Abdominal pain is a common symptom but on its own it is not usually a good indicator of the underlying cause. In this regard it is referred to as a non-specific symptom. Therefore it is important to isolate the pain to the location and take into consideration other symptoms that may be present in order to reach a possible diagnosis. This is further aided by the results of diagnostic investigations like an abdominal ultrasound or MRI.
Right side abdominal pain refers to any discomfort, tenderness, burning sensation or overt pain that occurs on the right half of the abdomen. It can be further isolated to whether it occurs on the upper or lower portion of the right side of the abdomen. This corresponds with the four abdominal quadrants and with right side abdominal pain it includes the right upper quadrant (RUQ) and right lower quadrant (RLQ).
Organs on the Right Side of the Abdomen
Understanding what organs lie in this area and what symptoms may be associated with specific organs can be helpful in identifying the cause of right side abdominal pain. The location of pain on its own is also not a good indicator of the cause.
Sometimes pain may rise from a problem at one site but be felt elsewhere. This is known as referred pain. At other times pain that arises at one location may extend to a wider area beyond where the diseased organ lies. This is known as radiated pain.
The following organs lie on the right side:
- Cecum with appendix (if present), ascending colon and half of the transverse colon
- Kidney and ureter (right)
- Portion of the pancreas
- Part of the small intestine
- Terminal portion of the stomach
Organs like the ovary, fallopian tube and uterus are technically in the pelvic cavity. In addition, the overlying skin, abdominal wall (muscles and fascia), large blood vessels (aorta and inferior vena cava), nerves, lymphatics, fat tissue, deep muscles and sheets of tissue known as peritoneum are also part of the abdomen.
Causes of Upper and Lower Right Abdominal Pain
There are many conditions that may cause diffuse abdominal pain. This means that the abdominal pain is spread over a large area of the abdomen or even the entire abdomen. This is mainly due to the structures extending over many quadrants of the abdomen, like with the abdominal wall, small intestine and peritoneum. This article focuses specifically on right side abdominal pain arising from the organs in these quadrants.
Liver and Gallbladder
The liver has a host of different functions in the body and is among the most versatile of organs. It processes nutrients, toxins and waste products in the system. Waste, toxins, metabolic byproducts and excess substances that are not needed in the body are processed by the liver and some is excreted through the bile that the liver produces.
This bile filters out of the liver and into the gallbladder. Eventually bile is secreted into the small intestine (duodenum) and ultimately expelled with stool. The liver is a large organ that lies under the diaphragm. Most of it sits in the right upper quadrant which can start as high up as below the right nipple and a portion extends to the left side of the upper abdomen.
The gallbladder lies in a small indentation (fossa) under the gallbladder but more towards the center of the abdomen. The gallbladder duct connects with the common bile duct and this also communicates with the pancreas before empting its contents into the duodenum which is the first part of the small intestine.
Liver, gallbladder and bile duct conditions which may cause right side abdominal pain includes:
- Hepatitis (inflamed liver) – usually due to a viral infection.
- Hepatic carcinoma (liver cancer)
- Gallstones and bile duct stones
- Cholecystitis (inflamed gallbladder)
- Cholangitis (infected bile duct)
- Cancer of the gallbladder or bile ducts
An enlarged liver, fatty liver disease and cirrhosis may also present with abdominal pain but often these conditions remain silent (asymptomatic) for long periods of time. Related symptoms include jaundice, nausea, vomiting, pale stools, diarrhea and loss of appetite. The pain is usually in the right upper quadrant.
The pancreas extends from the right side to the left side of the abdomen. It lies close to the midline. The pancreas also has several functions in the body. It produces and secretes important hormones in the bloodstream like insulin and glucagon to control blood glucoses levels. It also produces and secretes strong digestive enzymes through ducts into the small intestines, along with bile from the gallbladder.
- Pancreatitis (acute or chronic pancreas inflammation)
- Pancreatic cancer (malignant tumor in the head of the pancreas)
- Pancreatic pseudocyst
Related symptoms include diarrhea, nausea, vomiting, abdominal distension, loss of appetite and fatty stools. The pain is usually around the upper middle abdomen and may extend slightly to the left or right.
Most of the stomach lies in the left upper quadrant, tucked under the left ribcage. However, the terminal portion of the stomach extends to the right side. Therefore conditions that involve this last part of the stomach may cause right side abdominal pain, more so in the right upper quadrant (RUQ).
- Gastritis (inflamed stomach wall)
- Peptic ulcer disease (extends to duodenum)
- Gastric perforation (tear in the stomach wall)
- Gastric outlet obstruction
Related symptoms include nausea, vomiting, indigestion, changes in appetite and bloating. The pain is usually on the left side of the abdomen but can extend across to the right side, closer to the midline.
Kidney and Ureter
The kidneys filter wastes, excess water, metabolic byproducts and non-essential substances from the bloodstream to expel it in the form of urine. This urine passes down the ureter and is stored in the bladder until it can be expelled into the environment. The right kidney lies behind the liver, slightly under the diaphragm. Kidney and ureter problems usually present with flank and back pain.
- Pylenopheritis (kidney inflammation)
- Ureteritis (ureter inflammation)
- Kidney cyst
- Adrenal gland hemorrhage (bleeding)
- Cancer of the adrenal gland or kidney (right)
- Renal (kidney) abscess or perirenal abscess
- Renal artery stenosis (narrowing) or occlusion (blockage)
Related symptoms include changes in urination (volume and/or frequency), color or odor of urine, nausea, vomiting and alterations in blood pressure. The pain is towards the flanks and often reported as mid back pain on the right side.
Colon and Appendix
The large intestine starts at the cecum which communicates with the last part of the small intestine, the ileum. The appendix is a protrusion from the cecum. Both the cecum and appendix lie in the lower right quadrant. It then continues into the ascending colon which travels up from the right lower quadrant to the right upper quadrants. The colon then takes a 90 degree turn at the right colic (hepatic) flexure. It continues as the transverse colon which passes from the right side to the left side of the abdomen.
- Appendicitis (inflamed appendix)
- Colitis (inflamed colon)
- Inflammatory bowel disease (IBD) – Crohn’s disease or ulcerative colitis
- Volvulus (twisting of the colon)
- Colon cancer
Related symptoms include alterations in bowel habit especially diarrhea, blood or mucus in the stool, nausea, flatulence, loss of appetite and abdominal distension. Pain may involve both the upper and lower quadrants of the right side of the abdomen.