Pain in the Upper Right Abdomen

Stomach ulcer

A peptic ulcer or gastric ulcer is an open sore that forms when inflammation occurs in the stomach lining.

This stomach inflammation is caused by the bacteria Helicobacter pylori (H. pylori) and by prolonged use of pain relievers such as ibuprofen or aspirin. Chronic inflammation allows acid to damage the stomach lining and an ulcer may form.

Smoking, drinking alcohol, stress, and spicy foods may aggravate ulcers, but do not cause them.

Symptoms include burning pain in the stomach; heartburn; nausea; and bloating.

The pain may be worse between meals or at night. Antacids will only work for a short time. There may be dark red blood in the vomit or stools.

Left untreated, ulcers may bleed and cause anemia. They may perforate the stomach and cause peritonitis (serious infection of the abdominal cavity.)

Diagnosis is made through physical examination and by testing breath and stool for H. pylori. Endoscopy is sometimes used.

Treatment involves a course of antibiotics to kill the bacteria, and medication to block excess acid and heal the stomach.

Rarity: Uncommon

Top Symptoms: fatigue, nausea, loss of appetite, moderate abdominal pain, abdominal cramps (stomach cramps)

Symptoms that never occur with stomach ulcer: pain in the lower left abdomen

Urgency: Primary care doctor

Indigestion (dyspepsia)

Indigestion, also called upset stomach, dyspepsia, or functional dyspepsia, is not a disease but a collection of very common symptoms. Note: Heartburn is a separate condition.

Common causes are eating too much or too rapidly; greasy or spicy foods; overdoing caffeine, alcohol, or carbonated beverages; smoking; and anxiety. Some antibiotics, pain relievers, and vitamin/mineral supplements can cause indigestion.

The most common symptoms are pain, discomfort, and bloating in the upper abdomen soon after eating.

Indigestion that lasts longer than two weeks, and does not respond to simple treatment, may indicate a more serious condition. Upper abdominal pain that radiates to the jaw, neck, or arm is a medical emergency.

Diagnosis is made through patient history and physical examination. If the symptoms began suddenly, laboratory tests on blood, breath, and stool may be ordered. Upper endoscopy or abdominal x-ray may be done.

For functional dyspepsia – "ordinary" indigestion – treatment and prevention are the same. Eating five or six smaller meals per day with lighter, simpler food; managing stress; and finding alternatives for some medications will provide relief.

Rarity: Common

Top Symptoms: nausea, stomach bloating, dyspeptic symptoms, bloating after meals, vomiting

Symptoms that always occur with indigestion (dyspepsia): dyspeptic symptoms

Symptoms that never occur with indigestion (dyspepsia): vomiting (old) blood or passing tarry stools, rectal bleeding, bloody diarrhea, fever

Urgency: Self-treatment

Hepatitis B

hepatitis B, or "hep B," is a viral liver infection. It is spread through direct contact with the blood or other bodily fluids of an infected person, especially through sexual contact and/or sharing needles. A baby can be infected by the mother during birth; however, the newborn can receive a vaccine to protect it.

Symptoms appear one to four months after exposure and include abdominal pain; nausea and vomiting; joint pain; fever; dark urine; and jaundice, which is yellowing of skin and whites of eyes.

If not treated, hepatitis B can become chronic – especially in children. This increases the risk of developing liver failure, liver cancer, or cirrhosis (damage from scarring.) hepatitis B is a medical emergency and requires immediate care.

Diagnosis is made through blood tests and sometimes through liver biopsy.

Acute hepatitis B can be managed with rest, fluids, and good nutrition while the body fights the virus. However, a chronic infection may be treated with antiviral medications or liver transplant.

There is a vaccine for hepatitis B, recommended for anyone at risk.

Hepatitis A

hepatitis A is a liver infection caused by the virus. It can severely affect the liver's ability to function.

The disease is highly contagious and spreads through traces of fecal matter. hepatitis A can be contracted from contaminated food or water, especially in a place with poor sanitation; from sharing hypodermic needles; or from close contact with an infected person, including sexual contact.

