Upper Right Abdominal Pain
Causes And Treatment Options

Let's Help You Work Out What Might Be Causing Your Upper Right Abdominal Pain

Do you have pain under your right rib cage or upper right abdomen? When exactly did it start? Did you wake up with the pain at night, or did it start within an hour after meal? Is the pain coming on and going away in waves at intervals? Does this pain seems to spread through the right side of your body to the back under your shoulder blade bone? Feeling sick and nauseated?

Pain in the right side of the upper stomach or abdomen is very common. It is also referred to as right upper quadrant pain. Like in other parts of the abdomen, the key to finding out what might be causing your pain lies in understanding and being familiar with the organs in this part of the body. Housed in this region of the body are:

• The Liver
  
• Gallbladder,
  
• Upper part of the barge bowel,
  
• Right kidney and kidney tubes or ureters,
  
• Lower part of the right lungs from the back,
  
• Right Adrenal gland
  
• Muscles, bones, blood vessels, nerves and skin covering the region.
  

Any problem in these structures or organs lying in here or near by ones will cause upper right abdominal pain. So, how can we work out what is causing your right upper abdominal pain now? Let's go through the common causes of pain in this region and see if any of these sounds like what is happening to you.

Common Causes Of Right Upper Abdominal Pain

Common causes of pain in the right upper abdomen include conditions affecting any of the organs listed above that are housed in the right upper abdomen as well as some other organs in the chest.

We shall now list these common causes of pain under the right rib. They include:

• Biliary Colic. This is a very common cause of right upper abdominal pain after eating. The pain typically comes on within the first hour or two after having a rich or fatty meal. The pain could be gradual in onset, or may come on suddenly. It could be moderate to very severe in intensity. It is often cramp-like, comes and go, or may be there constantly, but with times of more severe pain intermittently. As mentioned above, the pain may spread through the right side of body to the back, just below the tip of the right shoulder blade bone or scapular. Those suffering with attacks of biliary colic often want to pace about, not keeping still, in a bid to find a comfortable position to easy the pain. There may be associated feeling of nausea and actual vomiting. Is this you? Biliary colic is usually due to the presence of stone trapped in the ducts of the gallbladder, or too strong contraction of the wall of the gall bladder. You can read more on biliary colic here.
• Cholecystitis. Cholecystitis is the word used to describe the presence of infection or inflammation in the gallbladder. Like biliary colic, it causes pain in the right upper abdomen too. The pain though, tends to last longer than that of biliary colic and there may be associated fever or high temperature, and jaundice or yellowness of the white of the eye. There may also be associated pain in breathing deep on the right side (catching of your breathe when breathing in), due to the pain. If you have cholecystitis, you may have all the symptoms of biliary colic but feels more unwell and might lose appetite and pass dark colored urine. You can read more on cholecystitis here.
• Costochondritis. Costochondritis is a common cause of chest pain or rib cage pain, due to the inflammation of a part of the rib. It causes a sharp or dull ache in the rib cage. The pain could be mild, moderate or severe. It is brought on by taking in a deep breath, coughing or touching the area. Unlike biliary colic, the pain is always there and could take several days to settle and go away. Costochondritis does not lead to serious problems and with pain killers and rest, it often goes away on its own.
• Kidney Stones. Kidney stones are debris that collect from the salts and chemicals in our urine to form hard rock-like materials which may accumulate in our kidneys or bladder. If a piece from this rock-like material breaks off, it travels down the tube that drain from the affected kidney. If the size is very small, they pass down the tube or ureter without us ever getting to know. However, stones larger than 5 millimeter long in size could get trapped in the ureter. This provokes a very strong contraction in the ureter, in a bid to dislodge the stone, leading to severe, often sudden onset loin pain. A stone in the right kidney therefore can cause sudden onset upper right abdominal pain, starting more from the upper right back, moves in a spiral fashion down the side to the front and spreads toward the groin. The pain is often described by sufferers as the most severe pain ever. It comes in waves, just like that described for biliary colic above, and there may be associated nausea and vomiting. Again like biliary colic or gallbladder stone pain, persons suffering with a kidney stone attack finds themselves pacing about, looking for a comfortable position to adopt. Apart from the pain, they often feel well in themselves. Occasionally, there might be associated fever - feeling hot and cold. The pain lasts for a few minutes (though there might still be a background level of aching), goes away, and then comes back. A urine test by the doctor typically shows the presence of blood in the urine (not visible to the naked eye).
  
