Right upper quadrant abdominal pain


  • This page outlines the general approach to RUQ pain

Classification by Abdominal pain location

Side-by-side comparison of quadrants and regions.
Chart of commonly reported referred pain sites.
RUQ pain Epigastric pain LUQ pain
Flank pain Diffuse abdominal pain Flank pain
RLQ pain Pelvic pain LLQ pain

Clinical Features

  • Right upper quadrant pain

Differential Diagnosis

RUQ Pain


Gallbladder anatomy (overview).
Gallbladder anatomy



  • Abdominal panel
    • CBC
    • Chemistry
    • LFTs + lipase
    • Coagulation studies (PT, PTT, INR), as a marker of liver function
  • Urinalysis
    • Leukocytes will be present in 40% of patients[1]
    • Urine pregnancy test (if age and sex appropriate)


  • Biliary ultrasound
  • Consider CXR to assess for free air under the diaphram
    • If at risk for a perforated ulcer (e.g., age >55)
  • Consider ECG
    • If may be cardiac in nature


  • Definitive diagnosis may be determined via a combination of history, labs, and imaging
  • If no definitive diagnosis at end of ED workup, but no signs of emergent pathology, may be empirically treated (e.g., for GERD) with further workup as an outpatient


  • Treat underlying disease process


  • Disposition per underlying disease process

See Also

External Links


  1. Baird DLH, Simillis C, Kontovounisios C, Rasheed S, Tekkis PP. Acute appendicitis. BMJ. 2017;357:j1703. Published 2017 Apr 19. doi:10.1136/bmj.j1703