Hepatic Flexure Syndrome

Hepatic Flexure Syndrome

What is the hepatic flexure in the colon? What is its health implication? Hepatic flexure is also known as right colic flexure. It is found in the digestive system and bends the colon that connects both the ascending and transverse colon. It is called hepatic flexure because of its proximity to the liver.

Hepatic flexure syndrome is a common medical issue, which causes a variety of symptoms. The common hepatic flexure syndrome symptoms are abdominal discomfort and gas pains. The pain is felt in the upper right portion of the abdomen. Because of the location of pain, hepatic flexure syndrome is oftentimes confused with other types of abdominal disorders.

Hence, it is important to thoroughly assess the condition of the patient so that proper medical intervention will be given. ^{(1, 2)} Hepatic flexure is a condition in which the ascending colon moves upwards and turns to take waste across the transverse colon.

The ascending colon moves across the abdomen from the right going to the left. The lowest point of the liver touches the colon, the very same point of the hepatic flexure.

There are two flexures in the body that are associated with the colon. These are the hepatic flexure or right colic flexure and splenic flexure or left colic flexure. ^{(3, 4)}

 

Photo 1: The anatomical presentation of the colon.
Picture Source: images.slideplayer.com

Image 2: A colonoscopy procedure to check the hepatic flexure and splenic flexure of the colon.
Photo Source: howshealth.com

What is the splenic flexure?

The splenic flexure syndrome is characterized by periodic gas pains. The pain can be extreme to the point that it is unbearable and may lead to ruptured appendix. Just like hepatic flexure syndrome, splenic flexure can be mistaken for other abdominal disorders.

Fortunately, it is not a life threatening condition but the symptoms are annoying that it disturbs your day to day activities. Symptoms include pain that is concentrated near the upper left side of the abdomen. The pain also takes place if you bend or twist your abdomen.

The upper left part of the abdomen is distended and tender to touch. If you tap the abdomen, you will notice a hollow-like sound. The patient also experiences bowel irregularities. Some people have severe bout of diarrhea while others are constipated. ^{(4, 5, 6)}

Why is it important to detect the presence of hepatic flexure syndrome?

It is important to detect hepatic flexure syndrome at an early stage because serious illnesses can root from it. Possible medical conditions that can result from hepatic flexure syndrome include hepatocellular disease, hepatitis, hepatolenticular degeneration, hepatojugular reflux, hepatoma, hepatomegaly, and the likes. ⁽⁷⁾

Diagnosis

If the doctor is suspecting hepatic flexure syndrome, he/she will usually order a liver function test. The expected result should be normal but still patient complains of painful episodes. The doctor will also order for a colonoscopy to have an accurate view of the inside structure of the large intestines.

On the camera image, the hepatic flexure looks like a bluish structure that is triangular in shape. ^{(7, 8)}

Hepatic flexure syndrome Treatment

Mild cases of hepatic flexure syndrome can be treated at home using natural remedies. The primary goal is to relieve gas pain so as to provide comfort to the patient. How to prevent gas pain? If you feel the pain, you need to lie down, relax, and gently massage the affected area. Once the gas has passed, the patient will be relieved from pain. Drinking warm water and tea can also improve the overall condition of the patient. ⁽⁸⁾

There is a recommended hepatic flexure syndrome diet. Dietary changes can significantly improve the condition of the patient and prevents gas pain attacks. There are certain foods that should be avoided or be eaten in small amount such as milk, beans, and carbonated beverages.

Ideally, patients are advised to avoid gas forming foods, limit the intake of foods containing high fat including foods rich in fructose and lactose. ^{(9, 10)}

Antacids work best in pain management. They can also relieve abdominal bloating. If the condition of the patient is recurrent and does not resolve using the interventions mentioned above, then the doctor will opt for surgical intervention. However, surgery should only be the last resort. It should be ordered when all other measures failed to improve the overall condition of the patient.

How to prevent hepatic flexure?

• Live an active lifestyle and avoid unnecessary stress – Gas pain can be prevented if you keep on doing things that are good not just for your body but for your brain too. As much as possible, you should limit your exposure to stress. Keep a healthy relationship with the people around you and most importantly, keep your body healthy. As the famous saying goes, “you are what you eat.” ⁽¹⁰⁾
• Maintain a proper healthy diet – You should limit your intake of foods high in soluble fiber such as broccoli, cabbage, oats, peas, and beans. Artificial sweeteners should be avoided too. Examples are sorbitol, xylitol, maltitol, and mannitol. Foods high in lactose should be taken in moderate amount such as milk, ice cream, and yogurt. Those foods known to trigger gas pain should be removed from your diet such as caffeinated beverage, alcohol, and fried foods. If you are constipated, you should increase your intake of insoluble fiber such as green leafy vegetables and whole grain bread. It is also important to keep the body well hydrated. Water and natural fruit juices are enough to hydrate your body. ^{(2, 5, 7)}
• Increase your intake of probiotics – if the condition is severe, the doctor will prescribe antibiotics. While or after the antibiotic treatment, you should increase your intake of probiotics. They are good bacteria and they play a very important role in preventing constipation and bloating. Foods rich in probiotics are yogurt and dairy products. ⁽¹⁰⁾

Hepatic flexure should be diagnosed the earliest time possible. Not treating the condition right away could lead to severe health condition, which could be extremely difficult to treat. If you are suspecting alarming symptoms, you should consult your doctor right away.

References:

1. https://en.wikipedia.org
2. www.nursingtimes.net
3. www.belmarrahealth.com
4. www.ehealthstar.com
5. www.wisegeek.org
6. www.healthresource4u.com
7. www.helpforibs.com
8. www.ibsgroup.org
9. www.healthhype.com
10. emedicine.medscape.com