Right upper quadrant pain

Where is my right upper quadrant?

The right upper quadrant is a section of your tummy (abdomen) on the upper right hand side.

Look down at your tummy, and mentally divide the area from the bottom of your ribs down to your pubic hair into four quarters. The quarter on your right side closest to your ribs is your RUQ.

© By Blausen.com staff (2014). “Medical gallery of Blausen Medical 2014”. WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436

Abdominal Quadrant Regions

© OpenStax, CC BY 3.0, via Wikimedia Commons

The organs within your right upper quadrant are your:

• Liver.

• Gallbladder.

• Duodenum and some other parts of your large and small bowel.

• Right kidney (at the back behind the other organs).

• Part of the pancreas.

• The aorta.

There are also the skin and nerves of that area of your abdomen.

In adults, the most common causes of right upper quadrant pain are:

• Gallstones.

• Shingles.

• Peptic ulcers - ulcers in the upper part of the guts.

• Gut problems (problems affecting the bowel).

• Pancreatitis.

These causes are discussed in detail below.

Gallstones and gallbladder problems

• Gallstones can block the bile duct, causing biliary colic – a severe, crampy pain in the right upper abdomen, often worse after eating fatty meals.

• The pain may spread to the back and shoulders.

• An infection may develop, called cholecystitis, which causes more persistent RUQ pain along with a high temperature.

Shingles

• Shingles can cause pain in the right upper abdomen because it affects the nerves in that area.

• The pain is usually on one side of the body, under the ribs or around to the back, in a stripe-like pattern.

• It often feels burning, sharp, or tingly, and the skin can be sore to touch.

• A blistering rash usually appears a few days later in the same area.

• Some people find they continue to get a pain long after the rash of shingles has gone. This is called postherpetic neuralgia.

• Many people get the shingles rash without significant pain.

Liver problems

The liver takes up a large part of your right upper quadrant but it doesn't often cause pain. Causes of pain from the liver include:

• Hepatitis (A, B, and C). This will usually result in jaundice and a fever and feeling generally unwell in addition to some pain in that area. Pain is not necessarily a feature.

• Abscess. This is a collection of pus causing pain, tenderness and fever.

• Alcoholic liver disease. Too much alcohol can damage your liver, which may affect its function, turn your skin yellow (jaundice) and give you RUQ pain.

• Liver cancer. This can start in the liver or have spread from other cancers. The liver may enlarge in certain blood cancers, such as lymphomas or leukaemias, and this can cause discomfort.

Gut problems

Several problems in your bowel can give you pain in the right upper quadrant. These include:

• Duodenal ulcer. Pain usually starts a few hours after eating and may improve with antacids. It can gradually worsen and, in severe cases, you may vomit blood. This is an emergency - it is important to go to hospital straight away.

• Gastroenteritis. Infections in your gut tend to give you pain all over your abdomen, typically more in the middle but occasionally the pain may be in the RUQ area. It is usually associated with diarrhoea and/or being sick (vomiting). You may have a mild fever.

• Indigestion. This can give you a pain in the upper part of your abdomen, along with bloating and acid reflux.

• Crohn's disease and ulcerative colitis. These long-term conditions can cause pain anywhere in the abdomen. They usually cause loose stools, sometimes with blood.

Pain coming from the pancreas

The pancreas sits in the upper middle of the abdomen and helps digest food and control blood sugar. Pain in the pancreas can be caused by:

• Pancreatitis (inflammation). This can cause right upper quadrant pain, nausea, and vomiting. Pain may be felt in the middle or on the right. In acute pancreatitis there is usually also a fever and you often feel very unwell.

• Pancreatic cancer. This can cause right upper quadrant pain or back pain but it often causes few symptoms until it is advanced.

Pain coming from the aorta

The aorta is the main blood vessel that carries blood from the heart through the abdomen to the rest of the body. Pain coming from the aorta can be caused by:

• Aortic aneurysm. The aorta becomes swollen and weakened and may cause abdominal or back pain if it starts to leak.

• Aortic dissection. The aorta can develop a tear in a weakened area of the lining of the aorta. This causes severe pain in the abdomen, back or chest.

• Aortic rupture. The aorta bursts, causing very severe pain in the abdomen, back or chest, and feeling very unwell.

Any pain which is suspected to come from the aorta is a medical emergency and needs immediate treatment.

As well as the more common causes already described, there are many other conditions which occasionally cause right upper quadrant pain.

• Irritation of the diaphragm. The diaphragm is a dome-shaped muscle at the bottom of the ribs. Pain can be caused by various conditions including a ruptured ectopic pregnancy, pneumonia, or a hernia involving the diaphragm.

• Kidney stones and infections.

  • Kidney stones can cause a severe pain - usually round the back - which occurs in spasms lasting from a few minutes to several hours.

  • A kidney stone or infection can cause pain anywhere along your urinary tract. So this could be anywhere from your loin, around to the front, the right upper quadrant, or down to the lower part of your abdomen.

  • It may also be associated with a fever, pain when you wee, or passing urine more frequently.

• Heart attack. This usually causes chest pain, but can sometimes cause pain in the right upper quadrant. You would usually feel very unwell, sweaty or short of breath.

• Pneumonia. This is an infection in the lung and normally gives you a cough, and a high temperature (fever), with or without breathlessness and pain in your chest. However, if the infection is in the lower part of your right lung, you may feel the pain in your right upper quadrant.

