Usually presents as a persistent dull ache in the right hypochondrium, sometimes radiating to either shoulder, or through to the back. It is frequently pleuritic in nature, made worse on sitting forward. It is often associated with anorexia and a feeling of fullness. Sometimes there is associated dyspnoea as the enlarged liver splints the diaphragm.
Explain the likely diagnosis to the patient and organise investigations if appropriate
If a new diagnosis of liver metastases has been made discussion with the oncologist or specialist in palliative care may be appropriate. In some instances palliative chemotherapy to reduce the size of metastases should be considered e.g. breast cancer.
Warmth therapies using wheat bags or heat packs help some patients.
Start an appropriate NSAID with appropriate GI protection in the form of a proton pump inhibitor or misoprostol.
The pain also responds to oral steroids, and if there are other symptoms requiring steroids, such as concurrent brain metastases causing headache, this should be first line. Suggested drug is dexamethasone 12mg as a single daily dose, titrating down to the minimum dose that keeps the pain and other symptoms under control. Appropriate GI protection should be concurrently prescribed.
