What To Know and Do About Right Upper Quadrant Pain

Right upper quadrant (RUQ) pain refers to discomfort in the upper right region of your abdomen, which often causes pain beneath or behind your lower ribs. Pain in the RUQ can range from person to person and may be mild, achy, dull, sharp, or throbbing. Depending on what's causing it, RUQ pain may be persistent or come and go in waves.

RUQ pain can be a sign of problems with one of the many organs, nerves, or soft tissues in this part of your abdomen. Because your right upper quadrant contains so many vital organs (like your gallbladder, liver, and pancreas), it's always a good idea to see a healthcare provider to discuss your symptoms and determine what's causing your pain. Early diagnosis and treatment are important for pain relief and preventing complications that can have serious health consequences.

What Organs Are In the Right Upper Quadrant? 

The right upper quadrant houses many organs, including the:

• Liver: The liver is the largest internal organ in the body, located on the upper right side below the lungs. It has over 500 functions, most related to supporting metabolic functions like filtering and eliminating waste from the blood and helping convert food to energy.
• Gallbladder: A pear-sized organ nestled beneath the liver, the gallbladder stores bile—a digestive fluid that helps break down fats in the small intestine and aids digestion.
• Pancreas: A large glandular organ that sits behind the stomach and extends across the upper abdomen, producing digestive enzymes and hormones to regulate blood sugar levels and support healthy digestion. 
• Small and large intestine: The RUQ contains portions of the small and large intestine. The small intestine absorbs nutrients from food and moves water from the bloodstream into the intestines. The large intestine breaks down the remaining nutrients from food and creates waste products (stool). 
• Stomach: A small part of the stomach is in the RUQ. The stomach produces digestive juices that mix with food and liquids you consume and moves its contents into the small intestine.

How Right Upper Quadrant Pain Presents 

Right upper quadrant pain varies in intensity and frequency. You may experience pain as dull, achy, sharp, or stabbing. The pain may also come and go or be steady and persistent. How you experience RUQ pain can offer clues about the underlying cause. Different types of RUQ pain include:

• Dull aching pain: Dull, aching, or throbbing discomfort may signal a problem with an organ within the RUQ. 
• Colicky pain: Sharp, stabbing pain that often starts suddenly and comes and goes in waves. Problems with the right kidney or gallbladder are common causes of RUQ colicky pain. 
• Cramping pain: Cramp-like pain is usually not serious and often occurs from gas, bloating, or diarrhea. 
• Localized pain: Pain concentrated in a particular area within the RUQ is usually the result of a problem with a specific organ.
• Generalized pain: Discomfort that spreads throughout the RUQ and at least half of your abdomen. Most causes of generalized pain are minor, but they can sometimes be a sign of something more serious, like an intestinal blockage. 

However, your healthcare provider will also look for other symptoms, such as nausea, vomiting, and fever to make an accurate diagnosis about the exact condition you have.

Potential Causes of Right Upper Quadrant Pain

A range of conditions cause right upper quadrant pain—and understanding the possible causes can help you and your healthcare identify the source of your pain. 

Gallstones 

Gallstones are small, hardened deposits of cholesterol (fat) or bilirubin (pigment) that can form in the gallbladder. When gallstones block bile ducts and prevent bile flow from the liver and gallbladder into the small intestine, they can cause sudden, sharp pain known as a "gallbladder attack." Gallbladder attacks most commonly occur after eating and may cause sharp pain, nausea, and vomiting.

Gallstones are very common and affect up to 15% of the United States population. Some people with gallstones don't always experience symptoms. However, older adults, women and people assigned female at birth, and people with a family history of gallstones have an increased risk of developing gallstones. Fortunately, several treatments can help remove or dissolve gallstones and treat any symptoms effectively.

Hepatitis 

Hepatitis is liver inflammation that can develop from viral infections, heavy alcohol use, or exposure to toxins or chemicals. The inflammation can be acute (lasting six months or less) or chronic, (persisting for over six months). When an inflamed liver enlarges and pushes against its protective membrane, it can cause dull, aching pain in the RUQ and tenderness when touched. 

