Upper Right Abdominal Pain

Upper Right Abdominal Pain refers to permanent or colicky pain in the area of ​​the upper right abdomen . Upper Right Abdominal Pain is often reported by patients. They can be based on very different causes.In medicine, the abdomen is divided into four quadrants , with a vertical and a horizontal line drawn through the umbilical region. The upper abdomen is thus divided into the rightand left upper abdomen .

More over, often the stomach area ( epigastric ), considered separately in the central upper abdomen. It should be noted that the cause of pain can not always be reliably deduced from the localization of the pain, since in some diseases the pain radiates and, in addition, each patient perceives pain differently.

Upper Right Abdominal Pain

In addition to the small bowel ulcer , other diseases of the intestine, such as inflammationand infection , can cause right upper abdominal pain. In cases of persistent pain in the right upper abdomen, a cancer of the intestine must always be considered. Colon cancer is a malignant tumor of the intestine . Most often, the tumor is localized in the colon , but it can in principle occur in all parts of the intestine.

Upper Right Abdominal Pain

Upper Right Abdominal Pain causes

Colorectal cancer is after breast cancer ( in women ) and prostate cancer ( in men) the second most common tumor disease. Colorectal cancer often develops on the basis of benign protrusions in the intestinal wall, the so-called polyps , which can be detected and removed in the course of a colonoscopy .

Removing the polyp can lead to uncontrolled growth and the development of a malignant tumor as part of various genetic changes . Other factors may favor the development of the malignant tumor. These include overweight , smoking , improper diet , as well as a family burden of cancer.

In many cases, that happensDevelopment to the malignant tumor very slowly , so that the typical symptoms can be missing. These include blood in the stool , persistent Upper Right Abdominal Pain or upper abdominal cramps, altered bowel habits, as well as unexplained weight loss , tiredness and fatigue in the later stages . To diagnose a cancer of the intestine, a test is used for blood in the stool, a palpation of the abdomen and a colonoscopy .

The therapy of colorectal cancer involves surgical removal of the tumor and possibly one Radiation and / or chemotherapy . The sooner the tumor is detected and the better the tumor can be removed during surgery, the better the prognosis.

Another liver disease that can cause Upper Right Abdominal Pain is cirrhosis of the liver . In liver cirrhosis, the liver and connective tissue are rebuilt, as the healthy liver cells are destroyed. The damage to the liver cells can be caused by various liver diseases, such as hepatitis and fatty liver, or more rarely by congenital liver disease. Also very common is destruction of liver cells due to excessive alcohol consumption .

The symptoms of liver cirrhosis can be very variable and range from itching , tiredness , fatigue , bloatingand Upper Right Abdominal Pain up to confusion in the liver coma. Through the connective tissue remodeling of the liver, one can feel it hardened during the physical examination . Also, an ultrasound examination of the abdomen, various laboratory tests and a detailed questioning of the person affected by the doctor can lead to the diagnosis.

The therapy of cirrhosis of the liver depends on the cause and ultimately consists of avoiding liver-damaging substances such as alcohol or medication. However, liver cirrhosis can only be cured with a liver transplant, Furthermore, many organs that are not localized in the right upper abdomen can still cause right upper abdominal pain.

These include, for example, the stomach and the pancreas , which are more likely to be in the left upper abdomen, but in case of illness can cause a radiating pain in the right upper abdomen. Furthermore, structures outside the abdominal cavity, such as the diaphragm , the heart and the spine , may have pathological changes, which also manifest themselves in epigastric pain on the right.

Figure right side abdominal pain

  1. Liver –  hepar
  2. Gallbladder – Vesica biliaris
  3. Stomach  gaster
  4. Large intestine, transverse part – Colon transversum
  5. Small intestine – intestinal tenue
  6. Large intestine, ascending part – ascending colon
  7. Cecum – caecum
  8. Worm- appendix – appendix vermiformis
  9. Fallopian tubes – tuba uterina
  10. Ovary – ovary
  11. Uterus – uterus

Upper Right Abdominal Pain when coughing

Upper Right Abdominal Pain, which is on the right side and only occurs when coughing , are mostly muscular . If organic causes were the cause, the pain would be mostly permanent. Since numerous muscles are stretched between the ribs, the coughing can lead to a kind of straining of the muscles, in this case then in the area of ​​the Upper Right Abdominal Pain, which then leads to pain, especially when coughing. It would be important to pay attention to concomitant symptoms such as shortness of breath , fever, etc., which would rather speak against a muscular cause.


