What are the most common causes of right upper quadrant pain?
Gallstones and gall bladder problems
Gallstones don't necessarily cause any symptoms, but when they get stuck they can give you pain. This is called biliary colic and is typically a severe crampy pain in the right upper quadrant (RUQ) shortly after eating a fatty meal. An infection may ensue, called cholecystitis, which will give you a more persistent pain in the RUQ, with a high temperature (fever).
Kidney stones and infections
Problems with the kidney tend to give you pain more around the right-hand side of the RUQ, or in your back (loin), but the pain may spread and involve the front of the tummy (abdominal) area. Kidney stones can cause a severe pain (usually round the back) which occurs in spasms lasting from a few minutes to several hours. There may be also be blood in your wee. A kidney infection can cause pain anywhere along your urinary tract. So this could be anywhere from the loin in your back, around to the front, the RUQ, or down to the lower part of your tummy. It may be associated with a fever, pain when you wee, or going to the loo more frequently.
In some cases you can get the pain from shingles before the rash appears. You may have pain for a few days before a blistery rash appears. The pain tends to be quite sharp or burning, and you may feel not quite right in yourself. The RUQ is a common place for a shingles rash.
Other people find they continue to get a pain long after the rash of shingles has gone. This is called postherpetic neuralgia.
The liver takes up a large part of your RUQ but, in fact, it doesn't very often give you pain. Causes of pain from the liver include:
- Infection of the liver (hepatitis). 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. There are a number of types of hepatitis, including hepatitis A, hepatitis B and hepatitis C.
- Abscess. This is a collection of pus around the liver or under the ribs, causing pain, tenderness and fever.
- Alcoholic liver disease. Too much alcohol can damage your liver, which may affect its function, turn your skin yellow and give you RUQ pain.
- Liver cancer - this can start in the liver or have spread from other cancers. Primary cancer in the liver is unusual. The liver may enlarge in certain blood cancers, such as lymphomas or leukaemias, causing discomfort.
Several problems with your guts can give you pain in the RUQ. For example:
- Duodenal ulcer. Pain typically comes on a couple of hours after eating and may be improved by taking antacids. The level of pain can gradually build up over time, eventually becoming severe and may be associated with bringing up (vomiting) blood. This is an emergency and you should call an ambulance to go directly to hospital if this occurs. See separate leaflet called Duodenal Ulcer for more information.
- Gastroenteritis. Infections of your guts tend to give you pain all over your tummy, or more in the middle; however, 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. See separate leaflet called Gastroenteritis in Adults for more information.
- Indigestion (dyspepsia) can give you a pain in the upper part of your tummy, along with bloating and acid reflux. See separate leaflet called Dyspepsia (Indigestion) for more information.
- Longer-term conditions such as Crohn's disease and ulcerative colitis can cause pain anywhere in the tummy at times. They usually cause loose stools, sometimes with blood. See separate leaflets called Crohn's Disease and Ulcerative Colitis for more information.
- The RUQ is not a common place for pain in irritable bowel syndrome, but in some people it may occur. Pain is usually on and off and accompanied by bloating and diarrhoea and/or constipation. See separate leaflet called Irritable Bowel Syndrome for more information.
What are the most common causes of right upper quadrant pain in pregnancy?
Any of the above conditions can cause pain in the RUQ whether you are pregnant or not, so you should always get checked out. However, in pregnancy a common cause of discomfort is the sheer pressure of the womb pressing on other organs, and pressing them into the diaphragm. Also, problems with indigestion tend to be common in pregnancy, again at least partly due to the pressure on the stomach. Urinary tract infections are also more common in pregnancy.
What are the most common causes of right upper quadrant pain in children?
In young children it is often quite difficult for them to show exactly where the pain is. If this is the case, the field of options widens to almost any cause of tummy ache. In children common causes include:
- Mesenteric adenitis. In children with infections such as colds, glands within the tummy commonly become inflamed giving them tummy ache.
- Appendicitis. Usually this gives pain in the lower right part of the tummy. However, if a child can't show you exactly where the pain is, or if the appendix has burst (ruptured), appendicitis may be a possible diagnosis to consider.
- Pneumonia. Infections of the lower parts of the lungs may cause pain in the tummy area.
Further reading and references
Kim JS; Acute Abdominal Pain in Children. Pediatr Gastroenterol Hepatol Nutr. 2013 Dec16(4):219-224. Epub 2013 Dec 31.
Wilcox CM; Sphincter of Oddi dysfunction Type III: New studies suggest new approaches are needed. World J Gastroenterol. 2015 May 2121(19):5755-61. doi: 10.3748/wjg.v21.i19.5755.
Cholecystitis - acute; NICE CKS, January 2017 (UK access only)
Gallstones; NICE CKS, February 2015 (UK access only)
Ahmed F, Fogel EL; Right upper quadrant pain and a normal abdominal ultrasound. Clin Gastroenterol Hepatol. 2008 Nov6(11):1198-201. doi: 10.1016/j.cgh.2008.06.020.
Cartwright SL, Knudson MP; Diagnostic imaging of acute abdominal pain in adults. Am Fam Physician. 2015 Apr 191(7):452-9.
This started in September 2017. I had a sharp pain under my rib cage, centre, above my belly button and was throwing up every time I stood up or walked. Dr came and out and gave me some tablets to...TheWolverine
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