Pain points of the liver, gallbladder, stomach and pancreas

By Cristiano Antonino Last updated Jun 7, 2023

Pain points have great significance in semeiotics, and in a physician’s ability to make a diagnosis

Hepato-colecystic and gastric pain points

Cystic point or Chauffard’s point

Meeting between the 10th rib and the outer margin of the rectus abdominis muscle.

It is painful in acute cholecystitis already on superficial palpation, in biliary lithiasis, acute cholecystitis and cholecystic dyskinesias.

Epigastric point

Located immediately below the xiphoid process.

Cruveilhier’s pain point

Located at the junction of the upper third with the two lower thirds of the xiphoid line; painful in ulceration of the cardia or fundus.

Left subcostal hypochondriac point

Located at the meeting of the external margin of the left rectus muscle and the costal border two fingers above the umbilicus; painful in ulceration of the lower part of the gastric fundus.

Ramond’s xiphoid point

It is located on the ensiform appendix or xiphoid process, pressure causes radiating pain in the back and scapula.

Coeliac point of Ramond

Located 2-3 cm distal to the umbilicus, to the right of the umbilicus.

Binet’s point

Located at the end of the 9th rib of the right side.

Point of Abraham

Located in the middle of the line between the umbilicus and the right IX costa.

Right phrenic point

Between the two clavicular heads of the right sternocleidomastoid muscle.

Schmidt’s point

At the trapezius muscle and the right brachial plexus.

Left hypochondriac point

Located on the sternal margin of the 9th rib 10-12 cm from the umbilicus.

Boas’ point

Located on the side of the 10th and 12th dorsal vertebrae.

Guillame’s point

It is located at the sacro-lumbar region, on the sides of the vertebrae.

Leclerq point

It is located at the junction between the lower edge of the right 12th rib and the outer edge of the lumbar muscle mass (in this location the pain may be spontaneous).

Pancreatic pain points

Choledochal pancreatic area and Desjardins’ point

The choledo-pancreatic area (Chauffard-Rivet) between the xipho-umbilical and the bisector of the angle formed to the right between the xipho-umbilical and the transverse umbilical (projection of first duodenal portion, head of the pancreas and choledoch) at about 6 cm from the umbilicus.

The Chauffard-Rivet triangle is painful in duodenal ulcer, acute pancreatitis and lithiasis of the choledoch.

Desjardins’ point is located on the line from the umbilicus to the apex of the axilla, at the adducted arm, about 5-7 cm from the umbilicus, corresponding to the papilla of the Vater; it is very painful in cases of pancreatitis.

This area is also considered a pain point of the gallbladder.

Point of Calot and Pic

Pancreatic area, located symmetrically to the previous one, painful in case of disease of the body of the pancreas.

Mayo-Robson’s point

Located between the tip of the right XI rib and the umbilicus at the midpoint, present in cephalo-pancreatitis.

Orlowsky’s zone

Corresponds to the right obtuse angle determined by two lines joining the coracoid apophyses with the midpoint of Poupart’s ligament or ligamentuminguinalis.

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