Dr. I. Farahat
29/07/2023
Sharp Liver Pain: 7 Causes & Mimics.
Our content is not intended nor recommended as a substitute for medical advice by your doctor. Use for informational purposes only.
Types of liver pain
A. 3 Important facts about liver pain:
1. Liver pain is a rare presentation of liver diseases.
The liver is insensitive to pain. Pain from the liver results from a stretch, inflammation, or destruction of its capsule (liver capsule or Glisson’s capsule).
You will only feel pain from the liver when severe or advanced liver disease.
Most famous chronic liver diseases such as fatty liver disease and liver cirrhosis rarely cause pain.
2. Liver pain is often dull.
Most of the time, liver pain is often a constant dull ache. The most common causes of liver pain, such as acute hepatitis and liver tumors, cause dull pain in the upper right quadrant of the abdomen.
Sharp liver pain is a rare presentation, and it is a sign of severe disease (see the cause of sharp liver pain below).
3. Sharp pain in the liver area is frequently due to non-liver causes.
Sharp pain in the liver area (upper right abdomen) is frequently of non-hepatic origin.
The most frequent sources of sharp pain over the liver area include the gallbladder, ribs, and abdominal and intercostal muscles (see mimics of liver pain).
MORE: Liver Pain in Females: Location, Causes, Pregnancy, & More.
4. Other symptoms of liver affection are often present.
Sharp liver pain is not the only symptom. The liver is suspected as a cause of the upper right abdominal area when there are other symptoms of liver affections such as:
- Jaundice.
- Dark urine.
- Ligh-colored stool.
- Swelling of the abdomen (ascites).
- Swelling of the lower extremities (lower limb edema).
- Weight loss.
- Fatigue.
- Sometimes, vomiting of blood or passage of black stools.
- Confusion or coma (hepatic encephalopathy).
Sharp pain in the liver area without any above symptoms is unlikely to be of liver origin.
B. Causes of Sharp liver pain.
The possible causes of sharp liver pain are in the table below:
| Causes | Common symptoms |
| Liver trauma | – Major trauma (as with road traffic accidents) can cause lacerations in the liver resulting in sharp liver pain. |
| Liver abscess or cysts. | – Acute onset fever (which can be high-grade). – Anorexia, nausea, vomiting. – Sharp pain in the liver area. – Extreme fatigue and sickness. |
| Liver tumors (benign or malignant). | – tumors of small sizes are essentially painless. – large tumors cause constant dull pain; it becomes sharper when the tumor progresses. – Weigh loss. – Signs of liver failure in advanced stages (liver failure, itching). |
| Portal vein thrombosis. | – Swelling of the abdomen (ascites). – fever. – Vomiting of blood or passage of black stools. – symptoms of the cause (liver cirrhosis, liver cancer, and blood diseases). – The pain is often mild and dull, but it can be sharp in advanced cases. |
| Budd-Chiari syndrome. | – massive distension of the abdomen (ascites). – signs of liver failure (jaundices, dark urine, swollen lower limbs). |
| Perihepatitis (Fitz-Hugh-Curts) syndromes. | – It is an inflammation of the capsule around the liver, mainly affecting women with pelvic inflammatory disease. – severe liver pain while you move, cough, sneeze. – fever may be present. – Nausea and vomiting. |
| Acute hepatitis (rarely cause sharp pain). | – Acute onset jaundice (yellow skin, eye whites). – Dark Urine. – Clay-colored stool. – Nausea and/or vomiting. – Low-grade fever may be present. |
| Liver congestion (as with some chronic heart or lung diseases): rarely cause sharp liver pain | – Symptoms of heart disease such as shortness of breath, and inability to lie flat. – Symptoms of chronic chest disease such as COPD (chronic cough, shortness of breath). – Swollen lower limbs (right-sided heart failure). |
| Liver transplantation. | Patients who undergo liver transplantation may experience sharp pain in the transplanted liver. |
C. mimics of sharp liver pain (common).
If you don’t have any history or evidence of chronic liver disease, don’t consider the liver the first cause of sharp pain.
1 . Biliary colics and acute cholecystitis.
The biliary system (the gallbladder and the bile ducts) is attached to the liver. Stones, inflammations, or obstructions in the biliary system are common causes of sharp pain in the liver area (the right upper abdomen).
Description. | Biliary colics | Liver pain |
1. Location. | Usually, The right upper quadrant of your abdomen. | Usually in the right upper quadrant (more diffuse than biliary colic). |
2. Spread | – The pain may spread to the back of the right shoulder. – Also, it spreads to the epigastric area. | – The right side of the rib cage. – The right shoulder. – The right mid-back. |
3. Character | – In the form of attacks, it constantly builds up and then disappears gradually. | – Constant dull ache, often less intense than the biliary colic. – May be sharp in severe cases such as malignancy. – Maybe throbbing (pulsating) pain. |
4. Duration | At least 30 minutes. It may last up to 6 hours. | Prolonged for days, weeks, or months. |
5. Related to | – Triggered by foods (especially fatty food and large meals. – However, it can start spontaneously. | – The pain is continuous, not related to food. – Pressing on the liver area or moving may exacerbate the pain. |
6. NOT related to: | Movement, bowel movements, or the passage of flatus. | – Not related to food, bowel movement, nor the passage of flatus. |
7. Nausea | Often Present, severe. | May or may not be present. |
8- Commonly associated symptoms | Vomiting, sweating during the attack, and nausea. | There are jaundice, dark urine, swollen lower limbs, swollen abdomen (ascites), coma, and weight loss. |
2. Muscle and bone pain in the liver area.
The muscles of the right abdomen and the lower right ribs of the rib cage are a common source of sharp pain in the liver area.
Muscle strain, rib trauma, or osteoporosis are the leading causes. Rarely, a condition that causes slipping rib syndrome can cause sharp pain in the liver area. Learn More.
3. Other mimics of sharp liver pain:
- Retrocaecal appendicitis.
- Pleurisy (inflammation of the lung envelop).
- Lower right lung inflammation, abscess, or tumor.
- Subphrenic abscess.
- Right kidney pain.
D. When to see a doctor for liver pain?
See a doctor if you have:
- Unexplained pain in the liver area.
- Jaundice (yellowish discoloration of the sclera and the eye whites.
- Swollen abdomen or lower extremities.
- Fever or chills.
- Dark urine.
- Nausea or vomiting.
- Vomiting of blood or passage of dark stools.
MORE: 8 Warning Signs of a Dying Liver.
- Evidence-based
- Written by a doctor.
MD, Associate Lecturer of Gastroenterology and hepatology. An IBS sufferer, gut health enthusiast and writer.
Dr. I. Farahat
21/03/2024