Along with RUQ pain, hepatitis can also cause jaundice (yellowing of the skin and whites of the eyes), dark-colored urine, fever, fatigue, nausea, vomiting, and loss of appetite. There are several types of hepatitis, each with unique risk factors. However, common risk factors include unprotected sex, sharing needles or other sharp objects with others, heavy alcohol use, or lack of access to clean or uncontaminated drinking water or food. 

Peptic Ulcer Disease

Peptic ulcers are open sores that develop on the inner lining of the stomach or duodenum (the first part of the small intestine). Digestive acids can irritate the open sore, leading to burning pain and discomfort in the middle of your abdomen that can spread to the RUQ. The pain can last minutes to hours and may stop if you eat or take antacids.

However, you may experience symptoms of peptic ulcers for several days or weeks. Other symptoms of these ulcers include bloating, feeling full, nausea, vomiting, and blood stools.

Helicobacter pylori (H. pylori) bacterial infections and prolonged use of nonsteroidal anti-inflammatory drugs (NSAIDs) commonly cause peptic ulcer disease. If you have H. pylori or consistently use NSAIDs like Advil (ibuprofen), it's important to ask your healthcare provider what you can do to lower your risk of peptic ulcer disease and treat the underlying H. pylori infection. 

Kidney Stones 

Kidney stones are hard, pebble-like deposits of minerals and salts that develop in your kidneys. A kidney stone that forms in the right kidney can cause RUQ pain if it travels down the urinary tract and irritates or gets stuck in the ureter—the tube that carries urine from the kidney to the bladder. 

If you develop a kidney stone, you may experience pain that feels sharp, severe, or cramp-like in your lower back which can radiate to your RUQ or groin area. The pain may be constant or come in waves. Other kidney stone symptoms include nausea, vomiting, fever, chills, and bloody or smelly urine. Being dehydrated, living with obesity, or eating food with too much sugar or salt are common risk factors for developing a kidney stone.

Pancreatitis 

Pancreatitis is the inflammation of your pancreas, a glandular organ behind the stomach that produces digestive enzymes and hormones. This condition develops when digestive enzymes damage the organ, causing inflammation and pain. Pancreatitis can be acute (short-term) and resolve within a few days with treatment or chronic (long-term), worsening over time. 

Acute pancreatitis can develop slowly or suddenly, causing RUQ pain that may spread to your back and last for several days. Short-term inflammation may also cause fever, nausea and vomiting, rapid heart rate, and abdominal swelling. Chronic pancreatitis pain is similar but worsens over time, causing symptoms like diarrhea, nausea and vomiting, greasy, foul-smelling stools, and weight loss. Factors like heavy alcohol use, gallstones, obesity, and diabetes can increase your risk of pancreatitis.

Shingles

Shingles is a viral infection that causes a painful, pimple-like rash that develops on one side of the body or face. Before the rash develops, you may experience burning, shooting pains, tingling, or itching on your RUQ. The rash typically develops a few days after the pain begins and appears as a single band of blisters. Shingles can also cause headaches, chills, or an upset stomach. 

The varicella-zoster virus, which causes chickenpox and shingles, can lie dormant in nerve cells after a chickenpox infection. Anyone who previously had chickenpox can develop shingles, though the infection is most common in people ages 50 and older.

