etc.). In each individual case, the doctor individually selects the necessary treatment regimen based on many factors. The stage of the tumor process, the presence of metastases to other tissues and organs, the general condition of the body, age, the presence of concomitant severe diseases of the cardiovascular system, kidneys or liver are taken into account. However, it is worth mentioning the fact that these drugs affect not only the tumor, but also healthy tissues. human body. That is why side effects such as hair loss, disruption of the digestive system, damage to the liver and kidneys can occur. At the moment, most often resort to the combined use of chemotherapy and radiotherapy, which allows most patients to long time (years and decades) move the cancer into remission ( subsidence of symptoms).
• Radiation therapy ( radiotherapy) involves the use of ionizing radiation to suppress the growth of cancer cells. During radiation therapy, certain groups of lymph nodes are dosed with radiation, while healthy tissues are covered with special lead filter plates. A separate course of radiotherapy without the use of cytostatic drugs is prescribed only in the case when symptoms of severe cancer intoxication of the body are not detected ( sudden weight loss, subfebrile fever, profuse night sweats).
• Surgery involves the complete removal of an organ splenectomy). Before the operation, a course of chemotherapy is mandatory. Access to the organ is carried out along the upper midline of the abdomen, which allows the surgeon to visualize not only the affected organ, but also, if necessary, to detect and remove distant metastases in the abdominal cavity. This operation is performed under anesthesia. AT postoperative period also given a course of chemotherapy to reduce the risk of recurrence ( recurrence of cancer).

Causes, symptoms, diagnosis and treatment of pain in the left side of the upper abdomen

Pain in the left side also occurs against the background of inflammation of various organs of the gastrointestinal tract. These pains can be caused by inflammation of the mucous membrane of the small or large intestine, intestinal obstruction or pancreatitis. In addition, in some cases, against the background of the above pathologies, compression or irritation of the spleen capsule may occur, which is also manifested by pain in the left hypochondrium.

Enteritis

Enteritis is an inflammation of the lining of the small intestine. It is worth noting that pain in the left side causes inflammation duodenum (duodenitis), as well as inflammation of the upper jejunum ( eunite). In some cases, enteritis is combined with gastritis ( inflammation of the stomach lining) or colitis ( inflammation of the colon mucosa).

The following reasons can lead to enteritis:

• irritable bowel syndrome ( functional disorders of the intestine without changing its structure);
• bacterial infections with intestinal damage ( typhoid fever, cholera , dysentery , salmonellosis , escherichiosis);
• intestinal viruses ( ECHO, coxsackie, polioviruses);
• helminthic diseases ( enterobiasis, giardiasis, ascariasis);
• taking medicines ( glucocorticoids, non-steroidal anti-inflammatory drugs, some antibiotics).

Enteritis can be acute and chronic. Acute enteritis can be mild, moderate or severe. In the case of a chronic course of enteritis, the mucosa of the small intestine gradually atrophies and loses its functionality. Regardless of the form of the disease with enteritis, there is a violation of intestinal digestion and absorption of nutrients from the intestine ( maldigestion and malabsorption), which negatively affects the state of the whole organism.

Enteritis symptoms include:

• Abdominal pain most often occurs in the umbilical region of the abdomen to the left of the navel or spreads throughout the abdomen. Enteritis is characterized by the appearance of dull cramping pains, which intensify in the second half of the day. Pain syndrome, as a rule, occurs due to stretching of the loops of the small intestine with gases or due to spasm of the smooth muscles of the intestine.
• diarrhea ( diarrhea) occurs due to the acceleration of the movement of the food bolus ( chyme) in the small intestine. With enteritis, there is an increase in stool ( diarrhea) up to five or more times a day ( with cholera can reach up to 20 times). In this case, the stool is unformed and watery. In addition, during the act of defecation, weakness occurs due to a decrease in blood pressure.
• Flatulence manifested by painful bloating, resulting from the accumulation of a large amount of gas in the intestinal loops. The feeling of fullness in the abdomen is aggravated immediately after eating. There is also rumbling and seething in the abdomen, which is associated with manifestations of intestinal dysbacteriosis ( disruption of normal intestinal microflora).
• Nausea and vomiting are quite common in acute inflammation mucous membrane of the small intestine. With the help of vomiting, the body tries to cleanse the gastrointestinal tract of pathogens and their waste products.
• Dehydration is a direct consequence of diarrhea and vomiting. The loss of a sufficiently large amount of fluid leads to headaches, dizziness, excruciating thirst, lowering blood pressure, and general weakness. In some cases, loss of consciousness may occur.

Gastroenterologist deals with the diagnosis of diseases of the gastrointestinal tract, including enteritis. Careful history taking the totality of all the information received from the patient during questioning) allows the doctor to suggest a diagnosis of enteritis. Then a physical examination is performed, during which symptoms of dehydration are detected, and also palpated ( probing) the abdominal wall in order to localize the painful area. To clarify the diagnosis, both instrumental and laboratory methods are used.

