Pain under the ribs on the right side originates in the Right Upper Quadrant (RUQ) of the abdomen. This region contains several vital organs, including the liver, gallbladder, right kidney, and parts of the large and small intestines. Because numerous organ systems are housed closely together, determining the exact source of the pain can be complex. Understanding the specific nature of the discomfort—such as whether it is sharp, dull, steady, or intermittent—provides necessary clues for distinguishing potential causes.
Causes Originating in the Gallbladder
The gallbladder is a small organ just below the liver, and issues here are a common source of acute RUQ pain. The most frequent cause is cholelithiasis, the formation of hardened deposits called gallstones, usually made of cholesterol or bilirubin. These stones can remain “silent,” but they trigger pain if they block the flow of bile.
When a gallstone temporarily obstructs the cystic duct, the gallbladder contracts forcefully against the blockage. This causes a sudden, severe, cramping pain known as biliary colic. This pain is typically felt in the right upper abdomen and often radiates to the right shoulder blade or back. Biliary colic frequently occurs 30 to 60 minutes after eating a fatty meal because fat stimulates the gallbladder to contract and release bile.
If the obstruction persists, it can lead to acute cholecystitis, which is inflammation and sometimes infection of the gallbladder wall. The pain associated with cholecystitis is more constant and severe than biliary colic, often lasting for many hours. This condition is typically accompanied by a fever, nausea, and vomiting. The intense inflammation often makes the area tender to the touch, and taking a deep breath can worsen the discomfort.
Liver and Kidney Related Conditions
The liver is a large organ occupying a significant portion of the RUQ. Pain related to the liver presents uniquely because the liver tissue itself lacks pain-sensing nerves. Pain is instead caused by the stretching of the thin membrane surrounding it, called Glisson’s capsule, which contains many pain receptors. Conditions like hepatitis (inflammation of the liver) or steatosis (fatty liver disease) can cause the liver to swell, resulting in a dull, constant ache or a feeling of fullness under the ribs.
The right kidney is positioned toward the back, just beneath the lower ribs. Kidney-related pain is often felt in the flank or back, but it can be perceived in the RUQ. A kidney infection, known as pyelonephritis, typically produces a dull, steady ache in the flank or back. This is often accompanied by systemic symptoms like a high fever, chills, and painful or frequent urination.
In contrast, a kidney stone passing through the narrow ureter causes severe, intermittent, cramping pain known as renal colic. This pain usually starts in the flank area and may move forward and downward toward the abdomen, groin, or inner thigh as the stone descends. The pain is often described as wave-like, increasing in intensity before subsiding slightly. This reflects the ureter contracting in an effort to push the stone along.
Gastrointestinal and Musculoskeletal Contributors
Pain in the RUQ can also arise from other structures in the digestive tract or the surrounding physical frame, presenting as either visceral or somatic pain. Visceral pain originates from the internal organs, tending to be vague, dull, or aching, and is poorly localized. Somatic pain, conversely, comes from the muscles, skin, or ribs and is typically sharp, intense, and precisely localized.
Visceral pain originating from the bowel involves the hepatic flexure, the sharp bend in the colon located right under the liver. Trapped gas or a buildup of stool here can cause hepatic flexure syndrome, presenting as a vague, pressure-like pain often associated with bloating and Irritable Bowel Syndrome (IBS). Another GI cause is a duodenal ulcer, a sore in the lining of the first part of the small intestine, which causes a burning or gnawing ache in the upper abdomen. Pain from a duodenal ulcer often improves temporarily after eating or taking an antacid, but it may return several hours later or wake a person from sleep.
Musculoskeletal sources, which are examples of somatic pain, include costochondritis, an inflammation of the cartilage connecting the ribs to the breastbone. If this inflammation affects the lower right ribs, it can mimic organ pain. The discomfort is typically sharp and reproducible when pressure is applied directly to the affected cartilage. Similarly, an intercostal muscle strain causes sharp, localized pain in the rib cage area, reliably aggravated by specific movements, twisting the torso, deep breathing, or coughing.
Recognizing Symptoms That Require Immediate Care
While many causes of RUQ pain are manageable, certain accompanying symptoms indicate a potentially life-threatening emergency requiring immediate medical attention. Sudden, severe, or incapacitating pain that causes a person to double over should be evaluated immediately. A high fever, especially when paired with chills and RUQ pain, can signal a serious infection like acute cholecystitis or an ascending cholangitis.
The appearance of jaundice (a yellowing of the skin and whites of the eyes) is a significant red flag, suggesting a severe problem with the liver or a blocked bile duct. Urgent warning signs also include persistent vomiting that prevents keeping down food or fluids, or the presence of blood in vomit or stool (which may appear black or like coffee grounds). Any pain accompanied by signs of shock, such as a fast heart rate, low blood pressure, or confusion, necessitates an emergency room visit.