• Pleurisy. Can also sometimes give you a pain low down in your chest and it can feel as though it is in your right upper quadrant..

• Diabetic ketoacidosis. A serious complication of type 1 diabetes that makes you very unwell generally, but abdominal pain can be one of the symptoms. This is an emergency and required immediate hospital admission.

• Addison's disease. A complication of Addison's disease called an Addisonian crisis occasionally can give you abdominal pain. Again you would feel very unwell and this also is also a medical emergency.

• Pregnancy-related liver problems. Rare complications in pregnancy can cause right upper quadrant pain.

• Pelvic problems. Conditions such as pelvic inflammatory disease or ovarian cysts can sometimes cause pain that is felt higher up in the abdomen.

• Budd-Chiari syndrome. This is a rare condition where blood flow out of the liver is blocked.

These listed causes are not exhaustive, and many other conditions can occasionally cause pain in the right upper quadrant.

During pregnancy, all of the above conditions can occur but there are some specific pregnancy-related causes of pain in the right upper quadrant.

• Ectopic pregnancy. This is where the pregnancy is developing outside of the womb, usually in one of the Fallopian tubes. It can cause right upper quadrant pain if it bleeds inside the abdomen, and this is a medical emergency.

• Pressure from the growing womb. The uterus can press on nearby organs and the diaphragm, causing discomfort.

• Indigestion. This is more common in pregnancy and can cause upper abdominal pain.

• Urinary tract infections (UTIs). Pain from UTIs can appear different during pregnancy because of the changes in positions of your organs due to the growing womb. They can occasionally cause pain in the right upper quadrant.

In young children it is often quite difficult for them to show exactly where the pain is. If this is the case, the range of options widens to almost any cause of abdominal pain.

In children common causes include:

• Constipation. Hard or infrequent poos can cause right upper quadrant pain (or pain elsewhere in the abdomen).

• Anxiety. Stress or worry can sometimes cause pain anywhere in the abdomen.

• Mesenteric adenitis. Infection can inflame glands in the abdomen, causing pain, often after a cold.

• Appendicitis. Usually this gives pain in the lower right part of the stomach but it can start around the belly button. Pain may be less clear if the child can’t describe it, or if the appendix has burst.

• Pneumonia. Infections of the lower parts of the lungs may cause pain in the right or left upper quadrant.

• Gastroenteritis. This infection (usually viral) causes abdominal pain, vomiting, and diarrhoea.

If you have a pain which doesn't settle, you will probably need to see a health professional to help work out the cause.

A doctor will be able to get a reasonable idea of the cause for the pain by:

• Asking you some questions about where the pain is and what it feels like.

• Physically examining you by feeling your abdomen in the area you have the pain.

• Examining other parts of your body, if needed, such as the rest of your abdomen and your chest.

Are tests needed?

You may be asked to provide a sample of urine to check for blood, glucose (sugar) and other abnormalities. You may need further tests, depending on what the doctor thinks is causing the pain.

Possible tests might include:

• Blood tests to check the function of your liver, and to look for signs of inflammation, infection, or other potential causes.

• An ultrasound scan to look for common conditions such as gallstones.

• Occasionally a chest X-ray might be needed to rule out a problem in your lungs, such as infection.

Referral might be needed for:

• A look into your stomach and upper bowel with a camera (endoscopy) and other scans and 'scopes'.

• A endoscopic retrograde cholangiopancreatography (ERCP) to examine your gallbladder and pancreas.

• A computerised tomography (CT) scan, to look for abnormalities of the pancreas or kidneys.

It is very unlikely that you would need all these tests - tests will be chosen depending on the likely cause of the pain after the examination.

What if no cause is found after tests?

If a serious cause has been ruled out, this is reassuring, but the pain may continue in some cases.

Sometimes it is hard to find a cause - for example, bowel spasm in a condition like irritable bowel syndrome may cause right upper quadrant pain and this can not be shown on tests.

It is also possible for there to be pain that is caused by "mistakes" in the signals your nerves are sending to your brain. This can cause "chronic" (ongoing) pain in various parts of your abdomen without any underlying medical cause.

The treatment for RUQ pain depends on the cause. Treatments for a few of the common causes are briefly discussed below.

• Gallstones. In some cases symptoms are not very troublesome and can be managed by sticking to a low-fat diet only. Many people choose to have their gallbladder removed, in an operation called a cholecystectomy. This can usually be done by keyhole (laparoscopic) surgery.

• Cholecystitis is treated initially with antibiotics, usually in hospital via injections or a drip (intravenous antibiotics). Once the infection has been treated, a cholecystectomy is usually advised.

• Shingles. The pain and rash settle on their own in time, but some people may be advised to take an antiviral tablet to help reduce the risk of long-term nerve pain after shingles. Also, some people may need medication for a few weeks or months after the infection to manage their long-term pain.

• Kidney infections are treated with antibiotics. Mild infections can be treated with antibiotics at home. If you are very unwell you may need admission to hospital for intravenous antibiotics and fluids.

• Kidney stones. Small kidney stones pass on their own eventually; you will need to drink plenty of fluids. Larger kidney stones may need one of a number of procedures done to break them up or remove them altogether.

• A duodenal ulcer is usually treated with acid-suppressing medication, as is indigestion.

This depends on the cause of the pain. Your doctor should be able to give you an idea of the outlook once a diagnosis has become clear.