Right Upper Quadrant Pain - Diagnosis

Authored by Dr Mary Harding, 08 Jul 2017

Patient is a certified member of
The Information Standard

Reviewed by:
Dr Adrian Bonsall, 08 Jul 2017

Your doctor will narrow the (enormous) field of possible diagnoses by talking to you and by examining you. They may be able to find the cause simply from doing so. For example, if they find the typical rash of shingles, you will need no further tests to find the cause. If they find a liver enlargement (unusual) this suggests the problem is in the liver. If examination is normal, that already rules out quite a few possible diagnoses. The doctor will certainly need to feel your tummy (abdomen) in the area you have the pain, but may also need to examine other parts too, such as the rest of your tummy and your chest.

You will probably be asked to provide a sample of urine, to check the colour and to rule out kidney problems.

You may well have to go for blood tests. These would check the function of your liver, rule out any inflammation or infection in your system, and check for anaemia.

An ultrasound scan is often a good next test. It is simple to perform and can look for common conditions such as gallstones. It can also give an idea about any liver abnormality or enlargement and can rule out some kidney and pancreas problems.

This is going to depend on what has been discovered so far through the tests above. More specific tests may be needed depending on where it is thought the pain is coming from. If your pain is thought to be coming from your guts, you are likely to have some type of endoscopy, which is an examination of the inside of your guts with a camera. A more specific type called endoscopic retrograde cholangiopancreatography (ERCP) can examine the tubes around your gallbladder and pancreas. In some cases special radio-isotope scans may be used. These show up certain organs and tissues by using a small dose of a radioactive chemical. 

If you might have a kidney problem, you might have a specialised form of computerised tomography (CT) scan, with a dye injected to highlight your urinary tract.

A chest X-ray might be needed to rule out a problem in your lungs, such as infection. If the pain is thought to come from the nerves around your spine, a magnetic resonance imaging (MRI) scan may be helpful. An MRI of the affected area of your tummy may also be useful in some cases.

Nobody will need ALL these tests of course. You are likely to need a few tests only. For example, if gallstones are found on the ultrasound scan in the first place, you would need no other tests.

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.

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