Schmerzen im rechten oberen Quadranten

Wo ist mein rechter oberer Quadrant?

The right upper quadrant is a section of your tummy (abdomen) on the upper right hand side.

Look down at your tummy, and mentally divide the area from the bottom of your ribs down to your pubic hair into four quarters. The quarter on your right side closest to your ribs is your RUQ.

© Von Blausen.com Mitarbeiter (2014). „Medizinische Galerie von Blausen Medical 2014“. WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436

Abdominale Quadrantenregionen

© OpenStax, CC BY 3.0, über Wikimedia Commons

Die Organe in Ihrem rechten oberen Quadranten sind Ihre:

• Leber.

• Gallenblase.

• Zwölffingerdarm und einige andere Teile Ihres Dick- und Dünndarms.

• Rechte Niere (hinten hinter den anderen Organen).

• Teil der Bauchspeicheldrüse.

• Die Aorta.

There are also the skin and nerves of that area of your abdomen.

Bei Erwachsenen sind die häufigsten Ursachen für Schmerzen im rechten oberen Quadranten:

• Gallensteine.

• Gürtelrose.

• Peptic ulcers - ulcers in the upper part of the guts.

• Gut problems (problems affecting the bowel).

• Pankreatitis.

These causes are discussed in detail below.

Gallensteine und Gallenblasenprobleme

• Gallensteine can block the bile duct, causing biliary colic – a severe, crampy pain in the right upper abdomen, often worse after eating fatty meals.

• The pain may spread to the back and shoulders.

• An infection may develop, called Cholezystitis, which causes more persistent RUQ pain along with a high temperature.

Gürtelrose

• Gürtelrose can cause pain in the right upper abdomen because it affects the nerves in that area.

• The pain is usually on one side of the body, under the ribs or around to the back, in a stripe-like pattern.

• It often feels burning, sharp, or tingly, and the skin can be sore to touch.

• A blistering rash usually appears a few days later in the same area.

• Some people find they continue to get a pain long after the rash of shingles has gone. This is called postherpetische Neuralgie.

• Many people get the shingles rash without significant pain.

Leberprobleme

The liver takes up a large part of your right upper quadrant but it doesn't often cause pain. Causes of pain from the liver include:

• Hepatitis (A, B, and C). This will usually result in jaundice and a fever and feeling generally unwell in addition to some pain in that area. Pain is not necessarily a feature.

• Abszess. Dies ist eine Ansammlung von Eiter, die Schmerzen, Empfindlichkeit und Fieber verursacht.

• Alkoholische Lebererkrankung. Too much alcohol can damage your liver, which may affect its function, turn your skin yellow (jaundice) and give you RUQ pain.

• Leberkrebs. This can start in the liver or have spread from other cancers. The liver may enlarge in certain blood cancers, such as lymphomas or Leukämien, and this can cause discomfort.

Darmprobleme

Several problems in your bowel can give you pain in the right upper quadrant. These include:

• Zwölffingerdarmgeschwür. Pain usually starts a few hours after eating and may improve with Antazida. It can gradually worsen and, in severe cases, you may vomit blood. This is an emergency - it is important to go to hospital straight away.

• Gastroenteritis. Infections in your gut tend to give you pain all over your abdomen, typically more in the middle but occasionally the pain may be in the RUQ area. It is usually associated with Durchfall and/or being sick (vomiting). You may have a mild fever.

• Verdauungsstörungen. This can give you a pain in the upper part of your abdomen, along with bloating and acid reflux.

• Morbus Crohn und Colitis ulcerosa. These long-term conditions can cause pain anywhere in the abdomen. They usually cause loose stools, sometimes with blood.

Schmerzen, die von der Bauchspeicheldrüse ausgehen

The pancreas sits in the upper middle of the abdomen and helps digest food and control blood sugar. Pain in the pancreas can be caused by:

• Pancreatitis (inflammation). This can cause right upper quadrant pain, nausea, and vomiting. Pain may be felt in the middle or on the right. In akute Pankreatitis there is usually also a fever and you often feel very unwell.

