Pain under the right ribs: causes, red flags and when to get it checked

The right upper abdomen lies under the lower ribs and contains the liver, gallbladder, part of the stomach, duodenum, right kidney and the lung base above the diaphragm. Pain here is classified by what makes it better or worse, and by symptoms such as nausea, fever, jaundice and urine or stool changes.

• Gallstones with biliary colic: sudden steady pain after meals, lasting 30 minutes to hours, with nausea; may radiate to the right shoulder blade.

• Musculoskeletal pain: strained muscles or irritated rib cartilage, tender on pressing, worse on twisting or deep breaths.

• Indigestion, gastritis and peptic ulcer.

• Cholecystitis: persistent gallbladder pain with fever and tenderness, needing urgent treatment.

• Fatty liver and hepatitis, with a dull ache and sometimes tiredness.

• Kidney stones and urinary infection on the right.

• Pneumonia or pleurisy at the lung base, with cough, fever and pain on breathing.

• Bile duct stones, pancreatitis, liver abscess and liver tumours, which are less common but serious.

Fever or shaking chills, yellowing of the skin or eyes, dark urine and pale stools, persistent severe pain, vomiting, pain with breathlessness, weight loss, a lump or swelling, and pain after an injury suggest a more serious problem.

• Call 999 or go to A&E: severe constant pain with collapse, a rigid abdomen, vomiting blood or breathlessness.

• Same-day GP or NHS 111: pain with fever, jaundice or persistent vomiting.

• GP within days: repeated attacks after fatty meals, or pain with dark urine and pale stools.

• Routine GP: reproducible chest wall tenderness that is improving.

The doctor asks about onset, duration, relation to meals, radiation, nausea, fever, urine and stool colour, alcohol, medicines, weight, injury and cough. They examine for jaundice, press on the right upper abdomen to check for a tender gallbladder, liver enlargement, rib tenderness and listen to the lungs.

• Abdominal ultrasound: the key test for gallstones and gallbladder inflammation.

• Liver function tests, amylase, full blood count and CRP.

• Urine dipstick: for kidney or urinary causes.

• Chest X-ray: if lung causes are suspected.

• MRCP or CT: for bile duct stones, masses or complications.

Avoid large, fatty meals while awaiting assessment, stay hydrated and use simple painkillers if appropriate. For chest wall pain, gentle movement and warmth help. Keep a record of attacks, meals and timing. Do not ignore attacks that last more than a few hours.

The NHS route is a GP with ultrasound, then a surgical referral for symptomatic gallstones. Private surgeons offer direct access to ultrasound and keyhole gallbladder removal.