Pain in the right upper abdomen: what could be behind it
The most important points at a glance
The liver and gallbladder are located on the right beneath the costal arch, along with parts of the stomach and intestine. Pain or pressure in this area can come from any of these organs, but also from the muscles and the ribs themselves. Which direction it points to is not determined by the sensation, but by the examination.
This text sorts through five possible directions, names the signs that mean you should stop reading and call, and openly explains where the limits of every test lie. It does not provide a diagnosis and does not replace a medical examination.
If you are feeling unwell right now, read Chapter 2 first. If you want to know why eating changes the pain, skip to Chapter 5. If you are left without a finding after evaluation, Chapter 7 gives you the honest answer to the question of what a test actually shows.
What to expect in this article
1. What is actually located on the right beneath the costal arch
2. When you should stop reading and call
3. The gallbladder: colic, triggers, radiating pain
4. Five directions compared
5. Stomach or gallbladder? What eating reveals
6. Three misconceptions about the right upper abdomen
7. What a test can and cannot show
8. What you can do now
Frequently asked questions
Sources
What is actually located on the right beneath the costal arch
The costal arch is the lower edge of the rib cage, which you can feel with your fingers on both sides. Anything you feel as pressure or pain directly beneath it comes from a small, densely occupied area. That is why the location alone is not yet an answer.
The largest organ there is the liver. In 2023, the Institute for Quality and Efficiency in Health Care (IQWiG) wrote: “An adult’s liver weighs about 1.4 kg and is located in the right upper abdomen below the diaphragm.” The same source gives the amount produced there each day in essence: about 800 to 1000 ml of bile per day.
The gallbladder sits directly next to it, the organ where bile collects. The bile duct leads from it and opens into the duodenum, the section of the intestine behind the stomach. According to IQWiG (2023), gallstones can “block the outlet of the gallbladder or the opening of the bile duct into the duodenum.” This means that organs from two completely different systems are located within the same hand’s breadth.
Key message
The location tells you which organs may be involved. It does not tell you which one is the cause.
This text deliberately stays on the right side beneath the costal arch. If you want to sort through the entire abdomen, with the upper, lower, left, and right sections side by side, you will find our overview more useful: Understanding abdominal complaints: which symptom belongs where. The map is there; here is one section of it.
Four figures help put things into perspective before we turn to individual directions. They all come from IQWiG and describe the organ’s size, how much it does, and how common two of the explanations we are about to discuss are.
1.4 kg
weighs in an adult, and is located in the right upper abdomen (IQWiG 2023)
800–1000 ml
gall is produced there in a single day (IQWiG 2023)
5–25 %
of the population have gallstones, meaning hardened components of bile (IQWiG 2023)
10–15 %
of adults in Germany have an irritable stomach (IQWiG 2025)
When you should stop reading and call
Some upper-abdominal questions can wait until the next working day; others cannot. That is why this chapter comes first, not at the end, where no one who is currently afraid will read it.
The signs below come from two IQWiG publications. They are not a checklist for self-treatment, but a list of situations in which a trained professional must take a look. What you can do yourself is choose whom to call.
Signs that require medical evaluation
Yellowing of the skin and eyes
IQWiG (2023) describes “jaundice (icterus)” in cases of bile duct stones, “recognizable by a yellowish discoloration of the skin and eyes.” Icterus is the medical term for this yellow discoloration. It still requires medical attention today.
Dark urine, light-colored stool
In the same situation, “the urine may be dark and the stool may be light in color” (IQWiG 2023). Both are more likely to be noticed by a partner than by the person themselves.
Black stool or vomited blood
In 2025, IQWiG lists “black-colored stool” and “vomited blood (red or black-colored vomit)” as warning signs of stomach and duodenal ulcers. Do not wait, and do not use home remedies.
Sudden, very severe abdominal pain
According to IQWiG (2025), such pain can indicate a perforated stomach. The source is unambiguous here: “If a perforated stomach is suspected, the emergency number 112 should therefore be called immediately.”
Fever, shortness of breath, or pain that does not subside
For that reason, we deliberately give you neither a number nor a time limit. If any of these occurs along with your symptoms, it is a reason to seek medical advice and no longer a question for a search engine.