In the treatment of enteritis, the following drugs can be used:

• Antibacterial drugs used only when it comes to bacterial infections ( dysentery, escherichiosis, salmonellosis, cholera). Of the antibiotics, sulfanilamide, ciprofloxacin, ofloxacin, sulfathiazole and others are most often used. The antibiotic is selected based on the results of the antibiogram ( determination of sensitivity and resistance of microbes to certain antibiotics).
• Anthelmintics necessary for the treatment of helminthic invasions. As a rule, drugs such as levamisole, mebendazole or helminthox are used.
• Antidiarrheals reduce the speed of passage of the food bolus through the intestines due to the inhibition of motility and peristalsis. Antidiarrheal drugs include loperamide, enterol, lopedium.
• Digestive enzyme preparations are also included in basic therapy. These digestive enzymes are necessary for the normalization of the process of digestion of food. The most commonly used drugs based on pancreatic enzymes are pancreatin, creon, mezim, pangrol.
• Antispasmodic drugs necessary to relieve pain caused by excessive contraction of the smooth muscles of the small intestine. With moderate pain, no-shpu, papaverine or drotaverine are prescribed. In turn, with severe pain, a spasmodrue or bepasal is prescribed.
• Rehydrators allow to eliminate such a dangerous manifestation of enteritis as dehydration. Rehydrants include rehydron, trihydron, hydrovit. With severe dehydration ( loss of more than 6 - 10% of the initial body weight) perform intravenous rehydration ( droppers) using solutions such as trisol, acesol or chlosol.
• Eubiotics are preparations containing special microorganisms that normalize the intestinal microflora by suppressing the growth and reproduction of pathogenic microbes. Eubiotics include drugs such as bifikol, bifiform, enterol, bifidumbacterin.

Regardless of the form and severity of enteritis, a diet is prescribed ( table number 4 according to Pevzner), which involves the intake of chemically, thermally and mechanically sparing food. In addition, this diet involves limiting the intake of fats, as well as carbohydrates.

Colitis

Colitis is an inflammation of the lining of the large intestine. Colitis is painful different localization and malabsorption of water and electrolytes ( sodium, potassium, magnesium, chloride, calcium). The causes of colitis are very diverse.

There are the following causes of colitis:

• intestinal dysbacteriosis disruption of normal intestinal microflora);
• intestinal infections ( salmonellosis, dysentery, escherichiosis, etc.);
• irrational intake of certain medications ( laxatives, antibiotics, antipsychotics);
• psycho-emotional stress;
• excessive physical activity;
• poor nutrition;
• hereditary predisposition.

It is worth noting that inflammation of the descending colon or the left segment of the transverse colon can lead to pain in the left side ( transverse). Along the course, acute and chronic forms of colitis are distinguished. Acute colitis is characterized by severe abdominal pain, while chronic colitis is usually It's a dull pain.

Colitis causes the following symptoms:

• Abdominal pain is the main symptom of acute and chronic colitis. Pain most often occurs with the urge to defecate. It should be noted that the pain is cramping in nature and occurs due to spasm of the smooth muscles of the large intestine.
• False urge to defecate ( tenesmus) are also quite characteristic of inflammation of the mucous membrane of the large intestine.
• stool disorder may present with diarrhea or constipation. It should be noted that for the defeat of the segments of the large intestine, located in the left side, the occurrence of a spasm of smooth muscles is characteristic, which is manifested by constipation.
• Flatulence is a direct consequence of a strong contraction of the smooth muscles of the intestine. As a result, a large amount of gas accumulates in the large intestine.

To establish the diagnosis of colitis, it is necessary to consult a gastroenterologist. The doctor collects all necessary information about the disease, and then conducts a physical examination using palpation of the abdomen ( palpation of the abdominal wall to determine the painful area) and anoscopy ( visual examination of the rectum with a special instrument). In the diagnosis of chronic colitis, as a rule, resort to the use of additional instrumental methods.

To clarify the diagnosis, the following diagnostic methods are used:

• Irrigoscopy is an x-ray of the large intestine with a preliminary introduction of a suspension of barium into it ( through anus ). This method allows you to evaluate the functional state of the mucous membrane of the large intestine, its relief, as well as the elasticity of the intestinal walls.
• Colonoscopy ( endoscopy) is a more traumatic method than irrigoscopy due to the introduction into the large intestine of an endoscope containing a video camera at the end. With the help of colonoscopy, you can examine the entire large intestine and visually detect inflammation of the mucosa or its ulceration. In addition, the method helps to identify the presence of polyps ( mucosal outgrowths). If necessary, colonoscopy allows biopsy of suspicious tissue ( take for cytological analysis piece of intestinal tissue).

Treatment is selected based on the clinic, form and severity of the disease. Diet is of particular importance table number 4 according to Pevzner), which is designed to reduce the burden on the intestines.

In the treatment of colitis, the following medicines are used:

• Anthelmintic drugs prescribed in the case when colitis is caused by helminthic invasion ( levamisole, piperazine, mebendazole).
• Antibacterial drugs are needed if colitis occurs against the background of a bacterial infection. In this case, sulfanilamide, fthalazol, levomycetin or other broad-spectrum antibiotics are used.
• Laxatives help to correct the frequency of stools with constipation. Drugs in this group cause irritation of receptors located in the mucous membrane of the colon. As a rule, bisacodyl or portalac are prescribed.
• Antispasmodic drugs taken to relieve painful bowel contractions ( spasms). Drugs from this group reduce the effect of calcium ions on smooth muscle cells, which ultimately manifests itself in the relaxation of muscle fibers. In most cases, if the pain is not very pronounced, it is prescribed to take papaverine, drotaverine or no-shpu. With severe pain, it is advisable to take such combined drugs as bepasal or spasmobru.
• Eubiotics appointed to restore normal microflora intestines ( bifiform, bifikol, bifidumbacterin, enterol).
• Vitamins and minerals prescribed due to the fact that with colitis, the absorption of various trace elements from the large intestine is impaired. That is why they prescribe various multivitamin complexes ( duovit, multi-tabs, vitrum, multimax, etc.), which are able to be absorbed into the bloodstream even before entering the large intestine.

