Abdominal pain can be hard to pinpoint or diagnose because of the many different organs in the area that can all potentially have problems. For most people, abdominal pains are usually mild and often related to minor conditions like gastritis or indigestion. There are also usually other gastrointestinal symptoms that can help identify the cause. If you feel pain in the liver, on the other hand, it could be a sign of a deeper medical condition that requires treatment from a gastroenterologist.

What Does the Liver Do?

The liver is an essential organ located in the upper right abdomen that is considered part of the digestive system. It performs a multitude of vital functions, including filtering toxins and waste products from the blood, producing bile to aid in digestion, regulating blood sugar levels, and storing essential vitamins and minerals. By filtering toxic substances, the liver helps to protect the body from potentially harmful substances. Additionally, it plays an important role in metabolism and helps the body break down and process fats, proteins, and carbohydrates.

How to Recognize Liver Pain

The tissues of the liver itself don’t actually contain pain receptors, so what is perceived as liver pain is typically the result of problems with the membrane that surrounds the liver. This membrane, called the peritoneum, forms the lining that surrounds the liver and the rest of the abdominal cavity. Inflammation or injury to this membrane often presents as a dull ache in the upper right abdomen, but it can also radiate elsewhere in the abdomen, the back, or the right shoulder.

What Causes Liver Pain?

There are a number of different conditions that can potentially cause liver pain, and the intensity and location of the pain can sometimes be an indicator of the underlying cause. Below are some of the most common causes of liver pain or conditions that may include liver pain as a symptom:

  • Cirrhosis: Cirrhosis of the liver is a chronic condition in which healthy liver tissue is gradually replaced with scar tissue. It is usually the result of long-term damage to the liver that stems from excessive alcohol use and some other conditions. In addition to abdominal pain, the symptoms can include fatigue, loss of appetite, nausea, yellowing of the skin or eyes, and ascites (buildup of abdominal fluid).
  • Gallstones: Gallstones are hard deposits that can become lodged in the bile ducts, the small tubes that carry bile from the liver to the small intestine. When a blockage happens and bile can’t drain from the gallbladder, it can cause inflammation of the bile ducts (cholangitis) and subsequent pain in the upper right abdomen.
  • Viral hepatitis: Viral hepatitis is an infection of the liver most commonly caused by hepatitis A, hepatitis B, or hepatitis C. The inflammatory immune response to the presence of the virus often causes liver pain and liver damage.
  • Autoimmune hepatitis: Another form of inflammation of the liver is autoimmune hepatitis. In this condition, the immune system mistakenly attacks the cells in liver tissue and causes liver pain and a number of other symptoms.
  • Fatty liver disease: Fatty liver disease comes in two types—alcohol-related liver disease (ARLD) and nonalcoholic fatty liver disease (NAFLD). The main difference is that one is caused by excessive alcohol use and the other has no clear cause. In both cases, an accumulation of fat in the liver can lead to inflammation and liver damage. Symptoms include liver pain, fatigue, loss of appetite, nausea, and jaundice.
  • Hemochromatosis: Hemochromatosis is an inherited disorder in which too much iron builds up in the body and causes inflammation and liver damage, leading to liver pain and other symptoms.
  • Liver cancer: Both cirrhosis and hepatitis can cause damage to the liver and eventually lead to liver cancer. In addition to the underlying inflammation and pain associated with liver damage, cancerous liver cell tumors can also put painful pressure on the areas of the abdomen surrounding the liver.
  • Liver injury or trauma: The liver is a relatively large organ and is susceptible to injury or trauma if the person is involved in an accident or fall. Such trauma can cause bleeding in the liver as well as tenderness or pain.
  • Liver cyst or abscess: Cysts are pockets of fluid that can potentially build up in the liver. An abscess is a pocket of pus that develops from an infection caused by bacteria, fungi, or parasites. The presence of a liver abscess or cyst can put pressure on tissue surrounding the liver or cause other problems that may also lead to liver pain.
  • Fitz-Hugh-Curtis syndrome: Fitz-Hugh-Curtis syndrome is a condition in which inflammation and scarring occur in the tissue around the liver. It is usually caused by a sexually transmitted infection, such as chlamydia or gonorrhea. Symptoms may include liver pain and tenderness in the right upper abdomen, as well as fever and chills.
  • Budd-Chiari syndrome: Budd-Chiari syndrome is a rare condition in which the veins that carry blood away from the liver become blocked. This can cause liver pain and other symptoms, such as swelling in the abdomen, fatigue, and jaundice.
  • Portal vein thrombosis: Portal vein thrombosis is a condition in which a blood clot forms in the vein that carries blood from the intestines to the liver. This can cause liver pain, abdominal swelling, and increased blood pressure (portal hypertension).
  • Reye’s syndrome: Reye's syndrome is a rare but potentially life-threatening condition that can occur in children and young adults, and it is usually caused by taking aspirin or other medications that contain salicylates for a viral infection. Symptoms may include nausea, vomiting, confusion, and liver pain.
  • Wilson’s disease: Wilson's disease is an inherited disorder in which the body is unable to properly metabolize copper. This can cause copper to accumulate in the liver, leading to inflammation and liver damage.

    Preventing and Treating Liver Pain

    As the list above demonstrates, the causes of liver pain are closely related to the causes of liver disease. Though there are a few liver problems that are made more likely by genetic factors, for the most part liver disease can be avoided through lifestyle changes. Alcohol use is one of the main risk factors in the development of liver problems, so the most important change to make is to severely limit or totally eliminate the use of alcohol (which is also just good for overall health, wellbeing, and even weight loss).

    The liver is the body’s main blood filtration system, so anything potentially harmful that goes into your body can cause problems if used long enough. You can lower the risk for liver disease by not using medications unnecessarily, avoiding chemicals and pesticides, and by maintaining a healthy weight. Also, the connection between liver disease and hepatitis means that you should avoid unprotected sexual activity, sharing hypodermic needles, and getting vaccinated against hepatitis.

    When to See a Doctor

    Liver pain that can be distinguished from other kinds of abdominal pain is always a potentially serious problem and should prompt a visit to the doctor. Other symptoms that can indicate a deeper problem are fatigue, jaundice, vomiting, itchy skin, or confusion. If you have been experiencing such symptoms, it may be time to meet with a gastroenterologist. At Cary Gastro, we are passionate about providing proactive digestive healthcare so that you can increase your quality of life and have peace of mind. Please contact us today to request an appointment.