Abdominal Pain on the Right Side: Could It Be Your Liver, Gallbladder or Appendix?

Right-sided abdominal pain is one of those symptoms that sends people straight to the internet and the internet, as always, is not particularly helpful. One search leads to appendicitis. Another leads to gallstones. A third raises the possibility of liver disease. By the end of it, most people are either convinced they’re seriously ill or so overwhelmed by contradictory information that they’ve decided to ignore it entirely.

Neither response is useful. What’s useful is understanding what’s actually on the right side of the abdomen, what each structure feels like when something goes wrong with it, and what the patterns and accompanying symptoms are that help distinguish one from another.

Right-sided abdominal pain has a range of causes some straightforward, some that need prompt attention. Here’s how to think through what might be going on.

What’s Actually on the Right Side of the Abdomen?

Before getting into symptoms, it helps to know what’s physically located there. The right side of the abdomen contains several important structures, and the specific location of the pain upper right, lower right, or diffuse gives a meaningful first clue about which one might be involved.

Upper right abdomen:

• The liver – the body’s largest organ, sitting beneath the right rib cage
• The gallbladder – tucked under the liver, storing bile
• Part of the large intestine – the hepatic flexure, where the colon turns
• The right kidney – sitting toward the back

Lower right abdomen:

• The appendix – a small pouch attached to the large intestine
• The right ureter – the tube carrying urine from the right kidney to the bladder
• In women – the right ovary and fallopian tube
• Part of the small intestine
• Muscles and nerves of the abdominal wall

Pain that’s clearly in the upper right is more likely to involve the liver, gallbladder, or right kidney. Pain in the lower right is more likely to involve the appendix, ureter, or in women gynaecological structures. Pain that moves or is less well-localised can involve multiple possibilities.

The Liver What Liver Pain Actually Feels Like

The liver itself doesn’t have pain receptors, it’s the capsule surrounding it (Glisson’s capsule) that does. Pain from the liver is therefore felt when the liver is enlarged or inflamed enough to stretch that capsule, or when something else is pressing on it from outside.

Liver pain is typically felt as a dull, constant ache in the upper right abdomen, sometimes extending into the right shoulder or back. It tends to be persistent rather than colicky, it doesn’t come in waves the way gallstone pain does. Lying on the left side sometimes eases it by shifting the liver’s weight.

What Causes Liver Pain?

Hepatitis – inflammation of the liver from viral infection (hepatitis A, B, or C), alcohol, or certain medications. Causes upper right tenderness, fatigue, nausea, and sometimes jaundice.

Fatty liver disease (NAFLD) – an enlarged, fatty liver can cause a persistent dull ache in the upper right, though many people with fatty liver have no pain at all.

Liver abscess – a collection of pus within the liver, usually from bacterial or amoebic infection. Causes fever, significant right upper quadrant pain, and feeling very unwell. Needs urgent treatment.

Liver congestion from heart failure – when the heart isn’t pumping efficiently, blood backs up into the liver, causing it to enlarge and the capsule to stretch. Causes right upper quadrant fullness and ache alongside other heart failure symptoms.

Liver tumours – primary liver cancer or secondary deposits from elsewhere cause liver enlargement and right upper quadrant discomfort, sometimes alongside weight loss and fatigue.

Most liver conditions also produce systemic symptoms fatigue, nausea, jaundice alongside the localised pain. Right upper quadrant pain with yellowing of the skin or eyes, dark urine, or pale stools points strongly toward liver or bile duct involvement and needs urgent assessment.

The Gallbladder The Most Common Cause of Upper Right Pain

For most adults presenting with right-sided upper abdominal pain, the gallbladder is the most likely culprit. Gallstone disease is extremely common, and its symptoms are frequently mistaken for indigestion, acid reflux, or gas until the pattern becomes clear.