The practical question remains: the emergency department or the waiting room? Instead of time estimates that no one can keep, three levels are enough. Classify yourself in the highest one that applies to you, not the most convenient one.
At a glance
Immediately, meaning call emergency services at 112: sudden, very severe abdominal pain or vomiting blood. Seek medical attention today: yellowing of the skin and eyes, dark urine with pale stool, black stool, along with fever or shortness of breath. Make an appointment at a medical practice in the next few days for anything that recurs, has lasted for weeks, or keeps you awake.
The gallbladder: colic, triggers, radiation
Gallstones are hardened components of bile. According to IQWiG (2023), they are common: “between 5 and 25% of the population” have them. This range is important because it says two things at once. Stones occur. And they do not cause symptoms in everyone.
According to the same source, symptoms occur when stones “block the outlet of the gallbladder or the opening of the bile duct into the duodenum.” IQWiG then describes “cramp-like upper abdominal pain (colic).” Colic is exactly that: pain that comes and goes in waves rather than pressing steadily.
And then there is the symptom that can easily lead you astray because it appears far from the abdomen.
Documented source
“The pain can radiate to the back and right shoulder.”
Institute for Quality and Efficiency in Health Care (IQWiG)
gesundheitsinformation.de, “Gallstones,” 2023
Anyone with a pulling pain in the right shoulder and pressure beneath the ribcage rarely thinks of the abdomen first. That is precisely why this sentence belongs in a conversation with a doctor, not in quiet self-interpretation. What you can describe, where the pain radiates, is information that no one else can provide for you.
The point remains where the source is silent and so are we: No description can determine whether your symptoms are caused by gallstones. An examination at a medical practice is needed to clarify that.
Five possibilities compared
The table compares five possibilities side by side. Two of them contain documented information, while three explicitly do not. This is not an oversight: We do not have a reliable source for the intestine, muscles, and ribs in this location, and we would rather say that we cannot provide information than invent something plausible.
| Direction | Where the pressure is typically felt | What supports this | What you cannot clarify yourself | Who checks |
|---|---|---|---|---|
| Gallbladder | Right upper abdomen, often in waves | “Cramp-like upper abdominal pain (colic),” radiating to the back and right shoulder; 5 to 25% of the population have gallstones (IQWiG 2023) | Whether there are any stones at all and whether they are the cause of your symptoms | Medical practice; still today if there is yellowing |
| Liver | Right upper abdomen, the organ is located exactly there (IQWiG 2023) | Only the location. A laboratory value such as gamma-GT, an enzyme, may be elevated (IQWiG 2025) - the source provides no more information | “A disease usually cannot be inferred from a single laboratory value.” (IQWiG 2025) | Medical practice, blood draw and discussion of the findings |
| Stomach | With a stomach ulcer, more likely in the middle to left upper abdomen, so specifically not on the right (IQWiG 2025) | Connection with eating; with an irritable stomach, meaning functional dyspepsia, “pain or a burning sensation in the upper abdomen” (IQWiG 2025); 10 to 15% of adults in Germany have an irritable stomach (IQWiG 2025) | Whether there is an organic cause behind it - this is ruled out before diagnosing an irritable stomach | Medical practice; immediately if stools are black |
| Intestines | Could be considered as a possibility | No documented information for this location, so there is no figure or explanation here | All of these | Medical practice |
| Muscles and ribs | Could be considered as a possibility | No documented information for this location, so there is no figure or explanation here | All of these | Medical practice |
Anyone who reads the table from right to left sees the actual result: The “Who checks” column is filled in every row. So is the “What you cannot clarify yourself” column. We cover general abdominal pain without specifying a side separately; see Abdominal pain: causes and how to classify it. And if it is more of a feeling of pressure without real pain, Pressure in the abdomen: classifying the causes is a better fit.
Stomach or gallbladder? What eating reveals
A natural suspicion with upper abdominal symptoms is that they are related to eating. There is some truth to this observation, but it does not distinguish between causes as clearly as one would like.
What the timing indicates
Regarding stomach ulcers, IQWiG wrote in 2025: “With a stomach ulcer, symptoms may occur in the middle to left upper abdomen - directly after eating.” The opposite applies to the duodenum: “With a duodenal ulcer, symptoms tend to occur when the stomach is empty and decrease after eating.” So if your symptoms are in the middle or on the left, this points you away from the right upper abdomen.