Upper Right Abdominal Pain can be associated with nausea . The nausea is a negative sensation that manifests itself with feeling unwell and feeling vomiting. Depending on the type of underlying disease, the nausea may be accompanied by other symptoms, such as vomiting , diarrhea , headache , eye pain , dizziness , fever, and cough .

After the ingestion of poisonous or spoiled food , nausea serves as a protective functionof the body to cause the harmful food to get rid of and is often associated with vomiting and upper abdominal pain.

However, nausea can also appear as a symptom of pathological processes. These include diseases of the abdominal organs (stomach, intestine, pancreas, gallbladder and liver), infectious diseases , diseases or injuries of the brain ( concussion , sunstroke or migraine ), diseases of the inner ear and mental illness.

In addition, medications , food sensitivities, and food allergies , as well as the excessive consumption of alcohol , can trigger nausea with or without vomiting. In women, the nausea is also possible during the early stages of pregnancy .

First, a detailed questioning by the doctor takes place. Important questions are when exactly the nausea occurs, whether it occurs in connection with the food, which symptoms accompany the nausea ( vomiting, diarrhea, epigastric pain, headache, dizziness, fever ) and whether diseases that cause nausea have been previously detected.

This is followed by a physical examination in which the abdomen is monitored and scanned . Often then can already be made the diagnosis. In addition, an ultrasound examination of the abdomen, an examination of the affected person’s blood and urine , gastroscopy and computed tomography (CT) of the head can be performed. Various measures can be considered for the treatment of nausea. The focus is on the treatment of the underlying disease .

If the nausea is due to food intolerance or excessive consumption of food and beverages, in most cases, a change in diet , a food break, and the renunciation of stimulants ( alcohol ). Medicines for nausea

Nausea medications are also called antiemetics . In case of nausea with severe vomiting hospitalization may be required to compensate for the high salt and water loss frominfusions .

Upper Right Abdominal Pain After Eating

If Upper Right Abdominal Pain occurs after eating , numerous causes can be considered. On the one hand, diseases of the stomach , the small intestine and the gallbladder ( see above on the main page ) can lead to Upper Right Abdominal Pain after eating.

Secondly, Upper Right Abdominal Pain after eating often by poor diet , food intolerances and – allergy related. Foods that often cause epigastric pain after eating are bloating foods such as legumes, bulbous plants and cabbage. These foods lead to increased gas formationin the stomach or intestines, which can cause epigastric pain after eating. Even very greasy foods can cause Upper Right Abdominal Pain immediately after eating.

But not only the food itself, but also the way the food is supplied plays a role in the development of upper abdominal pain. Always make sure not to consume too much in hectic rush . Furthermore, is on a sufficient amount of drinking To be taken to avoid constipation and an unpleasant feeling of fullness with Upper Right Abdominal Pain after eating. Some foods may cause intolerance reactions in some individuals, in addition to Upper Right Abdominal Pain after ingestion of the food, and often complaints such as nausea , vomiting,and diarrhea .

Examples are the lactose intolerance , in which due to an enzyme deficiency no lactose is tolerated, or the fructose intolerance , in which due to the lack of a transporter in the intestinal wall, no fructose is tolerated. Finds an incompatibility reaction after ingestion of a toxic food (poisonous plants, bacterial toxins in raw foods ) instead of, one speaks of a food poisoning .

Food poisoning can cause severe epigastric pain, nausea, vomiting and diarrhea, as well as seizures and hallucinations . The food allergy is an allergic reaction to certain foods and thus a special form of food intolerance. After ingestion of the food, there is an allergic reaction with symptoms such as itching and swelling of the skinand mucous membranes, thereby possibly narrowing the bronchi with shortness of breath, as well as excessive Upper Right Abdominal Pain with nausea, vomiting and diarrhea. For example, the allergy to peanuts is widespread.

The best therapy in these cases consists of avoiding the food which triggers the intolerance reaction or the allergic reaction. If diseases of the stomach , the small intestine and the gallbladder trigger the Upper Right Abdominal Pain after eating, then the treatment is in the foreground.

Upper Right Abdominal Pain with flatulence

Upper Right Abdominal Pain can be associated with flatulence . Flatulence is an unpleasant accumulation of air in the abdomen, which can occur when a person swallows air or when there is an increase in the formation of gases in the abdomen.

Flatulence can manifest itself in a frequent departure from intestinal gases , which is called flatulence . If the gases can not escape, it can lead to the formation of a swollen abdomen , what is called meteorism . In general, flatulence is not dangerous and just on wrong diet, hectic food intake or food intolerance .