Bowel obstruction

Intestinal obstruction is a pathological condition in which there is a partial or complete cessation of the movement of the food bolus through the intestines. There are two types of intestinal obstruction - mechanical and dynamic. The first type of intestinal obstruction occurs due to the appearance of an obstruction in one of the segments of the intestine. In turn, dynamic intestinal obstruction occurs against the background of complete intestinal atony ( lack of motility and peristalsis) or due to strong spastic contractions of the smooth muscles of the intestine.

Possible causes of intestinal obstruction are as follows:

• dietary changes;
• adhesions in the abdominal cavity;
• internal hernias;
• abdominal trauma;
• acute pathologies of the abdominal organs ( appendicitis, cholecystitis, colitis, urolithiasis, etc.);
• blockage of intestinal vessels thrombosis, embolism);
• squeezing of the intestine with a foreign object ( tumor, enlarged organ, hernial sac);
• poisoning with certain poisons lead salts).

Symptoms of intestinal obstruction can vary and depend on the type and stage of the disease, the general condition of the body, age, and the presence of concomitant pathologies.

The main symptoms of bowel obstruction include:

• Abdominal pain is one of the most early symptoms intestinal obstruction. As a rule, the pain appears suddenly and is permanent. The occurrence of pain in intestinal obstruction is associated with the advancement of the wave of peristalsis, which increases the spasm of the smooth muscles of the intestine and leads to cramping pain. The most severe pain occurs when the intestinal vessels are blocked ( mesenteric arteries and veins), while for intestinal atony ( paralytic form of dynamic intestinal obstruction) are characterized by dull or aching pains. In the future, the pain gradually subsides, which corresponds to the phase of complete lack of motor skills. Left bowel pain is associated with colonic obstruction at the level of the descending colon and the left transverse colon.
• Flatulence is a direct consequence of a violation of the passage of the food bolus through the intestines. Due to intestinal obstruction, not only gas retention occurs, but also stool retention ( constipation occurs).
• Nausea and vomiting appear reflexively and are associated with overflow of the gastrointestinal tract at a certain level. Then there is intoxication of the body associated with the long-term presence of the food lump and feces in the intestine. At the same time, various toxic substances enter the bloodstream, which is also accompanied by vomiting.

Intestinal obstruction is diagnosed by a gastroenterologist or surgeon. There are a large number of specific symptoms that are characteristic of intestinal obstruction.

The most common symptoms of intestinal obstruction are:

• Bayer's sign ( bloating along with abdominal asymmetry);
• Val's symptom ( protrusion of a segment of the intestine slightly above the level of the obstruction);
• Kocher's sign ( if you press on the anterior abdominal wall, and then sharply remove your hand, then pain does not occur);
• Mondor's symptom ( increased intestinal motility is gradually replaced by atony);
• Sklyarov's symptom ( listening to splash noise);
• Hose symptom ( auscultation determines the complete absence of any sounds).

In order to clarify the diagnosis of intestinal obstruction, various instrumental diagnostic methods are used.

The following methods are used to diagnose intestinal obstruction:

• Abdominal Ultrasound helps to identify signs of intestinal obstruction, as well as determine the type of this pathological condition. So, for example, with dynamic intestinal obstruction, the accumulation of a large amount of air and gases in the intestine is characteristic ( hyperpneumatization), the absence of retrograde ( back-forward) peristaltic waves, thickening of the kerkring folds due to the imposition of fibrin. In turn, with mechanical intestinal obstruction, a pronounced expansion of the intestinal lumen, an increase in the thickness of the intestinal walls, and hyperpneumatization of the intestine are observed.
• X-ray of the abdomen allows you to identify liquid and gas in the loops of the intestine, as well as the specific striation of the small intestine. The advantage of this method is its availability.

If you suspect intestinal obstruction The patient needs to be urgently hospitalized to avoid complications). In most cases, intestinal obstruction is treated with medication. Cramping pains are relieved with antispasmodics ( no-shpa, papaverine, etc.). If the blockage occurred at the level of the small intestine, then in this case, gastric lavage is performed to free it from stagnant contents. With blockage of the large intestine, they resort to setting siphon enemas ( allow you to completely cleanse the intestines). Only in case of failure drug therapy doctor may prescribe surgical operation. During the operation, intestinal patency is restored ( straightening of torsion, excision of the tumor, dissection of adhesions). In addition, if necessary, the removal of non-viable segments of the intestine is carried out. At the end of the operation, the abdominal cavity is washed with solutions of antiseptics and antibiotics and the wound is sutured in layers ( sometimes leave a drain).

pancreatitis

Pancreatitis is an inflammation of the pancreas that occurs due to premature activation of pancreatic enzymes ( pancreatic enzymes). Ultimately, these digestive enzymes begin to digest the tissues of the gland itself. The danger of pancreatitis lies in the fact that pancreatic enzymes can enter the bloodstream and, penetrating into various organs and tissues, cause serious damage to them ( until cell death).

The causes of pancreatitis are as follows:

• excessive alcohol consumption;
• cholelithiasis ( formation of stones in gallbladder that can block the pancreatic duct);
• unbalanced and irrational nutrition ( excessive consumption of fatty spicy food );
• direct trauma to the abdomen;
• various viral and bacterial infections ( helicobacteriosis, hepatitis viruses);
• helminthic infestations (opisthorchiasis, ascariasis);
• hormonal imbalance.

There are acute and chronic forms of pancreatitis. Acute pancreatitis is the most dangerous form, since in this case not only the tissue of the gland itself can be damaged, but also the lungs, heart, kidneys, and liver. The severity of symptoms depends on the severity and phase of pancreatitis.

