The liver, a large organ located in the upper right abdomen, plays a central role in maintaining overall health. It performs vital functions, including processing nutrients from food, metabolizing drugs and toxins, and producing bile for digestion. It continuously filters harmful substances from the blood for elimination.
The Liver and Pain Perception
The liver itself does not contain many pain receptors within its main tissue. This means that direct injury or disease affecting only the liver tissue may not cause immediate pain. Pain associated with the liver typically originates from the stretching of its outer covering, a thin fibrous membrane called Glisson’s capsule.
When the liver swells or becomes inflamed, this capsule can stretch. The stretching of Glisson’s capsule activates pain receptors, leading to discomfort. Therefore, while the liver’s internal structure might not feel pain, its surrounding protective layer can.
Why Pain is Felt in the Liver Area
Pain in the upper right abdomen often relates to the liver. Inflammation or enlargement of the liver causes Glisson’s capsule to distend, triggering pain signals. This discomfort can manifest as a dull ache or a throbbing sensation in the area just below the rib cage.
Pain in this region can also be a result of “referred pain,” where discomfort originates in one area but is felt in another. The liver shares nerve pathways with nearby organs such as the gallbladder and pancreas. Issues with these neighboring structures, or even musculoskeletal problems, can sometimes be mistaken for liver pain.
Common Conditions Causing Pain Near the Liver
Several conditions can lead to pain in the liver area, primarily by causing the liver to swell or affecting nearby organs.
- Hepatitis, an inflammation of the liver, can be caused by viral infections, alcohol use, or autoimmune disorders. This inflammation causes the liver to enlarge, stretching Glisson’s capsule and resulting in upper abdominal pain.
- Fatty liver disease, including nonalcoholic fatty liver disease (NAFLD) and its more severe form, metabolic dysfunction-associated steatohepatitis (MASH), involves fat accumulation in the liver. Significant fat buildup can lead to inflammation and liver enlargement, causing discomfort or a feeling of fullness in the upper right abdomen.
- Liver cirrhosis, characterized by widespread scarring, can also cause pain, often described as dull or throbbing. This pain can be due to the liver’s fibrous changes and associated conditions like fluid buildup in the abdomen (ascites) or an enlarged spleen, which place pressure on surrounding structures.
- Liver cancer can cause pulsating, sharp, or dull pain, depending on tumor size and location, by damaging soft tissue or pressing on nerves.
- Liver abscesses, pockets of pus from infections, can cause pain in the upper right abdomen and sometimes referred pain to the right shoulder.
- Budd-Chiari syndrome, a condition involving blockages in the veins that drain blood from the liver, leads to blood backing up and liver enlargement, causing abdominal pain.
- Gallstones or inflammation of the gallbladder, located directly beneath the liver, can cause upper abdominal pain that can radiate to the right shoulder or back.
When to Seek Medical Attention
Seek medical attention if you experience persistent or severe pain in the upper right abdomen. This is especially true if the pain is accompanied by other concerning symptoms. Signs like yellowing of the skin or eyes (jaundice), dark urine, or pale stools warrant prompt medical evaluation.
Other symptoms that signal a need for professional assessment include unexplained fatigue, nausea, vomiting, or swelling in the legs and ankles. A healthcare provider can accurately diagnose the cause of the pain and recommend appropriate treatment.