Dor no quadrante superior direito

Onde fica o meu quadrante superior direito?

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.

© Por equipe do Blausen.com (2014). “Galeria médica do Blausen Medical 2014”. WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436

Regiões dos Quadrantes Abdominais

© OpenStax, CC BY 3.0, via Wikimedia Commons

Quais órgãos estão no meu quadrante superior direito?

Os órgãos dentro do seu quadrante superior direito são seus:

• Fígado.

• Vesícula biliar.

• Duodeno e algumas outras partes do seu intestino grosso e delgado.

• Rim direito (na parte de trás, atrás dos outros órgãos).

• Parte do pâncreas.

• Aorta.

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

O que causa dor no quadrante superior direito?

Em adultos, as causas mais comuns de dor no quadrante superior direito são:

• Gallstones.

• Herpes zoster.

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

• Gut problems (problems affecting the bowel).

• Pancreatite.

These causes are discussed in detail below.

Cálculos biliares e problemas na vesícula

• Cálculos biliares 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 colecistite, which causes more persistent RUQ pain along with a high temperature.

Herpes zoster

• Herpes zoster 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 neuralgia pós-herpética.

• Many people get the shingles rash without significant pain.

Problemas no fígado

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:

• Hepatite (A, V, e 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.

• Abscesso. Esta é uma coleção de pus que causa dor, sensibilidade e febre.

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

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

Problemas no intestino

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

• Úlcera duodenal. Pain usually starts a few hours after eating and may improve with antiácidos. 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.

• Gastroenterite. 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 diarreia and/or being sick (vomiting). You may have a mild fever.

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

• Doença de Crohn e colite ulcerativa. These long-term conditions can cause pain anywhere in the abdomen. They usually cause loose stools, sometimes with blood.

Dor proveniente do pâncreas

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 pancreatite aguda there is usually also a fever and you often feel very unwell.

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

Dor proveniente da aorta

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:

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

• Dissecção aórtica. 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.

Quais são as outras possíveis causas?

Além das causas mais comuns já descritas, existem muitas outras condições que ocasionalmente causam dor no quadrante superior direito.

• 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 gravidez ectópica, pneumonia, or a hernia involving the diaphragm.

• Kidney stones and infections.

  • Cálculos renais 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 infecção 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.

• Infarto. 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.

• Pneumonia. This is an infection in the lung and normally gives you a tosse, 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.

• Pleurisia. 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..

• Cetoacidose diabética. A serious complication of diabetes tipo 1 that makes you very unwell generally, but abdominal pain can be one of the symptoms. This is an emergency and required immediate hospital admission.

• doença de Addison. 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. Condições como doença inflamatória pélvica ou cistos ovarianos can sometimes cause pain that is felt higher up in the abdomen.

• Budd-Chiari syndrome. 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.

O que causa dor no quadrante superior direito na gravidez?

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

• Gravidez ectópica. 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.

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

• Infecções do trato urinário (ITUs). 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.

O que causa dor no quadrante superior direito em crianças?

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:

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

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

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

• Apendicite. Geralmente isso causa dor na 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.

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

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

When to see a doctor for right upper quadrant pain

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

Como é feito o diagnóstico da dor no quadrante superior direito?

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.

São necessários exames?

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:

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

• Uma ultrassonografia to look for common conditions such as gallstones.

• Occasionally a raio-X de tórax 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 (endoscopia) e outros exames de imagem e 'escopios'.

• A Colangiopancreatografia retrógrada endoscópica (CPRE) to examine your gallbladder and pancreas.

• A tomografia computadorizada (TC), 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.

O que fazer se nenhuma causa for encontrada após os testes?

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 síndrome do intestino irritável 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.

Tratamento para dor no quadrante superior direito

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

• Cálculos biliares. Em alguns casos, os sintomas não são muito incômodos e podem ser controlados apenas com uma dieta pobre em gordura. Muitas pessoas optam por remover a vesícula biliar, em uma cirurgia chamada colecistectomia. Isso geralmente pode ser feito por laparoscopia (laparoscópica).

• Colecistite is treated initially with antibióticos, geralmente no hospital por injeções ou soro (antibióticos intravenosos). Após o tratamento da infecção, geralmente é recomendada uma colecistectomia.

• Herpes zoster. The pain and rash settle on their own in time, but some people may be advised to take an antiviral 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.

• Infecções nos rins 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.

• Cálculos renais. 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 úlcera duodenal is usually treated with medicação supressora de ácido, as is indigestão.

Qual é a perspectiva?

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.