Pain under the right rib cage — what doctors call right upper quadrant (RUQ) pain — is one of the most common reasons patients walk into a general surgical clinic in Dubai. The list of possible causes is long, ranging from a simple muscle strain to a true surgical emergency such as acute cholecystitis or appendicitis with an unusual position. Most patients understandably try over-the-counter painkillers, change their diet, or wait it out — sometimes for weeks. This guide will help you understand what RUQ pain means, which features should reassure you, which features should worry you, and when it is time to see a General Surgeon.
What lives in the right upper abdomen
Anatomy first. The right upper quadrant contains:
- •Liver and gallbladder
- •Right side of stomach and duodenum
- •Head of pancreas
- •Right kidney and adrenal
- •Hepatic flexure of the colon
- •Lower part of the right lung and diaphragm
- •Right-sided abdominal wall muscles
Pain in this region can therefore originate from any of these structures — surgical or non-surgical.
Common surgical causes
1. Biliary colic — pain after fatty meals, lasting 2–6 hours, often radiating to the right shoulder. 2. Acute cholecystitis — severe pain > 6 hours with fever and tenderness. 3. Bile duct stones (choledocholithiasis) — pain plus jaundice, dark urine, pale stools. 4. Right-sided inguinal or umbilical hernia causing referred discomfort. 5. Appendicitis — classically right lower abdomen but can present higher in pregnancy or unusual anatomy. 6. Right-sided abdominal wall injury or hernia at a previous scar.
Common non-surgical causes
- •Acid reflux and gastritis
- •Hepatitis or fatty liver disease
- •Right-sided kidney stones or urine infection
- •Right-lower lobe pneumonia (referred pain)
- •Costochondritis (inflammation of the rib cartilages)
- •Muscle strain or rib injury
- •Shingles (often before the rash appears)
Pattern recognition: what your pain may mean
Pain after fatty meals, radiating to right shoulder, settling within hours → biliary colic. Constant severe pain > 6 hours + fever + tenderness → acute cholecystitis. Pain + jaundice + dark urine → bile duct stones or cholangitis. Burning pain after eating, worse lying down → reflux/gastritis. Loin-to-groin colicky pain + blood in urine → kidney stone. Sharp pain on cough/breathing + recent chest infection → pleuritic / pneumonia. Localised tenderness on the rib + worse with movement → muscle/rib cause.
Red-flag symptoms — go to A&E
- •Severe pain lasting > 6 hours
- •Fever > 38.5 °C with shaking chills
- •Yellow tinge to skin or eyes
- •Persistent vomiting
- •Confusion, low blood pressure or sweating
- •Severe tenderness or board-like rigidity
What investigations you may need
- •Blood tests: FBC, CRP, liver function tests, lipase, kidney function
- •Urine dipstick (kidney/urine causes)
- •Abdominal ultrasound (best first test for gallbladder/liver/kidney)
- •MRCP if bile duct stones suspected
- •CT abdomen if diagnosis unclear or red flags present
- •Endoscopy (OGD) if reflux/gastritis suspected
When to see a General Surgeon
Book an outpatient appointment if you have:
- •Repeated episodes of pain after fatty meals
- •Confirmed gallstones on ultrasound
- •Pain lasting more than an hour
- •Symptoms not settling with antacids over 2–4 weeks
- •A visible lump or scar bulge
Go to A&E (or call us on WhatsApp +971 58 500 4596) for any red-flag features.