• Bauchspeicheldrüsenkrebs. This can cause right upper quadrant pain or back pain but it often causes few symptoms until it is advanced.

Schmerzen, die von der Aorta ausgehen

The aorta is the main blood vessel that carries blood from the heart through the abdomen to the rest of the body. Pain coming from the aorta can be caused by:

• Aortenaneurysma. The aorta becomes swollen and weakened and may cause abdominal or back pain if it starts to leak.

• Aortendissektion. The aorta can develop a tear in a weakened area of the lining of the aorta. This causes severe pain in the abdomen, back or chest.

• Aortic rupture. The aorta bursts, causing very severe pain in the abdomen, back or chest, and feeling very unwell.

Any pain which is suspected to come from the aorta is a medical emergency and needs immediate treatment.

Neben den bereits beschriebenen häufigeren Ursachen gibt es viele andere Bedingungen, die gelegentlich Schmerzen im rechten oberen Quadranten verursachen.

• Irritation of the diaphragm. The diaphragm is a dome-shaped muscle at the bottom of the ribs. Pain can be caused by various conditions including a ruptured ektopische Schwangerschaft, Lungenentzündung, or a hernia involving the diaphragm.

• Kidney stones and infections.

  • Nierensteine can cause a severe pain - usually round the back - which occurs in spasms lasting from a few minutes to several hours.

  • A kidney stone or Infektion can cause pain anywhere along your urinary tract. So this could be anywhere from your loin, around to the front, the right upper quadrant, or down to the lower part of your abdomen.

  • It may also be associated with a fever, pain when you wee, or passing urine more frequently.

• Herzinfarkt. This usually causes chest pain, but can sometimes cause pain in the right upper quadrant. You would usually feel very unwell, sweaty or short of breath.

• Pneumonie. This is an infection in the lung and normally gives you a Husten, and a high temperature (fever), with or without breathlessness and pain in your chest. However, if the infection is in the lower part of your right lung, you may feel the pain in your right upper quadrant.

• Pleuritis. Can also sometimes give you a pain low down in your chest and it can feel as though it is in your right upper quadrant..

• Diabetische Ketoazidose. A serious complication of Typ-1-Diabetes that makes you very unwell generally, but abdominal pain can be one of the symptoms. This is an emergency and required immediate hospital admission.

• Addison-Krankheit. A complication of Addison's disease called an Addisonian crisis occasionally can give you abdominal pain. Again you would feel very unwell and this also is also a medical emergency.

• Pregnancy-related liver problems. Rare complications in pregnancy can cause right upper quadrant pain.

• Pelvic problems. Conditions such as Beckenentzündung oder Ovarialzysten can sometimes cause pain that is felt higher up in the abdomen.

• Budd-Chiari-Syndrom. This is a rare condition where blood flow out of the liver is blocked.

These listed causes are not exhaustive, and many other conditions can occasionally cause pain in the right upper quadrant.

During pregnancy, all of the above conditions can occur but there are some specific pregnancy-related causes of pain in the right upper quadrant.

• Eileiterschwangerschaft. This is where the pregnancy is developing outside of the womb, usually in one of the Fallopian tubes. It can cause right upper quadrant pain if it bleeds inside the abdomen, and this is a medical emergency.

• Pressure from the growing womb. The uterus can press on nearby organs and the diaphragm, causing discomfort.

• Verdauungsstörungen. This is more common in pregnancy and can cause upper abdominal pain.

• Urinary tract infections (UTIs). Pain from UTIs can appear different during pregnancy because of the changes in positions of your organs due to the growing womb. They can occasionally cause pain in the right upper quadrant.

In young children it is often quite difficult for them to show exactly where the pain is. If this is the case, the range of options widens to almost any cause of abdominal pain.

In children common causes include:

• Verstopfung. Hard or infrequent poos can cause right upper quadrant pain (or pain elsewhere in the abdomen).