Biliary Colic

When a gallstone shifts and temporarily blocks the cystic duct, the outlet of the gallbladder, the gallbladder contracts against the obstruction, producing pain. This is called biliary colic, and its characteristics are fairly distinctive:

• Steady, cramping pain in the upper right abdomen or just below the breastbone
• Often starts after a meal, particularly a fatty or heavy one
• Can radiate to the right shoulder or between the shoulder blades
• Lasts anywhere from thirty minutes to several hours before easing
• May be accompanied by nausea and vomiting

The pain of biliary colic comes and goes in episodes rather than being constant. Between episodes, the patient may feel perfectly fine. This episodic nature pain after fatty meals, then resolution, is one of the most helpful distinguishing features.

Antacids often don’t help biliary colic, which is part of what eventually prompts people to seek a proper assessment. They’ve tried everything for what they assumed was indigestion, and nothing works because the gallbladder is the actual source.

Acute Cholecystitis

When a gallstone lodges permanently in the cystic duct and doesn’t move, the gallbladder becomes inflamed acute cholecystitis. The pain is similar in location to biliary colic but:

• Persists rather than easing after a few hours
• Is more severe and tender to touch in the upper right abdomen
• Is accompanied by fever and feeling significantly unwell
• Makes deep breathing uncomfortable

Acute cholecystitis needs prompt medical attention, it’s not something to manage at home with painkillers. Untreated, it can progress to a perforated or gangrenous gallbladder.

Other Gallbladder-Related Pain

Choledocholithiasis – a stone in the bile duct causes pain similar to biliary colic but often accompanied by jaundice and fever, indicating that bile is blocked and infection is developing. This is a more urgent situation.

Gallbladder polyps – usually found incidentally on ultrasound, may cause mild discomfort but are often asymptomatic.

The Appendix Lower Right Pain That Needs Urgent Attention

The appendix sits in the lower right abdomen, attached to the junction of the small and large intestine. When it becomes inflamed, appendicitis the result is one of the more common surgical emergencies.

Appendicitis has a fairly characteristic progression, though it doesn’t always follow the textbook exactly:

Early stage – vague, crampy discomfort around the belly button. Often feels like general stomach upset nausea, loss of appetite, mild discomfort. Easy to attribute to gas or something eaten.

Migration – over several hours, the pain moves from around the belly button to the lower right abdomen, becoming more localised and more constant. This migration is one of the most reliable signs of appendicitis.

Established appendicitis – persistent, worsening pain in the lower right abdomen. Tender to touch pressing on the area and quickly releasing causes a sharp increase in pain (rebound tenderness). Fever develops. Movement, coughing, and deep breathing worsen the pain.

The window between recognisable appendicitis and a ruptured appendix is 24 to 72 hours in many cases. A ruptured appendix spreads infected material throughout the abdominal cavity, causing peritonitis, a significantly more serious situation requiring more complex surgery and a longer recovery.

Lower right abdominal pain that’s been building for more than a few hours, particularly with nausea, fever, and loss of appetite, should be assessed the same day, not monitored overnight hoping it settles.

Other Causes of Right-Sided Abdominal Pain Worth Knowing

Beyond the liver, gallbladder, and appendix, several other conditions produce right-sided pain:

Right Kidney and Ureter

Kidney stones – a stone passing from the kidney into the ureter causes severe, colicky pain that typically starts in the flank (back, below the ribs) and radiates around to the groin. It’s often described as the worst pain a person has experienced. It comes in waves, makes the patient restless, and may be accompanied by blood in the urine.

Urinary tract infection or pyelonephritis – infection of the right kidney causes fever, right flank pain, and urinary symptoms. The pain tends to be constant rather than colicky and is accompanied by feeling generally unwell.

Gynaecological Causes in Women

In women, the right ovary and fallopian tube can produce lower right abdominal pain that closely mimics appendicitis, which is part of why investigations in women of reproductive age are particularly important before assuming appendicitis.

Ovarian cyst – particularly a ruptured cyst, which causes sudden one-sided pain.

Ovarian torsion – sudden, severe right lower abdominal pain with nausea, caused by the ovary twisting on its supporting structures. This is a gynaecological emergency.