The following symptoms of pancreatitis are distinguished:

• Pain in the upper abdomen- the most basic and characteristic symptom of pancreatitis. Pain may have different localization and depends on the area of ​​inflammation of the pancreas. If the head of the gland is involved in the pathological process, then the pain occurs directly under the sternum, while if the caudal part is affected, the pain radiates to the left side. In the case when the pathological process covers the entire gland, the so-called "girdle" pains appear. Abdominal pain in pancreatitis occurs suddenly and is very intense. It is characteristic that the pain syndrome is not stopped by conventional antispasmodic drugs and painkillers. It is worth noting that the pain can be reflected not only in the left side, but also in the left shoulder or under the shoulder blade.
• Vomit most often occurs after eating and is reflex in nature. In severe cases, repeated and indomitable vomiting appears, which does not bring relief.
• General deterioration observed at the average and severe course pancreatitis. Repeated vomiting leads to dehydration, which is manifested by severe thirst, weakness, blanching or cyanosis of the skin ( bluish skin tone). Blood pressure may also drop hypotension).

Pancreatitis is diagnosed by a gastroenterologist. Depending on the form of the disease ( acute or chronic pancreatitis) diagnosis may vary slightly.

The following methods are used to diagnose pancreatitis:

• Ultrasound examination of the abdominal organs- the main method of studying the pancreas. Ultrasound can reveal an increase in the size of the organ, detect the presence of areas of increased or decreased echogenicity, which corresponds to the inflammatory process, and also visualize cysts ( limited cavities where functional tissue is replaced by connective tissue).
• CT scan is a highly informative method that complements the results of ultrasound. With the help of computed tomography, even small segments of damage to the pancreatic tissue are detected. In addition, the method allows you to judge the state of the excretory ducts of the pancreas.
• Blood chemistry allows you to evaluate the work of many organs, including the work of the pancreas. Pancreatitis is characterized by elevated amylase levels ( pancreatic enzyme that breaks down carbohydrates). For greater reliability of the result, a comparative assessment of amylase indicators in the blood and in the urine is carried out.

In the treatment of pancreatitis, as a rule, use conservative method. To reduce the load on the pancreas, patients with acute pancreatitis should adhere to a starvation diet for several days. To relieve acute pain, they are used as non-narcotic ( analgin, paracetamol) and narcotic analgesics (promedol). With the help of anti-enzymatic drugs ( pantripin, gordox, traskolan) stop the process of tissue damage both in the pancreas itself and in other organs. In quite rare cases, they resort to surgical treatment in order to remove dead areas of the pancreas. Treatment of chronic pancreatitis involves reducing the functional load on the gland by prescribing pancreatic enzymes ( pangrol, pancreatin, creon, etc.).

What causes pain in the left side immediately after eating?

Pain in the left side, which appears immediately after eating, can occur with various diseases of the digestive system. Most often, this symptom occurs against the background of gastritis or stomach ulcers. The fact is that with these diseases, inflammation or ulceration of the gastric mucosa occurs. In the initial stages, pain may be almost imperceptible or completely absent. At the time of eating in the stomach, hydrochloric acid and gastric enzymes are produced, which affect not only the food bolus, but also the affected area of ​​the mucosa, causing pain and discomfort. As a rule, these pains are localized in the upper abdomen, directly under the sternum. However, in some cases, if there is a mucosal lesion in the region of the greater curvature of the stomach ( outer convex edge of the stomach), this pain can also occur on the left.

Sometimes this pain is the first symptom of an enlarged spleen. The stomach and spleen are located close to each other, but under normal conditions they practically do not contact. During eating, the stomach gradually stretches, while an enlarged spleen can prevent this and compress the stomach. This leads to rapid oversaturation and the appearance of pain in the left side immediately after eating.

Inflammation of the pancreas pancreatitis) can also lead to severe pain in the left hypochondrium. Most often, the abuse of fatty foods and alcohol leads to pancreatitis. Fatty foods increase the production of pancreatic enzymes, while alcohol causes spasm of the smooth muscles of the pancreatic excretory ducts. As a result, pancreatic enzymes ( pancreatic enzymes) begin to digest the pancreas itself, causing severe epigastric pain ( top part belly) or left hypochondrium.

What causes pain in the left hypochondrium and radiates to the back?

As a rule, pain in the left hypochondrium along with irradiation ( reflection of pain) in the back is observed in acute pyelonephritis. This disease is an inflammation of the kidneys and renal pelvis ( connects the kidney and ureter), which most often occurs due to a bacterial infection. Pyelonephritis is unilateral ( left handed or right handed) and bilateral. Since pyelonephritis affects the kidney parenchyma ( functional tissue of the kidney), then initially the pain occurs in the lumbar region ( at the projection site of the kidney). Then the pains are able to be reflected in the left side. In addition, with acute pyelonephritis, moderate or heat (up to 38 - 39ºС), chills, general malaise, nausea and even vomiting.

In some cases, this symptomatology is observed in acute pancreatitis ( inflammation of the pancreas). If only the tail of the pancreas is involved in the inflammatory process, then the pain appears in the left hypochondrium. The reflection of pain in the back suggests that the peritoneum is involved in the pathological process ( membrane that covers the abdominal organs). Acute pancreatitis is characterized by the appearance of a sharp and very severe pain. Also, with pancreatitis, pancreatic enzymes can enter the bloodstream, which can affect the heart muscle, liver, lungs, kidneys and other organs. That is why acute pancreatitis is very dangerous pathology which requires immediate hospitalization.

Why does pain occur in the left hypochondrium when inhaling?

The appearance of pain in the left hypochondrium during inspiration most often indicates inflammation of the pleural sheets. These leaflets ( parietal and visceral) consist of connective tissue and form the pleural cavity, which covers each lung from above. Normally, the pleural sheets slide smoothly in relation to each other during inhalation and exhalation. With the penetration of pathogenic bacteria ( most often it is E. coli, staphylococcus, streptococcus) fibrin threads are deposited into the pleural cavity on the surface of the pleural sheets ( one of the main protein components of the blood coagulation system). As a result, the parietal sheet begins to rub against the visceral sheet, which makes breathing painful. This is due to the fact that a large number of pain receptors are concentrated in the pleural sheets.

