Pain In The Upper-Right Abdomen Under Rib Cage

What Causes Upper-Right Abdominal Pain?

Upper-right abdominal pain can have various causes, ranging in severity from 'needs attention' to 'generally fatal'.  Finding the true cause means ruling out or confirming each possibility – in other words, diagnosis.

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Diagnosis is usually a complex process due to the sheer number of possible causes and related symptoms.  In order to diagnose upper-right abdominal pain, we could:

  • Research the topic
  • Find a doctor with the time
  • Use a diagnostic computer system.
The process is the same, whichever method is used.

Step 1: List all Possible Causes

We begin by identifying the disease conditions which have "upper-right abdominal pain" as a symptom.  Here are eight of many possibilities (more below):
  • Pancreatitis
  • Gallbladder Disease
  • Pneumonia
  • Liver Abscess
  • Gallbladder Cancer
  • Heart Disease
  • Possible Urgent Medical Need
  • Liver Disease

Step 2: Build a Symptom Checklist

We then identify all possible symptoms and risk factors of each possible cause, and check the ones that apply:
frequent unexplained vomiting
significant neck pain
history of birth control pill use
severe left iliac pain
recent productive cough
severe non-specific arm pain
having excess body fat
extreme calorie restriction
moderate right lumbar pain
shortness of breath when at rest
Caucasian ethnicity
... and more than 90 others

Step 3: Rule Out or Confirm each Possible Cause

A differential diagnosis of your symptoms and risk factors finds the likely cause of upper-right abdominal pain:
Cause Probability Status
Gallbladder Disease 98% Confirm
Pancreatitis 17% Unlikely
Heart Disease 12% Unlikely
Possible Urgent Medical Need 2% Ruled out
Gallbladder Cancer 0% Ruled out
Liver Abscess 0% Ruled out
Pneumonia 0% Ruled out
Liver Disease 0% Ruled out
* This is a simple example to illustrate the process

Arriving at a Correct Diagnosis

The Analyst™ is our online diagnosis tool that learns all about you through a straightforward process of multi-level questioning, providing diagnosis at the end.

If you indicate abdominal pain unaffected by eating, abdominal pain reduced by eating or abdominal pain increased by eating, The Analyst™ will ask further questions including this one:
UPPER-RIGHT abdomen: Do you experience discomfort or pain behind the right rib cage?
Possible responses:
→ No / only after meals / don't know
→ Occasional mild discomfort
→ Frequent mild and/or occasional moderate pain
→ Frequent moderate and/or occasional severe pain
→ Frequent or constant severe pain
Based on your response to this question, which may indicate mild right hypochondriac discomfort, moderate right hypochondriac pain, significant right hypochondriac pain or severe right hypochondriac pain, The Analyst™ will consider possibilities such as:
Budd-Chiari Syndrome

Pain in the upper right abdomen, along with ascites and liver enlargement, is one of the main signs of Budd-Chiari syndrome.

Coronary Disease / Heart Attack

Cardiac pain may occasionally present as upper abdominal pain.  An acute myocardial infarction can cause upper-right or epigastric discomfort that may be similar to that of a gallbladder attack.  Congestive heart failure may stretch the liver capsule.

Gallbladder Cancer

The pain is usually in the upper-right abdomen or above the stomach.

Gallbladder Disease

Biliary pain rapidly increases in intensity, then remains constant for 4 to 6 hours, occasionally radiating to the right shoulder blade area.  In cases of acute gallbladder inflammation, the pain can last longer than 6 hours and be accompanied by tenderness and fever.

Liver Abscess

As well as abdominal pain, the liver and area below the right rib are tender to the touch.

Liver Disease

Liver disease is usually only painful if it stretches the capsule of the liver.  The pain is felt in the upper-right quadrant beneath your rib cage, usually as a dull ache, or the pain can be sharp and can sometimes be accompanied by back/shoulder pain.


The pain is on the side(s) of the affected lung(s).

Subphrenic Abscess

The pain occurs on the affected side, in the chest, upper abdomen, and/or shoulder.

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