What is the pain under the right rib cage?

Pain under the right ribs is usually caused by a disease called costochondritis. Especially since the site of disease onset is relatively special, it will have a great impact on the human body and even affect the normal functions of the human body. Therefore, patients need to be admitted to the hospital for treatment as soon as the disease is discovered. Costochondritis is mainly divided into two types: nonspecific costochondritis and infectious costochondritis. Here we will introduce the relevant knowledge about costochondritis in detail!

1. Causes

1. Nonspecific costochondritis

The cause is still unclear, but the possible causes are as follows:

(1) Viral infection. Many cases reported a history of viral upper respiratory tract infection before the onset of the disease.

(2) Chronic strain of the sternocostal joint ligaments.

(3) Immune or endocrine abnormalities cause costal cartilage nutritional disorders.

(4) Other causes may be related to tuberculosis, general malnutrition, acute bacterial upper respiratory tract infection, rheumatoid arthritis, sternocostal joint subluxation, chest impact injury, severe coughing and other injuries.

2. Infectious costochondritis

Primary infection is relatively rare and is usually transmitted through the bloodstream. The causative bacteria are often Mycobacterium tuberculosis, Salmonella typhi or Salmonella paratyphi. Chondritis caused by infection after thoracic surgery is more common, and its causative bacteria are mainly purulent bacteria and fungi.

2. Clinical manifestations

1. Nonspecific costochondritis

In the early stage of the disease, patients feel chest pain. After a few days, swelling, bulge, dull pain or sharp pain appear in the affected costal cartilage. The site of occurrence is mostly the 2nd to 4th costal cartilage beside the sternum, with the 2nd costal cartilage being the most common, and occasionally it can also occur in the costal arch. This disease often affects a single rib, but occasionally multiple ribs or both sides of the ribs are affected at the same time. There is obvious local tenderness, and the pain radiates to the scapula or side shoulder, upper arm, and armpit of the back. The pain is aggravated by deep breathing, coughing, activity, chest straightening, and fatigue. Acute cases may occur suddenly, with a feeling of stabbing, throbbing or soreness in the chest; insidious cases develop slowly, causing the junction of the ribs and costal cartilage to become bow-shaped, swollen, and dull pain without any changes in the skin. The pain varies in severity and often lingers. Because the lesion is located in the upper part of the breast, there is also referred pain in the breast on the same side, and female patients mistakenly think they have breast pain and seek medical treatment. However, diseases of the breast itself can often be identified by feeling a lump or cord-like object in the breast, or by local redness of the breast skin. The course of the disease may last for several hours or days, but it may relapse and usually heal itself within a few months, but in some cases it may last for several years.

2. Infectious costochondritis

The local skin will become red, swollen, hot and painful, with chest pain being the main symptom. Most of the symptoms are of this type first, with varying degrees of severity. Patients are afraid to take deep breaths or cough due to chest pain, which can easily lead to lung infection. Soft tissue necrosis can form abscesses, and rupture of abscesses can form sinus tracts. Patients often have obvious systemic infection symptoms.

Treatment

1. Nonspecific costochondritis

(1) Costochondritis is generally treated only symptomatically, such as taking analgesics, hot compresses, physical therapy, or local blockade with procaine. Systemic or topical administration of corticosteroids may also help relieve symptoms. Erythromycin and morphine can be taken in the acute phase. Give antiviral drugs such as Virulin. Alternatively, you can use hormones such as prednisone or dexamethasone. For those with severe pain, 5 ml of lidocaine plus dexamethasone can be directly injected into the painful area, and local blockade can be performed with novocaine and prednisolone.

(2) If the pain fails to be relieved by long-term drug treatment, affects the patient's mood and work, or local malignant tumors cannot be ruled out, costal cartilage resection may be considered.

2. Infectious costochondritis

Perform conservative treatment first, use targeted antibiotics to effectively control infection and provide symptomatic analgesia. When the above methods are ineffective, surgical treatment is required.