Pain under the right side of the ribs is a common concern due to the many organs and structures in that area, known as the right upper quadrant of the abdomen. This region includes parts of the liver, gallbladder, right kidney, pancreas, intestines, muscles, and rib cartilage. Pain can range from a mild ache to sharp discomfort, stemming from minor issues or serious medical conditions. Understanding potential causes helps determine when medical attention is needed.
Common Reasons for Right Upper Abdominal Pain
Pain in the right upper abdomen often stems from musculoskeletal issues. Muscle strains in the abdominal wall, from coughing, strenuous exercise, or injury, cause aching pain that worsens with chest or torso movement. Costochondritis, an inflammation of the cartilage connecting ribs to the breastbone, is another cause. It manifests as sharp or pressure-like pain, worsened by deep breaths, coughing, or sneezing.
Digestive problems are also frequent culprits behind right upper abdominal discomfort. Gas and bloating can lead to fullness or pressure, especially if trapped on the right side of the colon. Indigestion (dyspepsia) often presents as upper abdominal discomfort, often with a burning sensation, accompanied by burping or a gurgling stomach. Gastroesophageal reflux disease (GERD), where stomach acid flows back into the esophagus, can also cause upper abdominal pain, often alongside heartburn, nausea, or a sore throat.
Constipation, characterized by infrequent or difficult bowel movements, can lead to abdominal discomfort, including right-sided pain from hardened feces. Irritable bowel syndrome (IBS), a chronic digestive disorder, commonly causes abdominal pain, cramping, and bloating, which may affect the right side. Mild gallstones can cause intermittent biliary colic, a severe, cramp-like pain in the right upper quadrant lasting minutes to hours, often triggered by fatty foods. Fatty liver disease can sometimes cause a dull or aching pain in the upper right abdomen, as the enlarged liver may put pressure on surrounding tissues.
Serious Conditions Requiring Attention
More severe medical conditions can also cause pain under the right ribs, requiring prompt evaluation. Gallbladder problems, such as acute cholecystitis, involve inflammation of the gallbladder, often from a blocked bile duct, leading to persistent, severe upper right abdominal pain lasting days, with fever and chills. Liver conditions like acute hepatitis (inflammation of the liver) or a liver abscess (a collection of pus) can cause significant pain in this region.
Pancreatitis, an inflammation of the pancreas, can cause steady or sharp upper abdominal pain, often radiating to the back, but sometimes presenting on the right side, along with bloating, nausea, and vomiting. Kidney problems affecting the right kidney, such as kidney stones or pyelonephritis (kidney infection), cause severe, cramp-like pain around the right side or back, which can spread to the front of the abdomen.
Issues with the lungs or diaphragm can also refer pain to the upper right abdomen. Conditions like pneumonia or pleurisy in the lower right lung cause pain worsening with deep breathing or coughing, and diaphragmatic irritation can also cause discomfort. Although typically causing lower right abdominal pain, appendicitis can, in atypical presentations, manifest with upper right abdominal pain, sometimes alongside nausea, vomiting, and loss of appetite. Peptic ulcer disease, particularly if an ulcer perforates, can result in severe burning or gnawing pain in the stomach or duodenum that may be felt in the upper right quadrant.
When to See a Doctor
Recognizing “red flag” symptoms is important for knowing when to seek medical attention for pain under the right ribs. Severe, sudden, or worsening pain that does not subside warrants immediate evaluation. Pain with fever, chills, or excessive sweating can indicate an infection or inflammation requiring urgent care. Jaundice (yellowing of the skin or eyes) signals serious liver or gallbladder issues, requiring prompt medical attention.
Persistent nausea or vomiting, especially if severe or with other concerning symptoms, should prompt a doctor’s visit. Any blood in the stool (black and tarry or bright red) or vomit (resembling coffee grounds) signals a gastrointestinal bleed, requiring emergency care. Difficulty breathing or chest pain with right upper abdominal pain can suggest cardiac or pulmonary involvement, requiring immediate medical assessment. Pain radiating to the shoulder or back, or pain after a recent injury, should be investigated. Unexplained weight loss alongside abdominal pain should always be evaluated to rule out underlying serious conditions.
How Doctors Diagnose the Cause
When evaluating pain under the right ribs, healthcare professionals begin with a comprehensive medical history and physical examination. They ask detailed questions about the pain’s nature, location, and duration, as well as associated symptoms, past medical conditions, and lifestyle factors. During the physical exam, the doctor palpates the abdomen, pressing on areas to identify tenderness, swelling, or masses, to narrow down the pain’s source.
Following the initial assessment, several diagnostic tests may be ordered. Blood tests check for inflammation, infection, or organ dysfunction, including liver function tests, pancreatic enzymes, and a complete blood count. Imaging studies provide visual information about internal organs.
Ultrasound is often a first test, especially for the gallbladder and liver, detecting gallstones or inflammation. Further imaging, such as CT scans or MRI, may offer a more detailed view of abdominal organs, while X-rays might assess ribs or lungs. Depending on the suspected cause, specialized tests like endoscopy, colonoscopy, or urine tests may be performed. The diagnostic process is tailored to individual symptoms to identify the precise cause.