Pain under the right ribs: causes and which doctor to see

For pain under the right ribs you can first see: Internal Medicine or General Surgery or Gastroenterology. In large hospitals, the Gastroenterology unit also deals with this. If you are not sure, a family doctor (general practitioner) can assess you first and refer you to the right specialist.

Common symptoms: pain or fullness in the upper right abdomen; cramping that gets worse after meals; pain spreading to the right shoulder or back; nausea, bloating; yellowing of the eyes (with some causes). Symptoms vary from person to person; a doctor’s examination is needed for a diagnosis.

The most common causes: gallstones and gallbladder inflammation; fatty and enlarged liver; hepatitis; duodenal ulcer; right kidney stone or infection; strain of the muscles between the ribs; pneumonia in the lower right lung and pleurisy. Only a doctor’s examination can determine the exact cause.

Muscle pain passes in a few days. If gallbladder attacks recur, the gallbladder is usually removed with keyhole surgery. Fatty liver improves with weight loss and lifestyle change.

It is more common in: overweight women over 40 (gallstones); people who lose weight quickly; people with diabetes and insulin resistance (fatty liver); people who drink alcohol.

Abdominal ultrasound is the first test. Liver enzymes, bilirubin, amylase-lipase and a blood count are requested; endoscopy or CT is done if needed.

A healthy weight, regular meals and avoiding alcohol.

Liver tissue does not feel pain; but when it enlarges quickly its capsule stretches and causes a dull pain and fullness in the upper right abdomen.

It is most often seen with gallbladder attacks.

If the answer to any of these questions is yes, call 112 without delay: “Is the pain accompanied by high fever, chills or jaundice?” “Has the pain not gone for several hours, with vomiting?” “Is there shortness of breath with pain that gets worse on deep breathing?” “Is there confusion, fainting or difficulty waking up?” “Is there facial drooping, slurred speech or sudden weakness in an arm or leg?” “Are you struggling to breathe even at rest?”

See a doctor: the pain keeps coming back after meals; your liver enzymes are high; there is weight loss or loss of appetite.