It is worth noting that this symptomatology occurs with dry or fibrinous pleurisy. Fibrinous pleurisy is characterized by an increase in body temperature to 37 - 38ºС and the appearance unproductive cough without sputum. Pain during inhalation forces you to switch to shallow breathing. In addition, to reduce pain in the left or right hypochondrium, patients take a forced position.

In this case, the pain occurs on the left side and gives more to the front, the patient feels supportive discomfort.

In addition, pain on the left under the ribs can be given to the anterior part with stomach and duodenal ulcers. With an ulcer, the pain is acute and migrates to the right hypochondrium.

In disorders of the nervous system, paroxysmal pain on the side under the left ribs is accompanied by such unpleasant symptoms as migraine and convulsions.

Shingles affects the nerve endings in the intercostal region, so it does not appear immediately. Initially, aching pain on the side in the left hypochondrium turns into acute, and only with time do herpetic eruptions appear on the skin.

Pain behind the left under the ribs

Pain in the left hypochondrium, which gives back, occurs with kidney disease (in this case, the left kidney) and vertebral osteochondrosis.

The kidneys can hurt in different ways:

• Severe, unbearable pain is a sign of renal colic.
• Constant, but not severe "severe" pain - with inflammation and enlargement of the organ.

Pain under the ribs on the lower left

Almost always, the pain under the left ribs below (especially under the lower rib) is aching in nature and is provoked by an enlarged spleen.

The spleen is an organ that, increasing, reacting to all kinds of diseases.

1. Infectious diseases provoke an increase in the spleen - infectious mononucleosis, accompanied by fever, tonsillitis, swollen lymph nodes.
2. Hemoblast diseases: lymphomas, leukemia, chronic lymphocytic leukemia.
3. Septic diseases: purulent abscesses, bacterial endocarditis
4. Chronic diseases with a high degree of severity: tuberculosis, lupus erythematosus, malaria.

Pain under the lower left rib, which is associated with an enlarged spleen, is a very dangerous symptom, since in difficult cases the inflamed organ can rupture even with the slightest movement.

Symptoms of pain on the left under the ribs

In order to understand what disease the pain on the left under the ribs can portend, it is not enough to determine its localization. An important point in making a diagnosis is the nature pain. The pain may be:

• Sharp.
• Dumb aching.
• Acute.
• Stabbing.

Depending on the nature of the pain and its accompanying symptoms, it is possible to determine which particular organ needs careful treatment. medical examination and subsequent treatment.

Dull aching pain on the left under the ribs

If you feel aching pain on the left under the ribs, which is also located in the middle of the abdomen, this indicates gastritis or stomach ulcer. Associated symptoms these diseases are:

• Relief vomiting.
• Decreased appetite.
• Diarrhea.
• Sour and bitter eructations.

Often gastritis with reduced secretion of gastric juice provokes the occurrence of such a terrible disease as cancer.

Dull aching pain in the left hypochondrium is also a sign of stomach cancer. But it should be remembered that pain can also take on a sharp character. Characteristics of stomach cancer are:

• Unreasonable weight loss.
• Anemia or signs of intoxication (jaundice of the face and eye proteins).
• Increasing weakness and impaired performance of a person.
• Depression.
• A sharp desire to change the diet, for example, an aversion to meat.

A dull aching pain at the bottom of the left rib indicates an enlarged spleen - splenomegaly.

Often, aching pain on the left pesters people suffering from diseases of the pancreas. It is in the left hypochondrium that the “tail” of the organ is located, so the attack begins there. After the pain takes on a girdle character. Concomitant syndromes of pancreatic diseases:

• Elevated temperature.
• Vomit.
• Nausea.

Sharp pain on the left under the ribs

Sharp pains in the left hypochondrium are characteristic of gastric and duodenal ulcers. They can give to the lower back and back. Sharp pains are so excruciating that the patient is forced to be in a squatting position, clasping or pressing his stomach against a solid object. In addition, ulcers suffer from:

• "hungry" pains.
• Heartburn.
• Vomiting.
• Constipation.
• Weakness, irritability and headaches.

Sharp pain can increase under the ribs on the left after physical exertion or nervous strain.

Stitching pain under the ribs on the left

Stitching pain in the left hypochondrium, which is aggravated by coughing or inhaling - serious symptom diseases of the lungs (left-sided pneumonia, inflammation of the left lung, tuberculosis, lung cancer) or the left side of the diaphragm.

Associated symptoms for lung diseases are:

• Elevated temperature.
• Fever (for pneumonia and subphrenic abscess).
• Constipation.
• Breathlessness.
• Pale blue color of the nasolabial triangle (for pneumonia).
• General intoxication of the body (if the diaphragm is damaged).

Severe pain in the left hypochondrium - its appearance is a symptom a large number various diseases and pathological conditions. Since the left subcostal region of the abdomen corresponds to a part of the stomach, the left side of the diaphragm, intestinal loops, the pole of the left kidney, the pancreas and the most obvious organ - the spleen, therefore, most often the causes of such pain may be a violation of the functioning of these organs.

