Discomfort or pain under the rib cage can be due to different causes depending on whether it is on the right, left or middle. The area just under the bottom part of the rib cage is the abdomen and not the chest cavity as is commonly thought. In fact the chest cavity ends where the diaphragm (a broad sheet of muscle) lies and this is just a short distance below the nipples. The abdomen starts immediately below the diaphragm. Therefore pain under the right rib cage is actually the same as right upper quadrant (RUQ) abdominal pain.
Organs Under the Right Rib Cage
The abdominal cavity has the most amount of organs from various systems, compared to any other cavity. As a result, right side abdominal pain may be due to different conditions than left side abdominal pain. However, there will be some degree of overlap as well since many of the abdominal organs are large and extend across the midline. So an organ that mainly lies on the left side may extend slight to the right, and vice versa.
The organs on the right side of the abdomen, just under the rib cage, includes:
- Gallbladder and bile ducts
- Right kidney
- Colon (right colic flexure and first part of the transverse colon)
- Stomach (end portion)
- Duodenum and a portion of the rest of the small intestine
However, it is important to note that the movement with breathing and change in position also means that organs of the chest cavity occupies this area at times. The diaphragm, base of the right lung, pleura (lining) around it and the inferior vena cava that runs to the heart may also contribute to pain under the right rib cage. As is evident, there will be some degree of overlap with the pain under the left rib cage. The peritoneum, fascia, abdominal muscles and overlying skin are continuous and can also be the point of origin of pain.
Causes of Pain Under Right Rib Cage
There are a number of different possible causes of pain under the right rib cage and only some of the more common abdominal conditions are covered in this article. Always consult with a medical professional about symptoms like pain. Further tests and investigations may be needed to identify the exact cause. Pain on its own without any other symptoms can be difficult to diagnose without appropriate investigations. Take note of signs and symptoms that can help with the diagnosis.
Kidney problems causing pain under the rib cage will usually present with urinary symptoms, such as burning or pain when urinating, frequent urination and large or small volume urine.
- Kidney stones (renal calculi) occur when sediment from the urine accumulates to form a small mass. It often passes out of the kidney with urine but may sometimes remain obstructed in the kidney or ureter.
- Pyelonephritis is a kidney infection. Bacteria are more commonly responsible. The infection can originate lower down the urinary system like in the bladder and ascend up to the kidney. Alternatively bacteria may spread from elsewhere in the body to the kidney via the bloodstream.
- Renal carcinoma (kidney cancer) is a malignant growth in the kidney. It may originate in the kidney or spread to the kidney from another site through the bloodstream, lymphatic system or via direct spread.
Liver problems may remain unnoticed for a long period of time. Symptoms that may be seen with the pain includes nausea, vomiting, jaundice changes in appetite, alterations in body weight, nutritional deficiencies and sometimes even blood clotting problems.
- Hepatitis means inflammation of the liver. Most cases of hepatitis are due to infections, like viral hepatitis. It can also occur with alcoholism, the overuse of certain drugs and with autoimmune disorders. Hepatitis can progress to cirrhosis.
- Hepatocellular carcinoma (liver cancer) is a malignancy within the liver. The risk is greater in people who have other liver diseases like chronic hepatitis.
- Non-alcoholic fatty liver disease is a condition where fat accumulates in the liver and is not associated with alcohol abuse. It is usually asymptomatic but in some rare instances it can be severe and progress to liver failure.
Gallbladder and Bile Ducts
The gallbladder lies closer to the midline than to the right flank. Therefore gallbladder pain is usually felt in the middle of the upper abdomen and slightly to the right. Nausea, vomiting, diarrhea, fatty stools and changes in appetite are some of the possible symptoms that may arise with gallbladder and bile ducts.
- Gallstones is one of the more common gallbladder problems. It arises when bile sediments in the gallbladder accumulate to form stones. Tiny stones may pass out into the small intestine unnoticed. Larger or multiple stones may block a duct and be asymptomatic.
- Cholecystitis is where the gallbladder becomes inflamed. It may occur due to gallstones, bile duct problems, tumor or infections. Cholangitis is inflammation of the bile ducts often caused by infections.
- Bile ducts strictures are where the bile ducts become narrow. These ducts carry bile to the gallbladder and from the gallbladder to the duodenum (small intestine).
- Cancer of the gallbladder or bile duct is not a very common cancer. It is more likely to occur in people with a history of gallstones, infections and other related diseases.
- Pancreatitis is inflammation of the pancreas that arises with excessive alcohol consumption, gallstones, abdominal surgery, infection, abdominal injury or cancer. It can be acute or chronic.
- Pancreatic cancer is one of the more common and serious types of cancer. It is more common among people who abuse alcohol and develop chronic pancreatitis.
Many other conditions that can cause pain under the right rib cage but there are the same as right side abdominal pain and sometimes even pain under the left rib cage. It includes:
- Infectious colitis
- Inflammatory bowel disease
- Food intolerances like lactose intolerance
- Peptic ulcer disease
- Ischemic bowel disease
- Volvulus (twisting of the bowels)
- Appendicitis (usually cause right lower abdominal pain)
- Trapped gas
- Lung diseases
- Heart attack (upper middle abdominal pain more often)