What are the other possible causes?
As well as the more common causes already described, there are many other conditions which occasionally cause right upper quadrant (RUQ) pain.
- Heart attack (myocardial infarction). Heart attacks normally present with chest pain, radiating to the left arm, or a tightness in the chest. Occasionally they can cause pain in the RUQ. Usually you would feel unwell in yourself if you were having a heart attack - for example feel sweaty or breathless.
- Pneumonia. This is an infection in the lung and normally gives you 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 RUQ. Other type of chest infections such as pleurisy can also sometimes give you a pain so low in your chest that it feels as if it is in your tummy (abdomen).
- Problems with the pancreas. This includes pancreatitis and cancer of the pancreas. Usually problems with the pancreas give you pain more in the middle of your upper tummy, which radiates to your back between your shoulder blades. But occasionally it can cause a pain on the right side.
- A serious complication of type 1 diabetes called diabetic ketoacidosis. This makes you very unwell generally, but occasionally tummy pain can be one of the symptoms.
- In a condition called Addison's disease, a complication called an Addisonian crisis occasionally can give you tummy pain. Again you would be unwell in other ways other than the pain.
- Rare complications of pregnancy affecting the liver.
- Pain radiating from problems with the spine. If nerves are being irritated or squashed, pain in any of the areas that nerve supplies can occur. Sometimes spinal problems cause pains in the tummy area.
- Pain which is referred from problems in the pelvis, which is below the tummy. This might include conditions such as infections (pelvic inflammatory disease) or ovarian cysts. Again the pain in the RUQ would usually be accompanied by one or more typical symptoms of these conditions.
- Budd-Chiari syndrome is a rare condition where the veins in the liver become blocked.
These listed causes are not exhaustive, and many other conditions occasionally cause pain in the RUQ.
What if no cause is found after tests?
Obviously if any serious cause has been ruled out, this is a relief, but doesn't settle the pain. There are so many possible causes that it may take quite a few tests before doctors are sure that they have ruled out all serious causes. In some cases when tests are normal, a condition called sphincter of Oddi dysfunction may be diagnosed. The sphincter of Oddi is a tight muscle band which controls the flow of a substance called bile which helps your digestion. It is located in one of the tubes around your liver and gallbladder. Even after having the gallbladder removed (a cholecystectomy), some people continue to get a pain which feels much like gallstone pain. There may not be anything to find on scans, etc, and sometimes this pain is put down to sphincter of Oddi problems.
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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