• Angstzustände. Stress or worry can sometimes cause pain anywhere in the abdomen.

• Mesenteriale Adenitis. Infection can inflame glands in the abdomen, causing pain, often after a cold.

• Blinddarmentzündung. Normalerweise verursacht dies Schmerzen im lower right part of the stomach but it can start around the belly button. Pain may be less clear if the child can’t describe it, or if the appendix has burst.

• Pneumonie. Infections of the lower parts of the lungs may cause pain in the right or left upper quadrant.

• Gastroenteritis. This infection (usually viral) causes abdominal pain, vomiting, and diarrhoea.

If you have a pain which doesn't settle, you will probably need to see a health professional to help work out the cause.

A doctor will be able to get a reasonable idea of the cause for the pain by:

• Asking you some questions about where the pain is and what it feels like.

• Physically examining you by feeling your abdomen in the area you have the pain.

• Examining other parts of your body, if needed, such as the rest of your abdomen and your chest.

Sind Tests erforderlich?

You may be asked to provide a sample of urine to check for blood, glucose (sugar) and other abnormalities. You may need further tests, depending on what the doctor thinks is causing the pain.

Possible tests might include:

• Bluttests to check the function of your liver, and to look for signs of inflammation, infection, or other potential causes.

• Ein Ultraschall-Scan to look for common conditions such as gallstones.

• Occasionally a Röntgenbild des Brustkorbs might be needed to rule out a problem in your lungs, such as infection.

Referral might be needed for:

• A look into your stomach and upper bowel with a camera (Endoskopie) und andere Scans und 'Scopes'.

• A endoskopische retrograde Cholangiopankreatikographie (ERCP) to examine your gallbladder and pancreas.

• A Computertomographie (CT) Scan, to look for abnormalities of the pancreas or kidneys.

It is very unlikely that you would need all these tests - tests will be chosen depending on the likely cause of the pain after the examination.

Was passiert, wenn nach den Tests keine Ursache gefunden wird?

If a serious cause has been ruled out, this is reassuring, but the pain may continue in some cases.

Sometimes it is hard to find a cause - for example, bowel spasm in a condition like Reizdarmsyndrom may cause right upper quadrant pain and this can not be shown on tests.

It is also possible for there to be pain that is caused by "mistakes" in the signals your nerves are sending to your brain. This can cause "chronic" (ongoing) pain in various parts of your abdomen without any underlying medical cause.

The treatment for RUQ pain depends on the cause. Treatments for a few of the common causes are briefly discussed below.

• Gallensteine. In einigen Fällen sind die Symptome nicht sehr störend und können durch die Einhaltung einer fettarmen Diät allein bewältigt werden. Viele Menschen entscheiden sich dafür, ihre Gallenblase entfernen zu lassen, in einer Operation, die als Cholezystektomie bezeichnet wird. Dies kann normalerweise durch eine Schlüsselloch- (laparoskopische) Operation erfolgen.

• Cholezystitis is treated initially with Antibiotika, normalerweise im Krankenhaus über Injektionen oder einen Tropf (intravenöse Antibiotika). Sobald die Infektion behandelt wurde, wird in der Regel eine Cholezystektomie empfohlen.

• Gürtelrose. The pain and rash settle on their own in time, but some people may be advised to take an antivirale Tablette to help reduce the risk of long-term nerve pain after shingles. Also, some people may need medication for a few weeks or months after the infection to manage their long-term pain.

• Niereninfektionen are treated with antibiotics. Mild infections can be treated with antibiotics at home. If you are very unwell you may need admission to hospital for intravenous antibiotics and fluids.

• Nierensteine. Small kidney stones pass on their own eventually; you will need to drink plenty of fluids. Larger kidney stones may need one of a number of procedures done to break them up or remove them altogether.

• A Zwölffingerdarmgeschwür is usually treated with Säureblocker-Medikamenten, as is Verdauungsstörungen.

This depends on the cause of the pain. Your doctor should be able to give you an idea of the outlook once a diagnosis has become clear.