However, various diseases of the gastrointestinal tract , gall bladder , liver and pancreas can lead to excessive formation of gases, so persistent flatulence should be clarified by a doctor. Flatulence can be associated with various other conditions, such as vomiting , abdominal cramping , diarrhea , or constipation .

Frequently, flatulent foods such as legumes, cabbage and bulbous plants are the cause of unpleasant flatulence. Even carbonated drinks have a flatulent effect Intestine . Furthermore, hectic feeding of food and stress can promote flatulence. Another major cause of flatulence is food intolerance. An important example is lactose intolerance . Often, the bloating is accompanied by severe Upper Right Abdominal Pain and diarrhea.

Flatulence may also be due to over or over colonization of the intestine with bacteria , or due to infection with fungi. Furthermore, a variety of drugs, especially antibiotics , cause flatulence.

Persistent flatulence, which is accompanied by severe Upper Right Abdominal Pain and other complaints, must always be onDiseases of the gastrointestinal tract , gall bladder, liver and pancreas are thought.

In order to identify the cause of the flatulence, a detailed questioning of the person affected by the doctor takes place. Important is the question of other complaints, such as upper abdominal pain, diarrhea or constipation, after pre-existing conditions that could be responsible for the bloating and after medication, which the person regularly takes. This is followed by a physical examination with listening and palpation of the abdomen. Further studies are useful in finding the cause, are testing for food intolerances, examinations of blood , stool and urineof the person concerned, an ultrasound examination of the abdomen and optionally an X-ray examination.

The therapy depends on the cause of flatulence. The focus is on the treatment of the underlying disease . If there are no diseases of the abdominal organs, it is often sufficient to avoid bloating foods, as well as to avoid foods that cause intolerance reactions. It can be consulted a nutritional counseling. Medicaments which are used for the treatment of flatulence are, for example, spasmolytics ( anticonvulsant action ), defoamers ( lead to the disintegration of gas bubbles ) and carminatives (herbal remedies with antispasmodic action).

Gallbladder inflammation and gallstone disease

In the area of ​​the right upper abdomen, the gallbladder is located with its bile ducts . Quite often it comes from a gallstone , which is either in the gallbladder or has dissolved and drives through the corridors, right upper abdominal pain. When a gallstone has peeled away and floats through the narrow bile ducts, it can get stuck in a narrow spot, which in turn can lead to very severe and colicky pains.

Furthermore, inflammation of the gallbladder, whether chronic or acute, can lead to right upper abdominal pain. Gallbladder inflammation sometimes occurs as a result of gallstones that are in the gallbladder.

  • Inflammation of the gallbladder , usually due to accumulation of bile in the gallbladder due to gallstones
  • Abdominal pain in the area of ​​the right upper abdomen, often the pain is colicky(alternately decreasing and increasing)
  • Risk factors for the formation of gallstones: female sex, fair skin color, overweight, older than 40 years, in the child of childbearing age, even own children
  • Diagnosis by ultrasound examination of the abdomen, certain laboratory parameters and possibly backup by an ERCP (= representation of the bile ducts as part of a gastrointestinal mirroring)
  • Therapy : Painkillers and antibiotics should be given in the acute phase . In the further course, the surgical removal of the gallbladder ( cholecystectomy ) is recommended .
  • Complications : collection of pus in the gallbladder, tearing of the gallbladder with emptying of the bile into the abdomen

Diagnosis in case of suspected gallstone problem

In order to clarify the cause of gall bladder inflammation, patient survey and physical examination are very important. Thus, the doctor will ask the patient about eating and bowel habits, severity of discomfort and first appearance, as well as known gallstones.

If the Upper Right Abdominal Pain occurs especially after eating fat foods , this already indicates a gallbladder or gallstone problemout. This is followed by a physical examination, in which the patient’s abdomen is first bugged to assess bowel sounds and then felt to find out the pain-causing points. To diagnose gallbladder inflammation is also the so-called Murphy test in which the patient is asked to first exhale completely and then inhale deeply. In this inhalation maneuver, the examiner presses the area below the right costal arch.

If the patient senses severe pain at this point during inhalation, this indicates a gallbladder inflammation. The confirmatory diagnosis is then made by means of an ultrasound examinationposed. In this case, possibly existing gallstones are white, an inflamed gallbladder may show up distended under certain circumstances with a three-layered gallbladder wall. If there is any doubt about the ultrasound examination and the physical examination, a blood test may also show an inflammation in the area of ​​the gallbladder. Inflammation levels such as CRP or the leukocytes would then be significantly increased.

