Liver Pain in Females: Location, Causes, Pregnancy, & More.

Liver pain location in females.

The liver pain location in females is mainly in the upper right quadrant of the abdomen. Other areas of liver pain include the right side of the chest, Mid-back to the right, and the right shoulder.

The illustration below shows the possible liver pain locations in females:

1. The right upper quadrant of the abdomen (the liver area).
2. The lower right side of the chest.
3. The right shoulder.
4. The right mid-back area.

Liver pain is often a dull constant ache felt in the right upper abdominal quadrant. It can be sharp or throbbing (pulsating) pain in severe diseases.

Other pain locations are often added to the RUQ pain. The pain may increase when you press.

It is important to note that the gallbladder is a more common cause of right upper quadrant (RUQ) pain than the liver. Gallbladder pain also is referred to in the back and the right shoulder.

Females are three times more likely to develop gallstones than males (reference). So, the pain in the liver area is more likely to be due to gallbladder pain than liver pain. 

The differences between liver pain and gallbladder pain are in the table below:

For more details, read the article: 4 causes of pain in the liver area that comes and goes.

Causes of liver pain in females.

NOTE: The symptoms of the below diseases are discussed in detail HERE and HERE.

1. Acute Hepatitis:
   Acute liver inflammation can be due to viral infections (as hepatitis A) or other less common diseases such as Autoimmune Hepatitis (AIH) which is more predominant in women.
2. Budd-Chiari Syndrome:
   It is an obstruction in the veins draining blood from the liver. Leading to hepatitis, liver pain, ascites, and liver failure. Females have almost twice the risk of Budd-Chiari Syndrome compared to males (reference).
3. Fitz-Hugh Curtis Syndrome (perihepatitis):
   The syndrome affects only females as it is a pelvic inflammatory disease (PID) complication.
   Pus from the inflamed pelvic organs reaches the liver capsules and causes inflammation and adhesions. The Fitz-Hugh Curtis syndrome is characterized by very sharp liver pain in females.
4. Portal Vein Thrombosis (PVT):
   The portal vein carries blood from the intestine to the liver. It is responsible for around 75% of the blood entering the liver. Portal vein thrombosis is more common in females; OCP (oral contraceptive pills) is one of the PVT risk factors.
5. Benign liver tumors (as hemangiomas):
   Hemangioma is the most common liver tumor; other tumors include liver adenomas and focal nodular hyperplasia. Benign tumors are typically asymptomatic (painless) unless they are huge.
6. Liver Cancer (primary or metastatic):
   Primary liver cancers (as hepatocellular carcinoma and cholangiocarcinoma) or secondary (metastatic) cancer cause pain in their advanced stage.
   Unfortunately, the early stages of liver cancers are painless and asymptomatic. However, the late stages of malignant liver cancer are excruciating and difficult to treat.
7. Liver Abscesses:
   Liver abscesses are due to infections (typically bacteria or amoebic). They are often associated with a severe fever, malaise, and sharp liver pain.
8. Liver congestion:
   The blood coming out from the liver reaches the right side of the heart and the lungs. As a result, right-sided heart failure and chronic lung diseases lead to chronic liver congestion and liver pain.
   If left untreated, liver congestion can progress into cirrhosis and liver failure.
9. Pregnancy-related liver diseases:
   Such as Cholestasis of pregnancy, HELLP Syndrome, and acute fatty liver of pregnancy. These diseases will be discussed in the next section.

Causes of liver pain during pregnancy.

1 . Non-liver causes of pain.

Many common liver diseases are painless such as fatty liver, chronic hepatitis, and liver cirrhosis. Liver pain occurs only when its capsule becomes stretched.

So, The upper right abdominal pain during pregnancy is often due to non-hepatic causes of pain such as:

• Gallbladder pain.
• Colonic pain (trapped gas, IBS, infection, etc.).
• Abdominal muscle pain (strain).
• Rib cage pain on the right side.

Learn More about the non-hepatic causes of pain in the liver area (The right upper quadrant).

So, consider these sources of pain during pregnancy, especially if you don’t have symptoms suggestive of liver disease (such as jaundice, dark urine, light-colored stool, or itching).

2. Conventional causes of liver pain (discussed above).

The conventional causes of liver pain, such as acute hepatitis, liver tumors, etc., are also common during pregnancy (see the previous section).

3. Pregnancy specific causes:

A. AFLP (Acute Fatty Liver of Pregnancy).

The acute fatty liver of pregnancy is a very rare liver disease affecting pregnant women in their late pregnancy (third trimester).

The exact cause is unclear. However, risk factors include low body weight of the mother, male fetus, multiple pregnancies, and other diseases such as Preeclampsia (reference).

Symptoms:

• Early symptoms are non-specific as nausea, vomiting, abdominal pain, headache, and fatigue.
• Acute onset Jaundice, Ascites, swelling of the lower limbs.
• Dark urine, Light-colored stool.
• Coma can occur due to liver failure or due to low blood sugar.
• The condition is an emergency, and multiorgan failure can occur.
• There is no need to worry as the condition is very rare, and liver pain doesn’t occur as a separate symptom. The pain is often associated with severe symptoms as jaundice, ascites, etc.

B. ICP (Intrahepatic cholestasis of pregnancy).

ICP is another liver disease of pregnancy with unclear cause. It affects pregnant women in the second or third trimester, causing itching and liver pain.

Symptoms:

• Pruritis (itching) is the most common symptom; It often starts in the palms and soles.
• Liver pain (in the right upper abdomen).
• Poor appetite and nausea.
• Sleep disturbances.
• Sometimes, fatty diarrhea.
• Advanced disease may cause hepatitis and liver failure symptoms such as jaundice, dark urine, ascites, and loss of consciousness.

C. HELLP Syndrome.

HELLP (Hemolysis, Elevated Liver enzymes, and Low Platelet) is a severe pregnancy complication that involves the liver, kidney, and blood.

The exact cause of HELLP syndrome is still unclear. It can occur as a separate syndrome or associated with severe Preeclampsia (reference).

It is characterized by hypertension, loss of protein in the urine, red blood cells (hemolysis), and low platelet.

Symptoms:

• Frothy urine, lower limb edema, and puffiness.
• Hypertension (headache and dizziness).
• Liver pain during pregnancy (right upper quadrant pain) is present in 40% to 90% of cases (reference).
• Nausea and vomiting.
• Jaundice.
• The blurring of vision.
• Fatigue, shortness of breath.

E. Others.

• liver endometroisis.
• Hepatitis E infection (the virus only affects pregnant women).
• Herpes simplex hepatitis is more severe during pregnancy (reference).
• Budd-Chiari syndrome is commonest during pregnancy, recent delivery, and oral contraceptive pills (reference).

MORE:9 Types of Lower Stomach Pain During Pregnancy Third Trimester.