Pain in your upper right abdomen most commonly comes from the gallbladder, but several other organs sit in that area and can produce similar discomfort. The upper right quadrant houses the right lobe of the liver, the gallbladder, part of the stomach, the first section of the small intestine (duodenum), the head of the pancreas, the right kidney, and a portion of the colon. Figuring out which organ is responsible depends on the type of pain you feel, how long it lasts, and what makes it better or worse.
Gallbladder Problems Are the Most Common Cause
Gallstones are the single most frequent reason for upper right abdominal pain. When a stone blocks the duct that drains the gallbladder, you get what’s called biliary colic: a sudden, intense pain in the upper right abdomen that can radiate to your shoulder. Despite the name “colic,” the pain is usually steady rather than crampy, and it typically lasts up to three hours before fading. Attacks are more common at night, likely because lying down shifts the gallbladder into a position where stones can more easily plug the duct.
If the pain lasts longer than three hours, the gallbladder itself may be inflamed, a condition called acute cholecystitis. This often starts as a vague ache near the center of the upper abdomen, then migrates to the right side. You may also notice nausea, vomiting, or a low-grade fever. Older adults sometimes have only localized tenderness without the classic pattern, which can make it harder to recognize.
Liver-Related Pain
The liver itself doesn’t have many pain-sensing nerves inside it, but the capsule surrounding it does. When the liver swells, from infection, fatty buildup, or congestion, that capsule stretches and produces a dull, aching sensation under the right rib cage. Hepatitis (viral or alcohol-related), a liver abscess, or significant fatty liver disease can all cause this kind of discomfort. In some cases the pain can feel sharper if nearby structures like the diaphragm are irritated. Because liver pain tends to be vague and slow to develop, people often describe it as a persistent heaviness rather than a sudden stab.
Ulcers and Other Digestive Causes
A duodenal ulcer, which forms in the first part of the small intestine just past the stomach, can produce burning or gnawing pain in the upper abdomen that overlaps with the right side. For some people, the pain is worst on an empty stomach or at night and temporarily improves after eating. For others, eating makes it worse. Gastritis, an inflammation of the stomach lining, can create a similar pattern. Both conditions often come with bloating, nausea, or a feeling of fullness after small meals.
Problems in the colon can also show up in this area. The colon makes a sharp bend (the hepatic flexure) just under the liver before crossing to the left side. Trapped gas, constipation, or inflammation at that bend can mimic deeper organ pain. If your discomfort improves noticeably after passing gas or having a bowel movement, the colon is a likely contributor.
Kidney Stones and Infections
The right kidney sits toward the back of the upper right abdomen, tucked behind other organs. Kidney stones typically cause pain in the lower back, side, or flank that radiates toward the groin, and it often comes in waves of increasing intensity. But a stone lodged high in the kidney or a kidney infection (pyelonephritis) can produce pain that feels like it’s coming from the upper right quadrant. Fever, painful urination, or blood in the urine point toward the kidney rather than the gallbladder or liver.
Muscle and Rib Cage Pain
Not all upper right abdominal pain comes from internal organs. Strained muscles in the abdominal wall or inflammation of the cartilage connecting your ribs to the breastbone (costochondritis) can create sharp, localized pain in the same area. The key difference: musculoskeletal pain usually gets worse when you take a deep breath, cough, sneeze, or twist your torso, and it often hurts more when you press directly on the sore spot. Organ pain, by contrast, tends to be deeper and doesn’t change much with body movement or breathing.
Upper Right Pain During Pregnancy
If you’re pregnant and experiencing upper right abdominal pain, especially in the second half of pregnancy, take it seriously. A condition called HELLP syndrome (a complication involving the breakdown of red blood cells, liver stress, and low platelet counts) specifically produces right upper quadrant pain. About 1 in 5 cases of HELLP syndrome occur without the classic warning signs of high blood pressure or protein in the urine, so the abdominal pain itself may be the first clue. This is a medical emergency that requires immediate evaluation.
How Doctors Figure Out the Cause
When you see a provider for upper right abdominal pain, expect a physical exam that includes pressing on different areas to locate the tenderness. The first imaging test is almost always an abdominal ultrasound. It’s fast, doesn’t use radiation, and is especially good at spotting gallstones, evaluating bile ducts, and detecting liver abnormalities. If the ultrasound doesn’t provide a clear answer, a CT scan with contrast is the typical next step. Blood work helps narrow things down further: liver enzymes point toward the liver or bile ducts, elevated white blood cells suggest infection or inflammation, and pancreatic enzymes flag pancreatitis.
Signs That Need Urgent Attention
Most upper right abdominal pain resolves on its own or turns out to be something manageable. But certain combinations of symptoms signal a situation that needs prompt medical care:
- Pain so severe it interrupts your ability to function, especially if it came on suddenly
- Fever with abdominal pain, which can indicate an infected gallbladder, liver abscess, or kidney infection
- Yellowing of the skin or eyes (jaundice), suggesting a blocked bile duct or liver dysfunction
- Persistent vomiting or an inability to keep liquids down
- Pain that feels different from previous episodes, particularly if it’s more intense or accompanied by new symptoms like a rapid pulse or abdominal swelling
If you’ve had abdominal surgery in the past, that also changes the risk profile, because scar tissue (adhesions) can cause bowel obstructions that present as severe upper abdominal pain with constipation and inability to pass gas.