Less Common Causes 

Although less common, many other conditions can cause right upper quadrant pain, including: 

• Hepatomegaly: An enlarged liver that develops due to excessive alcohol use, liver diseases like hepatitis or fatty liver disease, cancer, or infections like mononucleosis
• Liver abscess: A pus-filled mass within the liver that develops in response to a liver injury or infection
• Liver cancer: Malignant (cancerous) tumors originating in the liver
• Biliary dyskinesia: Dysfunction of the gallbladder or bile ducts, preventing normal bile flow
• Costochondritis: Inflammation of the cartilage that connects the ribs to the breastbone
• Gastritis: Inflammation of the stomach's lining that can develop from excessive alcohol use, long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs), and H. pylori bacterial infections

When to Contact a Healthcare Provider

RUQ pain has many possible causes, and while some are minor, see a healthcare provider for:

• Severe or persistent pain (lasting more than three days)
• Discomfort that worsens over time 
• Pain that radiates to your neck, chest, or shoulders

Seek emergency medical attention if you have sudden and severe RUQ pain or pain with any of the following symptoms:

• Fever
• Loss of appetite 
• Nausea and vomiting 
• Rapid heart rate 
• Difficulty breathing 
• Constipation or trouble passing stool 
• Bloody poops
• Vomiting blood 

Diagnosis

If you're reaching out to your healthcare provider about your RUQ pain, it can help to know a bit more about the diagnostic process. During your appointment, your provider will ask about your medical history, learn about your symptoms, and perform a physical exam to check for signs of pain. They can also order additional tests to confirm a diagnosis, which may include:

• Blood tests: Measure your blood cell counts, identify markers of infection or inflammation, and check the function of your organs 
• Ultrasound: Uses sound waves to create images of the organs and tissues in your right upper quadrant to identify abnormalities like gallstones, kidney stones, and blocked bile ducts
• Computed tomography (CT) scan: Injects a special dye into your vein before taking a series of X-ray images of your internal organs in the RUQ to check for issues in organs like your liver, pancreas, and gallbladder
• Magnetic resonance imaging (MRI) scan: Takes detailed images of the RUQ organs via radio waves to identify inflammation and any problems with organs that may not be detectable on other imaging tests 
• Gallbladder radionuclide scan: Administers a radioactive chemical into your vein and flows into your organs to help diagnose liver disease, gallstones, gallbladder infections, and bile duct obstructions

Treatment Options

Treatment options for right upper quadrant pain vary widely and depend on the underlying cause. The goal of treatment is to relieve symptoms and manage any underlying conditions that may be causing your pain. Your exact treatment plan may include home remedies, medical treatments, or a mix of both.

Home Remedies

At-home treatments and self-care strategies may relieve RUQ pain in some cases. These include: 

• Over-the-counter pain (OTC) relievers: Taking medicines like Advil (ibuprofen) or Tylenol (acetaminophen) can help manage mild to moderate pain.
• Heat therapy: Applying a heating pad or heat pack to your RUQ may ease pain and discomfort.
• Dietary changes: Avoiding fatty or greasy foods and eating more high-fiber foods, such as fruits, vegetables, and whole grains, may help reduce digestive strain and some causes of RUQ pain.
• Hydration: Drinking plenty of water can help your body eliminate wastes and toxins, prevent dehydration, and maintain optimal organ function.

Medical Treatments

Medical treatments for RUQ pain can often vary, depending on the organ that is affected and the exact underlying cause of your pain. Common treatments include:

• Prescription medications: Depending on the diagnosis, your provider may prescribe stronger pain relievers, antibiotics for infections, antiviral medicines for virus-related pain (e.g., hepatitis, shingles), medications to break up gallstones, or other drugs to manage and control the condition causing pain.
• Endoscopic retrograde cholangiopancreatography (ERCP): A procedure that combines endoscopy and X-rays to treat problems that block the bile and pancreatic ducts, including gallstones, infection, acute pancreatitis, and tumors.
• Surgery: Certain conditions, such as gallstones, pancreatitis, or liver disease, may require surgery to relieve pain and manage the condition.

A Quick Review

Right upper quadrant (RUQ) pain has many possible causes, including problems with the gallbladder, liver, pancreas, kidneys, or gastrointestinal tract.

It's important to see a healthcare provider for persistent or severe RUQ pain. Early diagnosis and treatment can relieve pain, manage the underlying cause, and prevent complications. Your treatment plan may include home remedies, medical treatments, or a combination of both.