Why is there a dull pain in the upper right side of the abdomen?

The right upper quadrant (RUQ) of the abdomen—located beneath the lower ribs on the right side—is home to several vital organs, including the liver, gallbladder, part of the duodenum, the hepatic flexure of the colon, and the right kidney. A dull, persistent, or intermittent ache in this region—often described as “dull,” “aching,” or “gnawing”—can arise from a wide spectrum of conditions, ranging from benign and self-limiting to serious and potentially life-threatening.

Common gastrointestinal causes include biliary tract disorders such as gallstones (cholelithiasis) or inflammation of the gallbladder (cholecystitis), which often present with RUQ pain that may radiate to the right shoulder or back and is frequently triggered by fatty meals. Hepatic conditions—including viral hepatitis, fatty liver disease (nonalcoholic or alcoholic), or less commonly, liver abscess or malignancy—can also produce vague, dull discomfort due to capsule stretch or parenchymal inflammation. Peptic ulcer disease involving the duodenum or gastric antrum may refer pain to the RUQ, especially when ulcers are posteriorly located.

Other important considerations include renal pathology—such as a right-sided kidney stone or pyelonephritis—which may cause dull flank pain that extends anteriorly into the RUQ; musculoskeletal strain of the intercostal muscles or costochondritis; and less common but critical diagnoses like ascending cholangitis, hepatic vein thrombosis (Budd–Chiari syndrome), or right-sided pneumonia with referred abdominal pain.

Red flag symptoms warranting urgent evaluation include fever, jaundice (yellowing of skin or sclera), dark urine, pale stools, unintentional weight loss, persistent vomiting, or pain that is severe, progressive, or associated with signs of sepsis or hemodynamic instability. A thorough clinical assessment—including history, physical examination (e.g., Murphy’s sign for cholecystitis), and targeted investigations (such as liver function tests, ultrasound of the abdomen, or CT imaging)—is essential to determine the underlying etiology and guide appropriate management.