By Beth Sissons

Reviewed by Saurabh (Seth) Sethi, MD MPH

Healthcare professionals consider the abdomen to have four sections, which they call quadrants. This classification helps them better identify symptoms.

The right upper quadrant (RUQ) includes the pancreas, right kidney, gallbladder, liver, and intestines.

Pain under the ribs in this area can indicate a health problem affecting one of these organs or the surrounding tissues.

Below, we describe nine causes of pain in the RUQ, their treatments, and when to see a doctor.

Gastrointestinal issues

RUQ pain can result from gastrointestinal issues, such as indigestion or gastroesophageal reflux disease (GERD).

Symptoms of GERD can include:

• frequent heartburn
• chest pain
• nausea
• vomiting
• a sore or burning sensation in the throat

Maintaining a healthful lifestyle, avoiding trigger foods, and taking antacid medications can often help with managing GERD.

Kidney infection

An infection in the right kidney can cause pain in the RUQ. Other symptoms of a kidney infection can include:

• pain in the groin and back
• fever and chills
• a frequent need to urinate
• pain when urinating
• blood in the urine
• dark or cloudy urine that may smell foul
• nausea
• vomiting

Bacteria or a virus may be responsible for this infection, and it can spread from the bladder.

Anyone who suspects that they have a kidney infection should see a doctor right away. They may receive a prescription for antibiotics.

If the infection is severe, a person may need to stay in the hospital to receive intravenous fluids and, possibly, further treatment.

Kidney stones

When a kidney stone forms in the right kidney, it can cause pain in the RUQ. Other symptoms of kidney stones can include:

• blood in the urine, which may appear red, pink, or brown
• fever and chills
• painful urination
• a frequent need to urinate
• low levels of urine
• an inability to urinate

If a person suspects that pain results from kidney stones, or if they have other symptoms of the condition, they should see a doctor right away.

Treatment may involve removing the stone or breaking it into pieces that the body can pass easily.

Gallstones

The gallbladder sits in the RUQ underneath the liver. Gallstones are small and made up of cholesterol or bilirubin, which is a substance that forms when red blood cells break down.

The primary risk factor for gallstones is being overweight, particularly if the weight is around the waist.

Gallstones can cause:

• sharp pain in the RUQ that lasts for hours
• fever and chills
• brown urine
• light-colored stools
• yellowing of the skin and eyes
• nausea
• vomiting

If a person experiences any of these symptoms, they should see a doctor right away. If left untreated, gallstones can block the bile ducts and cause complications.

One treatment for gallstones involves removing the gallbladder, which is not an essential organ.

Liver abscess

A liver abscess, which doctors also call a hepatic abscess or pyogenic liver abscess, is a collection of pus in the liver. The pus can result from infection with parasites, bacteria, or fungi.

A liver abscess can cause pain or tenderness in the RUQ, as well as:

• fever and chills
• unintentional weight loss
• nausea and vomiting
• yellow skin
• grey stools

Treatment typically involves a procedure to drain the pus. If the infection is bacterial, antibiotics can often help fight off the infection.

Other liver conditions

Pain in the RUQ can stem from other liver conditions, such as cirrhosis, fatty liver, and liver cancer.

Symptoms to look out for include:

• a sensation of fullness in the RUQ under the ribs
• a loss of appetite or feeling full quickly after eating
• unintentional weight loss
• a swollen abdomen
• yellowing of the skin and eyes
• fatigue
• itching
• blood vessels showing on the abdomen
• pain in the abdomen and right shoulder

If a person notices any of these symptoms, they should see a doctor.

Preeclampsia

Preeclampsia is a complication that develops in 5–8% of pregnancies. It tends to arise anytime between 20 weeks of gestation and 6 weeks after delivery.

Preeclampsia results from a sudden rise in blood pressure, and it causes swelling, mostly in the face, hands, and feet.

Other symptoms can include:

• pain in the RUQ that may spread to the shoulder and lower back
• headache
• weight gain of over 3–5 pounds in 1 week
• changes in vision
• shortness of breath
• nausea and vomiting

A doctor needs to monitor blood pressure with regular prenatal checkups. High blood pressure can indicate preeclampsia, even when no other symptoms are present.

A woman with any symptom of preeclampsia should receive immediate medical attention because the condition can become serious if it remains untreated. Treatment usually involves taking medication.

Pancreatitis

A pancreas condition can cause pain under the ribs in the middle of the abdomen, in the RUQ, or the left upper quadrant (LUQ).

Pancreatitis is inflammation of the pancreas, and it may result from gallstones or overuse of alcohol.

Symptoms of pancreatitis include:

• steady or sharp pain in the upper abdomen
• bloating
• nausea
• vomiting
• a loss of appetite

If a person has symptoms of pancreatitis, they should see a doctor right away because the condition can be severe.

Mild pancreatitis may go away within a few weeks. However, if pancreatitis becomes severe, a person may require medication and intravenous fluids in the hospital.

Other underlying conditions

Lung conditions, such as pneumonia, can cause pain that spreads to the right side of the chest under the ribs.

Other conditions in surrounding areas can also cause pain in the RUQ. Some include:

• shingles
• a hernia
• bruising of the ribs
• inflamed cartilage of the ribs, known as costochondritis

When to see a doctor

People with mild or reoccurring RUQ pain should see a doctor and discuss any other symptoms.

If a person experiences any of the following symptoms, they should see a doctor right away:

• unexplained weight loss
• yellowing of the skin or eyes
• swelling of the abdomen
• black stools
• blood in the stools or urine
• severe pain in the right side
• coughing or vomiting blood
• coughing up a substance that looks like coffee grounds

Also, seek immediate medical attention for any symptoms of preeclampsia or a kidney infection. These conditions can be dangerous if a person does not receive treatment.

Summary

Pain under the ribs in the RUQ can result from various conditions that affect the organs or surrounding tissues in that area of the abdomen.

These conditions may relate to the liver or right kidney, for example, or they may be gastrointestinal.

Anyone with consistent or severe pain in the right side of the abdomen should seek immediate medical attention.