Right Upper Abdominal Pain and Pain Radiating to the Back

Pain in the right upper abdomen (quadrant) that strikes through to the back, especially below the right shoulder blade, is a very classic and distinctive picture in medicine. Because the nerve networks of the organs in this area (the gallbladder, the liver, the pancreas and the lining of the right lung) work together with those of the back, a problem here can feel as though it is coming from the back.

1. The Most Common Cause: Gallbladder Disease

The gallbladder is the most common culprit behind pain that begins in the right upper quadrant and strikes through to the right shoulder blade.

• Gallstones and biliary colic: When stones in the gallbladder temporarily block its outlet, sudden pain begins in the right upper abdomen. The pain spreads to the right shoulder and below the right shoulder blade. It is usually triggered 1–2 hours after a heavy, fatty or fried meal. It can come in waves, last a few hours and then ease.
• Inflammation of the gallbladder (cholecystitis): When stones block the duct for a long time, the gallbladder becomes inflamed. This time the pain is fixed, constant and very severe. Touching the right upper abdomen or taking a deep breath makes the pain stab like a knife. High fever, shivering, nausea and vomiting usually accompany it.

2. Causes Arising from the Liver

The liver covers almost all of the right upper quadrant. The liver itself does not easily hurt, but when it enlarges it stretches the membrane around it (the capsule), and this causes pain.

• Fatty or enlarged liver: Enlargement of the liver as a result of excessive fat or inflammation (hepatitis) causes fullness, a feeling of pressure and a dull ache in the right upper quadrant. This ache may also be felt on the right side of the back.
• Liver infections (abscesses): Although rare, infection foci forming in the liver cause deep, throbbing pain and fever.

3. Inflammation of the Pancreas (Acute Pancreatitis)

The pancreas is an organ located in the upper back part of the abdomen.

• When the pancreas is inflamed, the pain usually begins in the upper middle of the abdomen (at the level of the stomach) or the upper left, but spreads “like a band” to the back — that is, across the whole back and towards the right side.
• This pain eases when leaning forward (in a position similar to prostration in prayer) and becomes unbearable when lying on the back. Vomiting that cannot be stopped is its most prominent feature.

4. Respiratory (Lung) Causes

The lower part of the right lung and the organs of the right upper abdomen are neighbours.

• Inflammation of the lining of the right lung (pleurisy) or pneumonia: An infection affecting the lower lobe of the right lung can cause a stabbing pain in the right upper abdomen and behind the shoulder blade when breathing in and out or coughing. The pain is directly related to movement and to how deeply you breathe.

Which Symptoms Mean You Should See a Doctor Urgently?

If any of the following accompanies right upper quadrant and back pain, go without delay to a hospital emergency department or a specialist:

• High fever and shivering together with the pain
• Yellowing of the whites of the eyes or the skin (jaundice)
• Urine darkening to the colour of tea, or stools that are clay-coloured (whitish)
• A stabbing sensation severe enough to stop you taking a deep breath
• Repeated vomiting that cannot be stopped