Liver pain in The back: 10 Causes & Mimics
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The most common liver pain location is the upper right quadrant of the abdomen.
The following diagram illustrates the possible sites of liver pain:
- The upper right abdominal quadrant.
- The lower right rib cage.
- The right shoulder.
- Liver pain in the back.
Non-liver causes of pain in the back (right side) are more common than liver causes.
Non-liver causes include muscle and bone pain, gallbladder pain, right kidney pain, etc.
Causes of liver pain in the back include:
- Acute hepatitis.
- Large-sized or multiple liver hemangiomas.
- Liver abscess or cyst.
- Primary liver cancer (Hepatocellular carcinoma).
- Secondary liver cancers (Metastases from other tumors).
- Previous surgery or taking a biopsy from the liver.
- Portal vein thrombosis.
- Perihepatitis (Fitz-Hugh Curtis Syndrome).
- Budd-Chiari Syndrome.
Causes of liver pain in the back.
1 . Acute hepatitis.
Acute hepatitis is an acute inflammation of the liver, often due to viral infection.
Acute hepatitis causes a dull aching pain in the upper right abdominal quadrant, the right side of the rib cage.
Acute hepatitis can also cause liver pain in the back. However, the liver rarely causes isolated back pain without upper right abdominal pain.
Symptoms of acute hepatitis:
- Acute onset jaundice (yellow skin and eye whites).
- Dark urine and light-colored stools.
- Diarrhea (pale yellow).
- Abdominal pain.
- Nausea with or without vomiting.
- Sometimes, low-grade fever exists.
Learn more about acute hepatitis.
2. Large-sized hemangioma.
Hemangiomas are irregularly shaped masses of blood vessels. They are entirely benign tumors that can affect different organs of your body, including the liver.
Liver hemangiomas are very common; Some studies found that almost 2% of people have liver hemangiomas (reference).
Liver hemangiomas are asymptomatic in 99% of people. Only huge or multiple liver hemangiomas can cause liver pain (including liver pain in the back).
Most liver hemangiomas are discovered accidentally during abdominal imaging (such as ultrasound or computed tomography).
Liver hemangiomas typically don’t require treatment unless they are huge, multiple, or complicated.
3. Primary liver cancer.
Primary liver cancer is a type of cancer that starts in the liver. Liver cancer rarely affects the healthy liver. Instead, they are often a complication of liver cirrhosis or viral liver infection (especially with hepatitis B virus).
Small-sized liver cancers are asymptomatic. But as the tumor grows, symptoms start to appear (including liver pain in the back).
Symptoms of liver cancer.
- Early stages (small-sized tumors) are often asymptomatic. Risk factors include hepatitis B and hepatitis c virus infection, liver cirrhosis, alcoholic liver diseases.
- Pain in the right upper quadrant of the abdomen often extends to the right side of the rib cage and the back.
- Weight loss, unexplained fatigue.
- Nausea, vomiting, change in bowel habits.
- The advanced disease causes jaundice, pale stools, dark urine, and loss of consciousness (hepatic coma).
Learn more about primary liver cancer (hepatocellular carcinoma).\
4. Metastatic liver cancer.
. Malignant tumors commonly spread to other sites of the body. The most common four organs of cancer spread are:
- The liver.
- The lungs.
- The brain.
5. Liver abscesses or cysts.
A liver abscess is a pus-filled mass inside the liver. Liver abscesses are not common and often develop due to bacterial or amoeba infection (reference).
Also, Your liver may contain cysts (a thin-walled structure with fluid within it). Most liver cysts are congenital (genetic defects).
Liver abscess causes severe symptoms with fever and severe pain (which can be felt in the back). On the other hand, liver cysts are often asymptomatic unless large in size or multiple.
6. Major liver trauma.
Because of its size, The liver is one of the easiest organs to be injured during abdominal trauma.
Major accidents such as road traffic accidents, fall from height are associated with blunt liver trauma.
The trauma may cause tears in the liver tissue and bleed into the abdominal cavity.
Liver trauma is often excruciating in the acute stage. Also, they can cause liver pain (including liver pain in the back) for weeks, months, or even years after the trauma.
7. Portal vein thrombosis.
The portal vein is the leading blood supplier of the liver; it is responsible for nearly 75% of the blood entering the liver.
It is vital because it is the leading way of nutrients absorbed from the intestine.
Obstruction of portal vein can be due to various causes such as primary liver tumors, Oral contraceptive pills, and blood diseases.
- Acute portal vein thrombosis can be silent at first.
- Abdominal pain (right upper quadrant).
- Liver pain in the back with acute portal vein thrombosis often signifies complications such as inflammation of the thrombosed pain or intestinal ischemia (death of the intestinal wall due to obstruction of its blood outflow) (reference).
- Fever may also occur.
- Bloating, nausea, and vomiting.
- Dyspepsia (indigestion).
Learn more about portal vein thrombosis.
8. Perihepatitis (Fitz-Hugh Curtis Syndrome).
Perihepatitis is an inflammation of the liver capsule enveloping the liver. Perihepatitis (Fitz-Hugh Curtis Syndrome) is a complication of pelvic inflammatory disease (PID).
PID is an infection of the female reproductive organs like the ovaries, fallopian tubes, and uterus. 10% of women present with perihepatitis (reference).
Perhepatitis pain is significantly severe, masking the original disease (PID).
- Severe upper right abdominal pain (The primary area of liver pain).
- The pain is often intense, associated with tenderness over the liver area when pressed.
- Liver pain frequently radiates to the right shoulder and the back.
- Pelvic (lower abdominal) pain.
- Abnormal uterine bleeding or discharge.
- Urinary frequency.
- Loss of appetite, nausea, or vomiting.
Learn More about Fitz-Hugh Curtis Syndrome.
9. Previous liver biopsy or liver surgery.
Some diseases may require a biopsy through a specialized needle from the liver. The most common complication of this technique is liver pain (reference).
The pain following biopsy is often in the upper right upper abdomen and radiates to the right shoulder and the back.
If you recently underwent a liver biopsy, consult your doctor for liver pain in the back.
Previous liver surgery:
Operations such as liver resection, liver transplantation can cause persistent postoperative liver pain.
Postoperative pain can be felt anywhere, including the upper right abdomen and the chest’s right side. Also, liver pain can be felt in the back and the right shoulder.
10. Budd-Chiari Syndrome.
Budd-Chiari Syndrome is an obstruction of the veins that drains blood from the liver. The block is often caused by a blood clot resulting from increased coagulability of the blood either due to a blood disease or a syndrome.
The syndrome affects women more than men. It causes liver pain (which can radiate to the back), swelling of the abdomen (ascites), and other symptoms of liver affections such as jaundice, weight loss, vomiting of blood, the passage of dark stool, etc.
Mimics of liver pain in the back.
A pain opposite to the liver area in the back is not necessarily of a liver origin. For example, pain in the mid-back area on the right side is more likely due to non-liver causes, as liver pain is rare.
The liver is not likely the cause of back pain as long as you don’t have other symptoms of liver affection.
More commonly, the below cause can cause back pain in the back (mid-back, right side).
- Muscle and ligament pain.
- Bone pain.
- Gallbladder pain in the back.
- Right Kidney pain.
- Slipped Rib syndrome.
- IBS pain.
These causes are discussed in-depth in this article.