The nature of the pain on the side under the ribs

First, it is worth deciding what the hypochondrium area means - this is the upper left quadrant, located under the ribs (see Fig.). Depending on the nature of the pain, when it appears, after what events, it is possible to determine what caused it and which doctor should be contacted for an accurate diagnosis and treatment:

Stitching pains in the left hypochondrium during exercise

If they occur only during intense physical activity, such as running, brisk walking (on a treadmill), jumping, during fitness training and other physical activities, this is not scary and happens in practically healthy people. Such pain passes quickly and speaks only of insufficient warm-up before exercise and too sharp or excessive movement.

Without a thorough warm-up (20 minutes), the body does not have time to adapt to a sharp increase in blood circulation. If the pain occurs only during exercise, there is no particular danger in this, if the person does not suffer from heart disease (cardiomyopathy, etc.). Even if you are absolutely healthy, you should not test the body - stop, relax your arms, shoulders, take a deep breath or, during a sharp exhalation, press your palm on the place where the pain is located, while sharply leaning forward with your body, so repeat 2-3 times and you can run further.

You should also ensure that breathing during exercise is deep enough, since shallow and frequent breathing is accompanied by small excursions of the diaphragm. Usually, sharp stabbing pains on the left and even on the right when running occur if the workout starts abruptly without warming up and after eating. After eating, at least 1-1.5 hours should pass, since the gastrointestinal tract is loaded with work, the body has not warmed up and rebuilt, hence the double load and double pain.

Dagger cutting acute pain syndrome

It is a completely different matter if there is a dagger cutting, sharp pain in the left side under the ribs, when it is not associated with a load and appears suddenly - this is a reason for urgent medical care. Sudden severe pain in the left hypochondrium may indicate a rupture of the renal pelvis, spleen, be the result of perforation of the loops of the small intestine or the stomach wall. And also as an abdominal variant of myocardial infarction or acute pancreatitis.

Sharp, severe pain after an injury

If pain occurs when breathing in after a fall, injury, or car accident- this can be a sign, a symptom of serious damage to the internal organs that threaten life.

Dull pain in the left hypochondrium

Diffuse, dull pain under the ribs on the left, if it periodically occurs for a long time, is a cause for concern, as it can be a symptom of a sluggish chronic disease of the gastrointestinal tract. Most often it is cholecystitis, gastritis, pancreatitis and others. To confirm or exclude these pathologies, you should contact a gastroenterologist, make a number of laboratory tests, instrumental studies, ultrasound and other procedures, tests.

Splenomegaly in various blood pathologies, autoimmune or systemic diseases, sepsis, bacterial infections - this is a reason for dull or aching chronic pain on the left in the hypochondrium.

It's a dull pain

Constant pulling, aching pain on the left under the ribs is a symptom, a sign of sluggish colitis or duodenitis, if this symptom is accompanied by nausea, vomiting, this may be a manifestation of a stomach ulcer. Unrelated to the gastrointestinal tract, such pain may be a sign of a pre-infarction condition, coronary heart disease, or angina pectoris.

So, the pain that occurs in the left upper abdomen can be caused by the following causes, pathologies and diseases:

• Cardiomyopathy, heart attack, heart muscle damage
• Most diseases of the gastrointestinal tract - cholecystitis, gastric ulcer, colitis, duodenitis
• Spleen rupture (trauma) or enlargement of the spleen due to infection
• Spleen infarction due to arterial thrombosis
• Tumors of internal organs
• Diaphragmatic hernia or diaphragmatic injury
• Rheumatic manifestations
• Left-sided pneumonia, left-sided pleurisy, which occur in the lower part of the left lung

Pain in the hypochondrium should be distinguished according to the mechanism of occurrence

All possible pains in the left side under the ribs are also divided according to the mechanism of occurrence, this can serve as an additional diagnostic feature to help determine the pathology of a particular organ or system.

Reflected pain - these pain sensations appear as radiating from fairly distant organs, such as in a heart attack, left-sided pneumonia, pleurisy or other diseases.
Visceral pain- with spasms of the intestines or impaired motility of the stomach, as well as sprains of their muscle fibers. When there may be aching and dull pain, or cramping pain - with intestinal colic, which often radiate to nearby parts of the body.
Peritoneal pain-constant and clearly localized pain, which is caused by irritation of the peritoneum, as, for example, with a perforated stomach ulcer. Such pain increases with breathing, movement, it is cutting, sharp.

When pain in the left hypochondrium in front

If such pain is localized under the ribs in front, this rather indicates diseases of the spleen or damage to the tissues of the stomach. In these cases, the differential diagnosis is carried out with myocardial infarction, colitis of the upper intestinal loops,. If the pain shifts more to the center, a combination of stomach disease with diseases of the gallbladder and duodenum is possible.

When pain is behind

Most often, when the left kidney is damaged, the pain is localized in the left hypochondrium at the back, it is strong enough, constant, to diagnose kidney diseases, an ultrasound should be done, and a general urine and blood test should be taken. In addition to the pathology of the left kidney, such pain can occur with thoracic and lumbar osteochondrosis, palpation of the paravertebral processes can give this pain syndrome.

Girdle pain combined with pain on the left

If girdle pain appears in the area under the left ribs, passing from behind to the anterior abdominal wall, this may be a sign of inflammation of the pancreas - pancreatitis. At the onset of inflammation, there is an unbearable burning girdle pain, which subsides a little when a person leans forward in a sitting position.

Diaphragm pathologies

Constant pain in this area can occur with pathologies of the diaphragm, diaphragmatic hernia. A hole in the diaphragm, necessary for the esophagus, which connects to the stomach, separates the chest cavity from the abdominal cavity. And with the weakening of the muscle tissue that regulates this hole, the lumen expands, therefore upper section stomach can extend beyond the abdominal cavity into the chest.