When nothing is found
There are cases in which symptoms persist for months and yet nothing is found. IQWiG described it this way in 2025: “With an irritable stomach, also called functional dyspepsia, symptoms occur in the upper abdomen for months and cannot be explained by organic causes.” These include “pain or a burning sensation in the upper abdomen” and “premature feelings of fullness while eating or a feeling of fullness after eating.” According to this, around 10 to 15% of adults in Germany have an irritable stomach.
The order is important, and it is also essentially stated by IQWiG (2025): Before a diagnosis of functional dyspepsia is made, other causes are ruled out, including stomach ulcers, reflux disease, inflammation, and gallstones. According to the same source, unintentional weight loss, blood in the stool, or other alarming symptoms should be evaluated urgently, especially from age 55 onward (IQWiG 2025). Functional dyspepsia is therefore not something that can be diagnosed at the kitchen table.
If your symptoms are focused more in the middle, continue reading Stomach Pressure and Feeling Full. If the connection with meals is the main concern, Stomach Pain After Eating is the right fit.
Three misconceptions about the upper right abdomen
Three statements keep coming up in customer questions. None of them is foolish, yet they all lead in the wrong direction.
Suppose
“Upper-right always means the liver.”
In fact
The liver is located there, that is true (IQWiG 2023). But the gallbladder and bile duct are directly next to it, along with parts of the stomach and intestines, as well as muscles and ribs. The location narrows things down; it does not determine the cause.
Suppose
“If it goes away again, it was nothing.”
In fact
By its nature, colic is pain that stops again (IQWiG 2023). The fact that something subsides is therefore not proof that it was harmless. Recurrent symptoms should be evaluated by a doctor, even if you are symptom-free at the appointment.
Suppose
“An at-home test tells me what it is.”
In fact
A test measures what it measures. A stool test shows the composition of the gut flora; a blood test shows values such as gamma-GT. Both describe a condition and do not identify the cause of pain.
What a test can and cannot show
Now to the question that appears at the end of every upper-abdominal inquiry on mybody®x (MYBODY Lab GmbH): Which test can clarify this? The honest answer is shorter than any provider would like.
Alternative route one: liver values
The value mentioned in this context is gamma-GT. In 2025, IQWiG explains it as follows: “Gamma-GT (GGT) is an enzyme needed to break down the molecule glutathione.” An enzyme is a protein that the body produces for processes like these. According to the same source, elevated levels can occur, among other things, with liver inflammation (hepatitis), fatty liver, or a blockage of bile flow.
The crucial sentence is the one directly next to it: “A single laboratory value usually cannot be used to infer a disease.” So a blood test provides a data point for your conversation at the practice, not a result to take home. Anyone who wants to understand which values matter and how they relate to one another can find that in Understanding liver values: which values matter.
Alternative two: the gut flora
The microbiome is the totality of bacteria that live in the gut. A stool test shows which species are present and in what proportions. Three terms appear on the report: Diversity describes how many different species coexist. Enterotype assigns the flora to one of several basic patterns. The FODMAP index refers to certain fermentable carbohydrates from food.
This is interesting for someone who has no findings after medical evaluation but continues to have recurring symptoms. For the acute question addressed in this article, it is the wrong approach. No test clarifies the cause of acute pain.
At-home stool test
Gut microbiome test | Complete
Shows more than 1,500 bacterial species through DNA sequencing, that is, by reading the bacteria's genetic material, along with diversity (variety of species), enterotype (basic flora pattern), and the FODMAP index (fermentable carbohydrates). What it does not show: the reason for pain in the upper right abdomen. It does not diagnose and does not replace an examination. Suitable for you if the practice has completed its evaluation and the symptoms recur.
A test shows values. It does not show the cause of pain.
What you can do now
At the beginning was the question of what lies under the right rib cage. The answer is a list of possibilities, and that is unsatisfying as long as you only read it. It becomes useful as soon as you translate it into something you can bring with you.
