(The medical term for Liver Pain is Hepatalgia)
Abdominal pain is one of the most frequent complaints of Hep C patients, and one taken less than seriously by many doctors, because “the liver cannot feel pain”.
HEPATITIS & LIVER PAIN
Many chronic hepatitis C patients have expressed their frustration when it comes to describing and sharing the experience of various abdominal pains and discomforts with their physicians. Frequently, these acute or chronic pains are dismissed as having little or nothing to do with chronic liver disease. What do physicians know about abdominal pain?
Read the following and learn about the mechanisms of abdominal pain in general and the types of pain that result from diseases of some specific organs.
Abdominal organs are unresponsive to many stimuli that normally would elicit severe pain.
For example, cutting or crushing of abdominal organs does not result in a recognizable sensation. The pain fibers in the viscera (large interior organs) are generally sensitive only to stretching or increased wall tension. The causes of stretching or tension vary. In hollow organs such as the intestine or gallbladder, nociceptive fibers are located in the muscular wall. Afferent (conveying towards a center) impuses travel along the sympathetic nerves.
In solid organs such as the liver and kidney, such fibers supply the capsule and react to capsular stretching. An inflammatory reaction to microbes or toxins produces organ pain (visceral) through the elaboration of tissue hormones or metabolites (substances produced by metabolism). Four different mechanisms give rise to abdominal pain: (1) visceral; (2) referred; (3) parietal peritoneal; and (4) psychogenic.
Pain resulting from stimulation of sensory afferent nerves innervating abdominal organs. The pain is often difficult to describe (usually as cramping or aching), dull in nature, and poorly localized to the midline from the upper (epigastrium) to the lower abdominal area. The pain may be accompanied by nausea, vomiting, sweating, pallor, and restlessness. Patients often move about in bed, occasionally finding relief with a change in position.
Visceral pain may be referred to a remote area of the body, where it is perceived as cutaneous pain (sensation of pain in the skin) in an area supplied by the same spinal cord level as the affected abdominal organ. Referred pain is usually well localized and appears when noxious visceral stimuli become more intense. Thus, swelling of the liver capsule by a hematoma (swollen blood vessels) after liver biopsy is first perceived in the abdomen but may be referred to the right shoulder.
PARIETAL PERITONEAL PAIN
When the parietal peritoneum (abdominal membrane that encloses that body cavity) becomes involved as a result of abdominal pathology (disease process), nerves supplying the area are stimulated and generally produce pain that is more intense and more precisely localized than is visceral pain. The classic example is the localized pain of acute appendicitis. Parietal pain is often aggravated by movement; hence the patient’s desire to lie completely still.
This is obviously abdominal pain that is perceived but without any local cause.
Unfortunately, this may be a pain mechanism that some physicians choose to attribute to some chronic hepatitis patients’ episodes of pain. However, as cited above, physicians should take the time to explain and concede that there are valid causes for different types and intensities of abdominal pain that arise from our internal organs due to inflammation and toxic conditions.
When the hollow structures of the gallbladder and biliary tract dilate due to the disease process, pain is experienced in the upper abdomen or right upper abdomen. Pain may also be referred to the back between the shoulder blades. Pain from the pancreas is also felt in the upper abdomen and is often referred to the middle of the back. In a manner analogous to the liver, gallbladder, and biliary tract on the right, lesions in the tail of the pancreas that involve the diaphragm, may result in referred pain to the left shoulder.
Bacterial or viral infection of any intraabdominal organ may cause abdominal pain
Interference with venous or arterial blood flow can affect the abdominal organs. Clinically this may present as severe abdominal pain and shock.
Source: FOCUS: On Hepatitis C Newsletter