In this case, the contents of the stomach are thrown into the esophagus, causing constant dull, aching pain on the left, with nausea, heartburn. Promote development diaphragmatic hernia can - pregnancy, obesity, excessive physical activity, and also often this pathology occurs in older people with a general weakening of the entire muscular apparatus. Sometimes this condition is aggravated by a pinched stomach, then there are sharp, cutting, sharp pains in the left hypochondrium.

Cause - intercostal neuralgia

Various neurological diseases can cause compression or irritation of the intercostal nerves. Pain in intercostal neuralgia has a wide range of manifestations:

• In the region of the ribs, under the ribs - shooting, piercing, sharp or aching, burning or dull pain (see also).
• The pain may increase with sudden movements, sneezing, inhaling, coughing, even with a change in body position.
• Attacks of intercostal neuralgia are accompanied by stitching, on the left side, manifested by muscle twitches, pallor or redness of the skin, and increased sweating.
• When pressing on some points on the back, chest, between the ribs or along the spine, pain also appears.

With neuralgia, pain can be localized not only in the left side, but also in the lower back, under the scapula (as in heart disease). They can be at night, and in the morning, and during the day, for quite a long time, sometimes a feeling of numbness appears in places of damage to the nerve pathways.

Cardiac pathologies

Aching pain in the left side in combination with shortness of breath during exertion and even at rest, nausea, palpitations, burning and heaviness in the chest occur with heart diseases, such as coronary heart disease. With the defeat of the coronary arteries, the blood supply to the heart muscle is disrupted, causing such a pathological condition as ischemia.

Also, similar pains under the ribs can occur with cardiomyopathy - these are several different diseases that lead to dysfunction of the heart muscle, while there is no pathology of the valvular apparatus, arterial hypertension, heart disease. In cardiomyopathy, the heart muscle changes structurally. It manifests itself fatigue, pain in the left side during physical exertion. .

Pathological conditions of the spleen

The spleen is a fragile, easily torn organ, so any of its pathological conditions is reflected in pain. Its slight increase is difficult to recognize, especially in fat people, because it lies deep in the left hypochondrium. Enlargement of the spleen or splenomegaly occurs with some infectious diseases such as infectious mononucleosis. However, in addition to pain in the spleen area, pronounced symptoms are inherent in this disease, such as fever, muscle pain, headache, swollen lymph nodes, general intoxication, tonsillitis, liver enlargement. The spleen performs several important functions in the body:

• This is the thinnest blood filter
• It is the largest lymph node
• It is the largest conglomerate of reticuloendothelial tissue

With hypertrophy of the spleen, when it performs an immune, phagocytic and filtering function in an enhanced mode, that is, against the background of immune complex diseases, hemolytic anemia, acute severe infections, it increases in size and can cause pain on the left. Other causes of pain and enlargement of the spleen include trauma, infiltration, tumors, or defects in its development. Especially acute sharp pain in the area under the ribs occurs upon impact, trauma, leading to rupture of the spleen. In addition to pain, a sign of a rupture is the cyanosis of the skin around the navel, since a large amount of blood accumulates there, and pain radiates from the left hypochondrium to the back, if such symptoms appear, you should call an ambulance.

Diseases of the stomach, pancreas

• Gastritis

This disease affects the majority of the population, since the current state of the food industry, aimed at creating chemicalized products, contributes to the development of functional disorders of the stomach and the entire gastrointestinal tract. The gastric mucosa is quite sensitive to any irritants, which are more than enough in our daily diet. Gastritis is most often manifested by belching, aching pain in the hypochondrium, nausea, pain in the epigastric region, vomiting, heartburn, heaviness, and a feeling of pressure. These symptoms appear shortly after eating, and general disorders may also occur - pallor, weakness, irritability, impaired sensitivity of the lower and upper limbs, signs of dyspepsia - diarrhea, .

• Stomach ulcer

It has similar symptoms with gastritis and depends on the duration and severity of the disease, in contrast to duodenal ulcers, when pain occurs during hunger, an empty stomach, stomach ulcer pain occurs after eating. Also, this causes heartburn, nausea, vomiting, belching sour, loss of appetite and body weight. With a perforated ulcer, the main striking symptom is dagger, sudden pain, pallor, and general weakness.

• Diseases of the pancreas

The most typical symptoms acute pancreatitis is a severe pain under the left hypochondrium, in the left side, and in the epigastric region, of a girdle character, accompanied by vomiting with bile, nausea, fever, it is also possible to stain the urine in a dark color and lighten the feces. The pain is so severe that the person is forced to sit bent over. In chronic pancreatitis, patients complain of dull aching pain, especially after a lavish feast. With oncological lesions of the pancreas, it is very difficult to establish a diagnosis, this is a very small, inaccessible organ that is difficult to diagnose and treat, and the symptoms of cancer are practically not noticeable at the onset of the disease.

• Oncological diseases of the gastrointestinal tract

In our time of oncological tension, any manifestations of ailments, weakness, lack of appetite, anemia, aversion to a certain food, for example, meat, rapid satiety, periodic pain in the stomach, intestines, a series of constipation with diarrhea, should alert a person, especially with age. Oncology is dangerous for its low-symptomatic course in the early stages. For any persistent pain, you should consult a doctor to find out the cause and conduct timely therapy.

The left half of the human body is a very vast area, where nature has placed a variety of organs and structures: intestinal loops, spleen, kidney, pancreas, stomach, reproductive system. If a person complains to a specialist about the appearance aching pain in left side- it is important to take into account all the points in order to conduct a competent differential diagnosis.

The localization of unpleasant sensations, their severity and nature, the presence of irradiation and duration are important. After making a preliminary diagnosis, the attending physician will recommend a number of diagnostic procedures to confirm it.

Reasons for development

Let's analyze the most common ones that need to be excluded first.