Gallstones, which only occasionally cause discomfort, need not be treated. It should be noted that symptomatic gallstones in the gallbladder can eventually lead to a painful colic. A gall bladder infection or a gallstone permanently triggered pain symptoms must be treated in any case. In the past, medications used to dissolve stones, but today gallbladder removal is the treatment of choice. The operation is performed endoscopically, ie by the gentle keyhole technique.


  • Ulcer in the small intestine (usually in the duodenum) with defects in the mucous membrane of the intestine
  • Abdominal pain especially in the right upper abdomen, which are sober and especially strong at night and lose weight when ingested.
  • Diagnosis by gastrointestinal reflection
  • Therapy : acid blocker , diet change (no roasting, no spicy food), smoking cessation
  • Complications : bleeding from the mucosal defect, breakthrough of the stomach wall with emptying of the stomach contents into the abdominal cavity

Liver disease

  • eg inflammation ( hepatitis ), thrombosis (blood clots) or swelling due to backflow of blood (eg heart disease)
  • Increase of the abdominal circumference, possibly yellowing of the skin, loss of appetite , and many more
  • Diagnosis by elevated liver values in the blood (liver enzymes, bilirubin), ultrasound examination of the abdomen, possibly sample collection of liver tissue for microscopic examination.
  • Therapy : Depending on the cause, liver diseases can be treated with medication. Sometimes, however, surgical or minimally invasive interventions are necessary.
  • Complications : Liver coma due to the accumulation of toxins that are broken down normally via the liver.

Pain radiates in the back

Right upper abdominal pain, which also pull in the back, can always come from an inflamed pancreas . This very serious clinical picture is caused either by excessive alcohol consumption or by a gall bladder stone, which is stuck in a corridor. Typical of pancreatitis is the abdominal, and belt-shaped, back pain. The diagnosis is made by ultrasound and blood test.

Upper Right Abdominal Pain during pregnancy

Even during pregnancy, Upper Right Abdominal Pain can occur on the right side. On the one hand, all diseases that cause Upper Right Abdominal Pain in the non-pregnant woman (for example gall bladder , liver and gastrointestinal tract disorders ) can also be the reason for this during pregnancy.

On the other hand, clinical pictures may be responsible for upper abdominal pain, which typically only occurs in pregnant women and is summarized as gestosis .

An important example of gestosis, which may be associated with right upper abdominal pain, is the so-called hyperemesis gravidarum . Hyperemesis gravidarum is a severe form of pregnancy sickness , which results in severe and persistent vomiting , epigastric pain and dizzy spells. How exactly the hyperemesis gravidarum arises is unclear.

The pregnant woman loses salt and fluid through excessive vomiting, which can lead to dehydration and circulatory weakness. In many cases, in-patient hospitalization is required to prevent further loss of salts and fluids through the use of infusions . If the administration of infusions is not sufficient, the pregnant woman can be treated with drugs that suppress nausea and irritation. These drugs are called antiemetics , an important agent is the so-called ondansetron . The prognosis of hypermesis gravidarum is good.

Another example of gestosis underlying Upper Right Abdominal Pain side of pregnancy is the so-called HELLP syndrome ( haemolysis, elevated liver enzymes , low platelets ). The cause of the onset of HELLP syndrome has not yet been fully elucidated, however, it is believed that processes in the placenta ( mother cake ) are involved.

In the case of the affected persons, the red blood cells decay ( haemolysis ), liver damagewith increased liver enzymes ( Elevated Liver Enzymes ) and a decrease in platelets( Low Platelets ), which can manifest itself in complaints, such as right upper abdominal pain, nausea and vomiting, headache and eyelashes .

The HELLP syndrome is potentially life-threatening for the pregnant woman , which is why Upper Right Abdominal Pain should always be interpreted as a warning signal on the right in pregnancy and clarified by the doctor. The treatment of HELLP syndrome involves immediate childbirth , as placental events are discussed as the cause of HELLP syndrome.

Upper Right Abdominal Pain Nocturnal

Upper Right Abdominal Pain, which occurs only at night , probably have no purely organic cause, since the pain would otherwise be present during the day. Nevertheless, eating habitsshould be reconsidered because it can always come to late, high-fat food to abdominal pain (even at night).

This would then also speak for a gall bladder involvement. It would also be important to ask if the pain occurs each night and how long it lasts. A treatment attempt with a hot water bottle should be made only tentatively, as a gall bladder problem could be aggravated thereby.

Upper Right Abdominal Pain
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