"Where does it hurt?" is likely the first question your doctor will ask if you come in with pain on the right side under your ribs (abdominal pain). This simple question serves an important purpose because the location of your pain provides clues about possible causes. Pain in your upper right abdomen beneath your lower ribs often signals a problem with one of the organs in this area such as your gallbladder, liver, or right lung or kidney.
Gallbladder disease tops the list of possible causes of pain under the right rib — the right upper quadrant (RUQ) in medical lingo. Your gallbladder stores bile, a digestive fluid produced by your liver. Several gallbladder conditions can cause RUQ pain.
1. Biliary Colic
Temporary blockage of bile flow from your gallbladder is a leading cause of RUQ. This causes a so-called gallbladder attack (known medically as biliary colic) characterized by achy RUQ pain that sometimes radiates to the right shoulder.
The pain occurs due to pressure build-up and subsides after the temporary blockage resolves, typically in five hours or less. Some people also experience queasiness and/or nausea. Biliary colic tends to recur periodically and is usually due to gallstones.
2. Acute Cholecystitis
Acute cholecystitis usually develops due to a persistent blockage of bile flow that leads to inflammation of the gallbladder. Severe RUQ pain and tenderness occur, often accompanied by nausea and vomiting and possibly a low-grade fever. In contrast to biliary colic, the pain due to acute cholecystitis characteristically persists for six hours or longer. Gallstones account for the overwhelming majority of cases.
3. Other Gallbladder Conditions
A muscle called the diaphragm separates your chest and abdominal cavities in your lower rib cage area. On the right side of your body, your right lung sits atop the diaphragm and the liver just below the muscle. As such, lung conditions affecting the right lower lung can sometimes cause irritation and RUQ pain.
It might surprise you to learn that the upper part of each kidney resides at the level of your lowest ribs in the back of your body. Certain conditions involving your right kidney can, therefore, cause pain in your right flank — the area starting at the lower rib cage next to your spine and wrapping around your side, possibly extending to the front of your abdomen.
Portions of both your small and large intestines pass through the right upper region of your abdomen and can potentially cause pain in this area. Intestinal disorders that can potentially cause RUQ pain near your lower ribs include:
- Perforated duodenal ulcer, a sore in the first part of the small intestine that causes a hole in the intestinal wall
- Noninfectious or infectious inflammation of the large intestine, such as ulcerative colitis or food poisoning-related colitis
- Irritable bowel syndrome
- Noncancerous or cancerous intestinal tumors
In addition to the conditions already discussed, several other ailments can potentially cause pain in your upper right abdomen. Your doctor typically considers these conditions if more common causes have been ruled out or seem unlikely based on other signs and symptoms you're experiencing.
Some examples of these diverse conditions include:
- Appendicitis with atypical symptoms
- Acute pancreatitis, sudden inflammation of the pancreas
- Abnormalities of the liver blood vessels, such as Budd-Chiari syndrome and hepatic hemangioma
- Heart attack with atypical symptoms
- Heart failure
- Typhoid fever
- Diabetic ketoacidosis, or DKA (usually causes generalized abdominal pain)
When to See a Doctor
Because RUQ pain occurs with a broad array of conditions of differing severity, contact your doctor if you experience this symptom. Seek medical evaluation and care right away if your pain is sudden, severe, worsening or accompanied by any potential warning signs or symptoms, including:
- Fever, with or without chills
- Cold sweats
- Nausea and/or vomiting
- Abdominal bloating or tenderness
- Bloody, maroon, black or light-colored stools
- Severe constipation
- Yellow discoloration of the skin and/or whites of the eyes
- Bloody or pink urine
- Increased urinary frequency and/or urgency
- Difficulty breathing or shortness of breath
- Chest pain
- Lightheadedness, dizziness or fainting
- Merck Manual Professional Version: Acute Abdominal Pain
- American Family Physician: Evaluation of Acute Abdominal Pain in Adults
- Michigan State University: Differential Diagnosis of Acute Right Upper Quadrant Pain
- Ultrasound: A Practical Approach to Clinical Problems
- Medical Institution: Abdominal Pain Differential Diagnosis
- Merck Manual Professional Version: Acute Cholecystitis