Pain Under Right Rib Cage

What Can Cause Pain Under Right Rib Cage?

About Pain Under Right Rib Cage

Pain under the right rib cage can cause discomfort of varying degrees. There are numerous causes that can lead to pain under the right rib cage. It is important to understand the cause of pain so appropriate treatment can be evaluated. Thus it is necessary to be aware about the possible causes of pain. It is important to evaluate associated symptoms and their relation to your pain.

Most of the times, the right rib cage is caused due to minor injuries, rib contusion or intercostal muscle spasm. In few cases right rib cage pain is caused by diseases of lung, muscle and nerves. Such pain needs appropriate treatment.

Medical assessment and examination is essential to diagnose the cause of pain under right rib cage. The proper diagnosis then follows right treatment plan for pain under right rib cage. The evaluation of pain involves proper evaluation of intensity of pain, nature of your pain, the time when the pain occurs, its relation with movement and consumption of food. These details are essentials during history taking and it helps your physician to identify the cause of the right rib cage pain.

What Can Cause Pain Under Right Rib Cage?

Acid Reflux and Ulcers Can Cause Pain Under Rib Cage

Pain under right rib cage can be due to acid reflux and ulcer. Regurgitation of food contents and reflux of acid into the food pipe can cause pain under the breastbone and the rib cage. There may be burning in the throat also in relation to eating food or when stomach remains empty for long. Peptic ulcers, particularly those affecting the duodenum, which is present on the right side, too can cause similar pain. These may require timely diagnosis and treatment to avoid further complications like perforation and abdominal bleeding.

Liver Disorders Can Cause Pain Under Right Rib Cage

The liver is one of the vital organs located in the right side of the body below the rib cage. Conditions like inflammation of liver (hepatitis), enlargement of liver(hepatomegaly), liver cirrhosis, fatty liver or infections, toxins, drugs and alcohol affecting the liver can cause liver damage and pain under right rib cage in the right upper part of the abdomen. There may be sharp pain under right ribs and associated gastric complaints. Rib pain is rarely observed when capsule of liver is inflamed. The condition is known as Fitz-Hugh-Curtis Syndrome.1

Gall Bladder Diseases

Diseases of the gallbladder, which is located below the liver, can give rise to pain under the right rib cage. Conditions like inflammation of the gallbladder (cholecystitis) or gall stones (cholelithiasis) can cause severe pain in the right upper part of the abdomen, under the right rib cage and may even radiate to the right shoulder. This is usually occurs after consumption of fatty food with bloating, nausea and sometimes vomiting.

Inflammatory Bowel Disorder

Obstruction of the bowel or inflammation of the gut can cause conditions like Crohn’s Disease and may be evident after consumption of particular food items. There may be abdominal pain and discomfort under the right rib cage, vomiting and altered bowel movements.

Appendicitis

In some cases, the appendix, which is a small extended part of the intestine on the right lower side of the abdomen, may get infected. This may cause inflammation and pain, which is more on the right lower side, however, sometimes even the upper area under the ribs may be painful. This needs immediate medical attention and treatment.

Rib Contusion and Fracture2

Ribs on the right side can get bruised or cracked during forceful activities or by injuries. The severity of pain under right rib cage caused due to fractured ribs depends on the degree of fracture and need proper evaluation and management.

Costochondritis-

Ribs are attached to cartilages in front of chest wall. Rib cartilage is attached to sternum. Sometimes, trauma or certain infections can cause inflammation of the cartilage joining the ribs leading to pain and tenderness. The pain under right rib cage caused due to costochondritis may even radiate and may be felt on breathing.

Osteoporosis

Disorders of the bone and joints can cause inflammation and pain under right rib cage. Vitamin D deficiency or other factors causing brittle bones or osteoporosis too can lead to pain under right rib cage.

Intercostal muscle spasm

Right side rib cage pain is frequently observed following severe bout of cough and sneezing. The frequent contraction of intercostal muscles causes muscle spasm. Pain increases with inspiration and deep breathing.

Intercostal Neuralgia3

Intercostal nerve passes under the rib. Disease like shingle causes inflammation of intercostal nerve. Such condition is known as post herpetic neuralgia. The disease causes severe pain at rest and during activities.

Pleuritis4

Pleura is a mucous membrane that covers chest wall and lungs. The pleura that covers chest wall is known as parietal pleura. Similarly, pleura that covers lung is known as visceral pleura. The inflammation of pleura is known as pleuritis. Pleuritis of lower lobe of right lung causes pain under right rib cage.

Pneumonia

Pneumonia is a infection of lung. Infection of right lower lobe lung causes severe pain under right rib cage.

Causes Of Pain Under Right Rib Cage

Diagnosis of Pain Under Right Rib Cage

Diagnosis of pain under right rib cage is made after thorough evaluation of medical history and clinical examination. Investigations may be ordered depending on the suspected condition. These may include, laboratory tests to study blood picture for infections, chemical analysis and other parameters.

  • Blood Examination-
  • White blood cell count (WBC)- WBC count is increased in cases like pneumonia
  • Liver Function Test- Liver function test like SGOT and SGPT is abnormal and increased.
  • Imaging Studies-
  • X-ray,
  • CT scan or MRI
  • Image studies may be required to study bony structures, fractures, tumors or organ enlargement.

Treatment of Pain Under Right Rib Cage

Treatment for pain under right rib cage is based on the precise diagnosis and generally includes rest in case of physical injuries to the ribs, muscles or soft tissues to allow healing.

  • Medications-
  • Rest- For liver disease
  • Pain- NSAIDs and Opioids
  • Infection- Antibiotics
  • Diarrhea– Pepto bismol, Kaopectate and Imodium
  • Surgery- fractured rib and esophageal varices.

When To See Physician for Pain Under Right Rib Cage

  • Pain under right rib cage not responding to oral pain medication
  • Shortness of breath
  • Rash along the chest wall suggest shingles or post herpetic neuralgia.
  • Frequent dry cough followed by chest pain suggest pleuritis

References-

  1. An Uncommon Manifestation of Fitz-Hugh-Curtis Syndrome with Right-side Chest Pain.

    Harada K1, Iwamuro M, Hanayama Y, Otsuka F., Acta Med Okayama. 2016;70(2):145-9.

  2. Cough-induced costal cartilage fracture.

    Daniels SP1, Kazam JJ2, Yao KV3, Xu HS4, Green DB5., Clin Imaging. 2019 Mar 13;55:161-164.

  3. Myofascial trigger points in intercostal muscles secondary to herpes zoster infection of the intercostal nerve.

    Chen SM1, Chen JT, Kuan TS, Hong CZ., Arch Phys Med Rehabil. 1998 Mar;79(3):336-8.

  4. Dry pleurisy complicating solitary pulmonary nodules caused by Mycobacterium avium: a case report.

    Asakura T1, Ishii M2, Haraguchi M3, Kamiyama I4, Kohno M5, Sakamaki H6, Emoto K7, Hayashi Y8, Sugiura H9, Kawada I10, Soejima K11, Namkoong H12, Tasaka S13, Hasegawa N14, Betsuyaku T15., J Med Case Rep. 2015 Oct 26;9:238. doi: 10.1186/s13256-015-0723-4.

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