Pancreas

Aching pain in the left side under the ribs, which occurs immediately after eating and is accompanied by severe flatulence, problems with bowel movements, may signal the presence of a pathology from the outside. This is the most common cause of rather unpleasant sensations under the left ribs.

Spleen

Less likely to suspect spleen problem, since clinical manifestations appear already at a very advanced stage. The spleen is an organ that makes itself felt already in the period of decompensation of its own capabilities. It is responsible for hematopoiesis, therefore, the symptom of aching pain in the left side in front may be accompanied by the formation of hematomas of varying severity. Blood tests will confirm abnormalities in the blood system.

Heart disease

People tend to get confused heart pathology(for example, ischemic disease), with deviations in the activity of the digestive organs. This is due to the fact that periodic aching pain in the left side is similar to angina attacks. Specialist only cardiology profile a good differential diagnosis can be made. Confirmation will be the results of the ECG and ultrasound.

kidneys

If more discomfort occurs from the lumbar region, suspicion falls on the formation of inflammatory manifestations in or in the human musculoskeletal system. Aching pain in the left side from the back, accompanied by an increase in temperature parameters, as well as dysuric disorders, are pathognomonic (unambiguously indicating) for kidney pathologies (for example,).

Confirmation will be the results of urine tests:

• The presence of proteinuria and leukocyturia
• Increasing specific gravity

Problems with the spine

Provoking pain by physical exertion, an awkward turn of the body, long stay in one pose - they will talk about degenerative modifications in the structures of the spine. Significant, acute restriction of mobility, often characteristic of either hernial incarceration.

Stomach

Stomach problems are one of the most common causes discomfort caused by gastritis or other dyspepsia (deviation in the normal activity of the stomach). Aching pain in the left side of the abdomen, which occurs in its upper region, begins to disturb a person when eating poor-quality food, alcohol abuse, after taking certain medications (for example, Aspirin). Symptoms may include nausea and even vomiting. With gastritis, you can remove such discomfort by taking antacids that lower the level of acidity in the stomach.

Appendicitis

Despite the fact that the process of the caecum is located on the right, the left side of the lower abdomen often aches due to incipient inflammation of the appendix. This is a very dangerous condition, so when acute pain occurs, the patient needs urgent operation because delay poses a threat to human life.

Diaphragmatic hernia

Diaphragmatic hernia is a pathology in which the diaphragm that separates the chest cavity from the abdominal cavity expands the opening through which the esophagus connects to the stomach. Dull aching pain in the left side at the top appears when the stomach protrudes through this pathologically enlarged hole, aggravated during bending or while lying down.

Traumatization

If the appearance of severe aching pain in the left side preceded by trauma, a person can clearly indicate the time and location of the impact, as well as the nature of the injury itself (bruise or fracture).

The specialist will carry out diagnostic procedures to clarify the nature of the injury, the presence of complications, for example, hemo- or pneumothorax.

Symptoms may get worse after vigorous movement, sneezing, talking loudly, adopting a certain body position. This greatly complicates the performance of the work capacity of the victim. There comes the impossibility of a good night's rest. Timely seeking a consultation and carrying out adequate treatment tactics in the situation that has arisen will eliminate the main root cause of pain in the left side in a short time.

Girdle nature of pain, with the addition of a variety of rashes, may also indicate the addition of a viral pathology - herpetic lichen. Therapeutic tactics will be adjusted by the attending physician according to the existing clinical manifestations. The subgroup of NSAIDs (non-steroidal anti-inflammatory drugs) will be supplemented with antiviral drugs.

Pain in the lower left region

If a person during a consultation with a specialist complains about the presence of aching pains in the left side of the lower abdomen, one can suspect inflammatory manifestations in the loops of the large intestine, as well as in the urinary structures, or the genitals.

The nature of the pathology of the intestine will be indicated by a change in the stool:

• Its darkening or lightening
• Liquid consistency
• The presence of various impurities

Exacerbation of pyelonephritis or glomerulonephritis will lead to darkening of the urine, the presence of blood, leukocytes, and protein in it. The symptoms of hyperthermia and general intoxication will join.

Aching pain in the left side in women can be a symptom inflammatory pathology in the tubes of the uterus or ovaries. A sign of suspicion of an ectopic pregnancy will be especially alarming. An emergency vaginal ultrasound will put everything in its place.

Aching pain in the left side in men can be observed due to vesiculitis, prostatitis or orchitis. All these pathologies inflammatory nature quite amenable to treatment tactics, you just need to turn to a specialist in a timely manner.

The nature of the pain

Left-sided pain manifestations can be of a varied nature of severity, which speaks volumes to specialists:

• Dull, aching pain in the left side indicate a gradual, often chronic inflammatory process. Often there are cases when the patient has not consulted a specialist for too long, trying to cope on his own by taking analgesics.
• Drawing pain on the left side most often characteristic of purulent pathologies pelvic structures. This indicates a long course of pathology, the presence of infringement of nerve endings by a negative focus, for example, a malignant neoplasm.
• If a aching left side under the ribs, in addition, there is belching, heartburn, nausea - pathologies of the digestive tract should be excluded.
• Sharp pain on the left, caused by spasms at the time of passage of stones through the ureters, are so intense that a person even loses consciousness. In women, ovarian rupture may be suspected.
• Stitching character of pain indicates the presence of ulceration of organ tissues, for example, the ureter or intestinal loops.

Do not ignore the accompanying symptoms. If aching pain in the left side of the abdomen is also accompanied by an increase in temperature, urge for nausea and vomiting, diarrhea or general lethargy, a specialist should be consulted immediately. Delay can contribute to the formation of life-threatening complications (eg, peritonitis).