Write down four things before your appointment. When the symptoms occur, measured against your daily routine and meals. How long they last, in minutes or hours. Whether they radiate anywhere, such as to your back or right shoulder. And what changes them, such as lying down or eating. Notes like these are worth more in the consultation than any speculation, because no one but you can provide them.
The warning signs from Chapter 2 remain unaffected. If the skin and eyes turn yellow, if there is dark urine with pale stools, black stools, vomited blood, or sudden, very severe abdominal pain, do not make notes - call. For the last two, IQWiG’s wording applies: call emergency services immediately on 112.
Everything else can be clarified calmly. A test comes last in this sequence, not first, and it answers a different question from the one that brought you here. Saying this costs us a sale and saves you a detour.
Frequently asked questions
Why does the pain radiate to the right shoulder?
This observation has been described in connection with gallstones. In 2023, IQWiG stated: “The pain can radiate to the back and the right shoulder.” However, this does not mean that shoulder pain automatically indicates a gallbladder problem, because the shoulder has its own reasons for hurting. Take this observation with you to the doctor’s office and describe precisely where the pain radiates and when it does so.
Can I find out at home where the pain is coming from?
No. No test can determine the cause of acute pain. A stool test describes the composition of the gut flora, while a blood test shows values such as gamma-GT; and for the latter, IQWiG (2025) states: “A single laboratory value usually cannot be used to infer a disease.” Both are one component of a conversation with medical guidance, not a shortcut around it.
Should a feeling of pressure without pain be assessed in the same way?
The warning signs are the same in either case: yellowing of the skin and eyes, dark urine with pale stools, or black stools should be medically assessed. For interpreting things in everyday life, however, a pure feeling of pressure is a separate issue that we will address separately. Start there with our overview of abdominal pressure and bring your notes with you.
What does it mean if all the examinations are unremarkable?
This does not mean that you are imagining your symptoms. In 2025, IQWiG explicitly describes upper abdominal symptoms associated with an upset stomach, or functional dyspepsia, as symptoms “that cannot be explained by organic causes,” and estimates the proportion at around 10 to 15% of adults in Germany. An unremarkable finding is therefore an interim result, not a judgment about you.
Does avoiding certain foods help?
We cannot give you a recommendation on this because we do not have a reliable source for this question. Instead, observe and write down: which meal, what time, and how long afterward. In 2025, IQWiG explicitly describes symptoms of a duodenal ulcer as occurring "on an empty stomach" and decreasing "after eating." The timing is useful in practice.
Next step
Clarify first, then measure
If your symptoms have been medically evaluated and nevertheless recur, looking at the gut flora may be a possible next step. If not, start with the overview.
View the gut test Back to the abdominal overviewRead more
You might also be interested in
How a stool sample is collected and what information ultimately appears on the test result.
Why a single laboratory value says less than a guidebook title promises.
Sources
- IQWiG / gesundheitsinformation.de: How does the liver work? (as of 2023) - gesundheitsinformation.de
- IQWiG / gesundheitsinformation.de: Gallstones (as of 2023) - gesundheitsinformation.de
- IQWiG / gesundheitsinformation.de: Irritable stomach (functional dyspepsia) (as of 2025) - gesundheitsinformation.de
- IQWiG / gesundheitsinformation.de: Stomach and duodenal ulcers (as of 2025) - gesundheitsinformation.de
- IQWiG / gesundheitsinformation.de: Gamma-GT (GGT) (as of 2025) - gesundheitsinformation.de
Information on the liver's condition and function is based on [1], all information on gallstones, colic, and jaundice on [2], information on irritable stomach on [3], the distinction between stomach and duodenal ulcers and the emergency warning signs on [4], and the interpretation of Gamma-GT on [5]. Information on the gut microbiome test | Complete comes from the mybody®x product pages, checked live on 14.09.2026.
mybody®x Editorial & Specialist Team
Digestion Laboratory values
This text was created by the mybody®x specialist editorial team and is based exclusively on the publications mentioned above. Information about the people behind it can be found on the authors page.
Published on 14.09.2026 · Last updated on 14.09.2026
The content is for general information only and does not replace medical advice, diagnosis, or treatment. Reference ranges depend on the laboratory, method, and age - the information on your test result is always authoritative.
Our products are not intended to diagnose, treat, cure, or prevent diseases.
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