Ectopic pregnancy – a fertilised egg implanting in the right fallopian tube causes right lower abdominal pain with vaginal bleeding. Any woman of reproductive age with lower abdominal pain and a missed period needs pregnancy excluded urgently.

Endometriosis – cyclical pain related to the menstrual cycle, sometimes producing right lower abdominal discomfort if endometrial deposits are on the right side.

Musculoskeletal Pain

Not all abdominal pain comes from internal organs. The muscles of the abdominal wall, the lower ribs, and the spine can all produce right-sided pain. Musculoskeletal pain is typically:

• Related to movement worse with specific positions or twisting
• Reproducible pressing directly on the painful area reproduces it
• Not associated with digestive symptoms, fever, or systemic illness

A muscle strain from exercise, a rib injury, or nerve irritation from the spine can all produce what feels like abdominal pain. But musculoskeletal pain should only be assumed once more significant causes have been considered.

Inflammatory Bowel Disease

Crohn’s disease frequently affects the terminal ileum, the last part of the small intestine, which sits in the lower right abdomen. Right lower quadrant pain from Crohn’s can closely mimic appendicitis, which is why some patients end up in theatre for a suspected appendicitis that turns out to be Crohn’s disease affecting the terminal ileum.

Hernia

An inguinal or femoral hernia on the right side can produce groin and lower abdominal pain that worsens with standing, lifting, or straining. A hernia producing acute, severe pain in the right groin that won’t reduce needs urgent assessment for incarceration or strangulation.

How to Tell Which One It Might Be A Practical Guide

No table or guide replaces a proper clinical assessment, but certain patterns help point in the right direction:

Upper right, after fatty meals, comes and goes, no fever → Gallbladder most likely. Ultrasound is the first investigation.

Upper right, constant, with fever and feeling very unwell → Acute cholecystitis or liver abscess. Needs same-day assessment.

Upper right with jaundice, dark urine, pale stools → Liver or bile duct involvement. Needs urgent assessment.

Lower right, started around belly button, now localised, with fever and nausea → Appendicitis until proven otherwise. Go to the hospital.

Lower right in a woman, sudden onset, one-sided → Ovarian cyst, torsion, or ectopic pregnancy needs to be excluded urgently.

Flank pain radiating to groin, comes in waves, blood in urine → Kidney stone. Needs assessment and imaging.

Lower right, worse with movement, no fever or digestive symptoms → Musculoskeletal. But consider other causes first.

Lower right, related to menstrual cycle → Gynaecological cause worth investigating.

When to Seek Medical Attention

For mild, brief discomfort that resolves completely, monitoring for a day or two is reasonable if there are no fever, no vomiting, and no worsening.

But see a doctor without delay if:

• Pain has been worsening over several hours
• Fever is present alongside abdominal pain
• Nausea and vomiting are accompanying the pain
• The pain is severe enough to limit movement
• Jaundice, dark urine, or pale stools are present
• A woman of reproductive age has lower right pain with a missed period
• The pain woke you from sleep
• Any previous history of gallstones, hernia, or bowel disease and new or changed pain

And go to the emergency department immediately if:

• Pain is sudden and severe
• The abdomen is rigid or board-like
• There are signs of significant illness high fever, rapid pulse, collapse

Final Thoughts

Right-sided abdominal pain has a wide range of causes from the common and benign to the urgent and surgical. What most of them have in common is that they don’t declare themselves clearly from the outside. The same lower right quadrant location can mean appendicitis, a kidney stone, an ovarian cyst, or a muscle strain and the treatment for each is completely different.

Getting it properly assessed with a clinical examination and the right investigations, is what leads to an accurate answer rather than an educated guess. And an accurate answer is what leads to the right treatment.

Our surgical team evaluates right-sided abdominal pain thoroughly from clinical assessment through to ultrasound, blood tests, and further investigation where needed. If right-sided abdominal pain has been coming and going, or if something doesn’t feel right, come in rather than continuing to manage it alone. The answer is usually clearer than the internet makes it seem.