There may be few symptoms or there may be fatigue; nausea and vomiting; pain in the upper right side of the abdomen; dark urine; and yellowing of the skin and eyes, called jaundice.

Anyone with symptoms of hepatitis A should be seen by a medical provider. Most patients recover completely, but in rare cases acute liver failure can result.

Diagnosis is made through blood tests.

Treatment involves rest and caring for the symptoms, since antibiotics cannot cure a viral illness. Mild cases usually clear up on their own.

Frequent and thorough handwashing is the best prevention. Vaccines are available for those at higher risk, such as health care workers.

Gallstones

Gallstones are small, pebble-like, mineral deposits that can form inside the gallbladder. They may cause no symptoms unless they become lodged in a duct leading out of the gallbladder.

Gallstones are thought to be caused by high cholesterol, which can form into crystals in the gallbladder; by cirrhosis, or scarring, of the liver; or by incomplete emptying of the gallbladder.

Most susceptible are women over age 40. Other risk factors are obesity, lack of exercise, poor diet, and rapid weight loss as with gastric bypass surgery.

Symptoms include sudden sharp pain in the center or upper right abdomen, in the right shoulder, and in the upper back. There may also be nausea and vomiting, yellowing of skin and eyes, and fever and chills.

It's important to see a medical provider for these symptoms. Gallstones can lead to pain, infection, and further complications.

Diagnosis is made through physical examination, CT scan, blood tests, and sometimes specialized scans to examine the gallbladder system.

Treatment usually involves surgery to remove the stones and sometimes the gallbladder itself.

Gall bladder infection (cholecystitis)

Gallbladder infection, also called cholecystitis, means there is a bacterial infection of the gallbladder either with or without gallstones.

The gallbladder is a small organ that stores bile, which helps to digest fats. If something blocks the flow of bile out of the gallbladder – gallstones, damage to the bile ducts, or tumors in the gallbladder – the bile stagnates and bacteria multiplies in it, producing an infected gallbladder.

Risk factors include obesity, a high-fat diet, and a family history of gallstones.

Symptoms include fever; chills; right upper quadrant abdominal pain radiating to the right shoulder; and sometimes nausea and vomiting. A gallbladder infection is an acute (sudden) illness, while the symptoms of gallstones come on gradually.

Untreated cholecystitis can lead to rupture of the gallbladder, which can be life-threatening.

Diagnosis is made through physical examination, ultrasound or other imaging, and blood tests.

Treatment involves hospitalizing the patient for fasting with IV fluids, to rest the gallbladder; antibiotics; and pain medication. Surgery to remove the gallbladder is often done so that the condition cannot recur.

Rarity: Uncommon

Top Symptoms: abdominal pain (stomach ache), nausea, loss of appetite, diarrhea, constipation

Symptoms that always occur with gall bladder infection (cholecystitis): abdominal pain (stomach ache)

Symptoms that never occur with gall bladder infection (cholecystitis): pain in the upper left abdomen, pain in the lower left abdomen

Urgency: Hospital emergency room

Appendicitis

Appendicitis is an inflammation of the appendix, the small, finger-shaped pouch projecting off the colon on the lower right side of the abdomen.

The inflammation is caused by anything blocking or irritating the appendix opening or walls, such as hard stool or damage from other bowel disease. The blocked appendix can quickly swell with bacteria and pus.

Appendicitis is most common from ages 13-30, but can happen to anyone.

Symptoms include sudden, severe pain in the abdomen that begins near the navel and soon moves to the lower right side. There may be low-grade fever; nausea and vomiting; feeling bloated; and constipation or diarrhea.

If not treated, an infected appendix can rupture and cause a life-threatening infection of the abdomen called peritonitis. This is why appendicitis is a medical emergency. If suspected, take the patient to the emergency room or call 9-1-1.