• Myofascial Trigger Point Pain (Myofascial Pain Syndrome). Myofascial trigger point pain is pain resulting from weakness or repetitive injury of a muscle, leading to a sustained contraction of a small part of the muscle. Such contractions sends a trigger of painful sensation to other parts of the body, causing varying degree of intensity of pain. Trigger points are like a knot in your muscle, causing continuous misfiring of pain to a region of your body. Also called myofascial pain syndrome, these trigger points pain are an amazingly common cause of pain in many parts of the body, including the right upper abdomen. There are at least 14 trigger points that can lead to pain in the right upper quadrant of the abdomen. Unfortunately, myofascial trigger point pain is a concept not well appreciated by many doctors, as it is only recently that many pain specialist doctors are gaining better understanding of it. You can download a free copy of the myofascial trigger point manual here to see if this might be the cause of your chronic right upper stomach pain.
• Musculoskeletal Pain. If you sprain a muscle in this region, from exercise or too much work or from hitting it on a hard surface, no doubt this will cause pain. Musculoskeletal pain will be easy to diagnose as you may remember hitting your body or being hit, or engaged in an unusual amount of strain. Lower right rib fracture can also cause upper right abdominal pain.
• Pneumonia. A right lower lobe pneumonia (infection of the lower part of the right lung), can present as upper right abdominal pain. Patients with this condition will typically develop a crushing or sharp upper right abdominal pain, fever, difficulty in breathing and cough. The cough may be productive of yellowish or brown phlegm or sputum. This is even more so in children, who sometimes come in complaining of upper right abdominal pain with heavy breathing, and looking very unwell with fever. Some doctors have been caught out, thinking such a child has appendicitis, when in fact, it is due to a lower lobe pneumonia.
• Liver Disease. Any disease affecting the liver can cause pain in the upper right side of the abdomen. Such pain are typically a nagging long standing pain and are often not related to movement. The sufferer may become unwell, jaundiced and sometimes with associated weight loss depending on the type of liver disease. Common types of liver diseases that can cause a right upper abdominal pain include hepatitis, liver parasite infections like amoeba liver infection, liver cysts, liver cancer, Budd Chiari syndrome, ascending cholangitis (infection of the liver ducts leading to a combination of right upper quadrant pain, fever and jaundice), Fitz-Hugh-Curtis syndrome which causes liver pain in people with gonorrhea.

The above listed conditions are those that commonly cause right side stomach pain or pain under right rib. There are other conditions like constipation, non alcoholic fatty liver disease, HELLP syndrome in pregnant women with pre-eclampsia, severe diabetic ketoacidosis, epiploic appendagitis, right pulmonary embolism or blood clot in the lower right lung, heart failure, cronh's disease, bowel cancer, and many others.

If you have a right side abdominal pain that is not going away after an hour, it is recommended that you should seek medical advice from your healthcare provider.

Tests And Treatment Of Right Side Stomach Pain

If you suffer with upper right abdominal pain that is difficult to diagnose, the following are the typical tests you may need to have done:

• Blood Tests. These could include a Full Blood Count - FBC ( or Complete Blood Count - CBC), Electrolyte And Urea Tests, Liver Function Test, C-Reactive Protein - CRP, Erythrocyte Sedimentation Rate - ESR, Blood Sugar levels, and clotting profile tests, as well as some other specialized blood test. Your doctor will no doubt guide you as to which of these is most relevant for your condition.
• Urine Test. This is important to exclude conditions like urine kidney infection or kidney stone, as the cause of the upper right abdominal pain. There will be the presence of blood in the urine at microscopic level if kidney stone is the culprit, and leucocytes and nitrites, if kidney infection is the problem and both can co-exist.
  
• Chest X-Ray. This may become necessary, if you doctor suspects that the cause of your upper right abdominal pain is from the lungs (e.g pneumonia or blood clot), or to exclude a bowel perforation, if you also have a shoulder tip pain.
  
• Ultrasound Scan & HIDA Scan. These are commonly requested scans needed to exclude or confirm a suspected case of gallbladder stones or gallbladder infection, kidney stone, or liver disease.
  
• CT Scan & MRI. These may be necessary for more detail
• Endoscopy & Colonoscopy.
  
• Other Specialist Testings.

The treatment of a upper right abdominal pain will obviously depend on what is causing the pain. We have provided a link to more details on the various common causes of pain in this region of the body.

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Last Updated: 19th March 2013

Related Topics:

• Biliary Colic
• Cholecystitis
• Costochondritis
• ERCP
• Upper Left Side Abdominal Pain
• Upper Central Abdominal Pain
  
• Lower Right Side Abdominal Pain
• Causes of Abdominal Pain Overview
  

Return To Right Side Abdominal Pain Page From Upper Right Abdominal Pain Page

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