Diagnosis is made through patient history, physical examination, blood and urine tests, and imaging such as ultrasound or x-ray.

An inflamed appendix must be surgically removed as soon as possible.

Acute pancreatitis

Acute pancreatitis is the inflammation of the pancreas, which creates and releases insulin and glucagon to keep the sugar levels in your blood stable. It also creates the enzymes that digest your food in the small intestine. When these enzymes accidentally get activated in the pancreas, they digest the pancreas itself, causing pain and inflammation.

You should go to the ER. There, diagnosis is made by physical examination, imaging, and blood tests. Treatment typically involves intravenous (IV) fluids and medicines to control the pain.

Rarity: Rare

Top Symptoms: constant abdominal pain, nausea or vomiting, being severely ill, severe abdominal pain, fever

Symptoms that always occur with acute pancreatitis: constant abdominal pain

Urgency: Hospital emergency room

Acute hepatitis C

Acute hepatitis C is a liver inflammation caused by Hepacivirus C. The acute form of the disease means that it arises suddenly, within six months of exposure.

hepatitis C is spread through infected blood, usually through sharing hypodermic needles for intravenous drug use or from sharing personal items such as toothbrushes or razor blades. It can also be sexually transmitted.

Most susceptible are intravenous drug users; hemodialysis patients; HIV patients; and babies born to infected mothers.

Early symptoms may mild, with fatigue, fever, pain in the upper right side of the abdomen, and loss of appetite. Some patients will develop dark urine, pale white stools, and jaundice, which is yellowing of the eyes and skin.

Diagnosis is made through patient history, physical examination, and blood tests.

About half of all cases clear spontaneously, but it is still important to see a medical provider to prevent further liver damage from inappropriate medicines, supplements, or alcohol.

Otherwise, treatment involves antiviral and other medications. In severe and complicated cases, a liver transplant may be necessary.

Rarity: Ultra rare

Top Symptoms: fatigue, nausea, loss of appetite, muscle aches, fever

Symptoms that never occur with acute hepatitis c: pain in the upper left abdomen, pain in the lower left abdomen, pain in the lower right abdomen, pain around the belly button

Urgency: Primary care doctor

Can I prevent the formation of gallstones?

Yes, maintaining a healthy weight and exercising regularly are the best ways to prevent the formation of gallstones. Studies show that people who are overweight are more likely to develop gallstones.

How can I live without my gallbladder?

Gallbladder removal is a very common surgery. Having your gallbladder removed does not affect digestion significantly because the liver can also make bile to help with digestion of fatty foods. Symptoms after gallbladder removal include gassiness, bloating, or more watery bowel movements. After removal of the gallbladder, there is a small likelihood that gallstones will recur.

Do gallstones have to be removed with surgery?

No. Gallstones do not have to be removed with surgery. There are oral medications that can be taken to break down or dissolve gallstones. The success of oral therapy depends on the size and composition of the gallstones in addition to the functionality of the gallbladder and duct system.

What is the treatment for hepatitis A?

There is no medication that treats Hepatitis A. Your physician will recommend rest, fluids, and adequate nutrition since it is a short-term infection that often resolves. However, some people with Hepatitis A experience severe symptoms and need to be hospitalized in order to get appropriate fluid and nutrition.

Is pain in the upper right abdomen life-threatening?

Some causes of upper right abdomen pain such as pancreatitis can be very severe. According to a large study in the United States, 15 to 25% of people with acute pancreatitis develop severe pancreatitis. Severe pancreatitis can result in fever, hypotension, and organ failure, and require monitoring in the intensive care unit. It is important to not ignore symptoms of pain in the upper abdomen and seek medical attention before the condition worsens.

Questions your doctor may ask about pain in the upper right abdomen

• Have you experienced any nausea?
• Any fever today or during the last week?
• Have you lost your appetite recently?
• Have you been feeling more tired than usual, lethargic or fatigued despite sleeping a normal amount?

Self-diagnose with our free Buoy Assistant if you answer yes on any of these questions.