Sudden Sharp Pain Under Right Rib Cage in Ages 65+

Experiencing a sudden sharp pain under the right rib cage can feel alarming—especially for someone over 65. While many causes are benign, others can be serious. This guide explains common triggers, when to seek help, and next steps.

Common Causes

Below are frequent reasons for a sudden sharp pain under right rib cage in older adults:

1. Gallbladder Problems

• Gallstones (Cholelithiasis)
  • Hard deposits block the cystic or common bile duct.
  • Pain may come on suddenly (biliary colic), peak in 30–60 minutes, then ease.
• Acute Cholecystitis
  • Inflammation of the gallbladder, often triggered by gallstones.
  • Features include steady pain, fever, nausea or vomiting.
  • Elderly patients may have subtler symptoms but higher risk of complications (Thulin et al., 1990).

2. Liver-Related Issues

• Capsular Stretching
  • A swollen liver (hepatomegaly) from congestive heart failure or hepatitis can tug on its capsule, causing sharp discomfort.
• Liver Abscess or Tumor
  • Localized infection or growth can present with pain, fever, weight loss.
• Cirrhosis with Ascites
  • Fluid build-up in the abdomen stretches tissues under the ribs.
  • Management guidelines recommend diuretics or paracentesis (EASL, 2021).

3. Biliary Tract Infections (Cholangitis)

• Blockage of the bile duct by stones or strictures leads to infection.
• Classic signs: pain, fever, jaundice.
• Requires urgent antibiotic therapy and often endoscopic intervention.

4. Kidney Causes

• Kidney Stones
  • A stone in the right ureter can radiate pain up to the rib cage.
• Pyelonephritis
  • Kidney infection causing steady flank pain, fever, urinary symptoms.

5. Musculoskeletal Strain or Injury

• Costochondritis
  • Inflammation of cartilage connecting ribs to the breastbone.
  • Sharp pain worsened by movement or deep breathing.
• Muscle Strain
  • Overexertion or coughing spasms can injure intercostal muscles.
• Rib Fracture
  • A minor fall or coughing fit can crack a rib, leading to sharp, local pain.

6. Lung and Pleura

• Lower Lobe Pneumonia
  • May irritate the diaphragm or pleura under the right ribs.
  • Accompanied by cough, fever, changes on chest X-ray.
• Pleurisy
  • Inflammation of the lung lining causes sharp pain with breathing.
• Pulmonary Embolism
  • A blood clot in the lung can cause sudden pain, shortness of breath, rapid heart rate.

7. Heart-Related

• Inferior Myocardial Infarction
  • Though chest pain often centers on the left, right-sided MIs can manifest under the right ribs.
  • May be accompanied by sweating, nausea, shortness of breath.

8. Gastrointestinal Causes

• Peptic Ulcer Disease
  • Ulcers in the stomach or duodenum can refer pain to the right upper quadrant.
• Gastritis or Acid Reflux
  • Inflammation or acid irritation may be felt under the right ribs.
• Pancreatitis
  • Although usually left-sided, sometimes right upper pain occurs if the head of the pancreas is inflamed.

9. Shingles (Herpes Zoster)

• Early pain may precede the rash by days.
• Sharp, burning discomfort along a rib dermatomal distribution.

When to Seek Immediate Medical Attention

Although some causes are mild, others can be life-threatening. Call emergency services or go to the nearest ER if you experience:

• Severe, unrelenting pain
• Fever over 101°F (38.3°C) with pain
• Jaundice (yellowing of skin or eyes)
• Difficulty breathing or chest tightness
• Lightheadedness, fainting
• Blood in vomit or stool

For less acute but concerning symptoms—persistent pain, worsening discomfort, nausea, changes in bowel habits—speak promptly with your primary care provider.

Diagnosis: What to Expect

Your doctor will tailor tests based on history and exam findings. Common evaluations include:

• Blood Tests
  • Liver function tests (AST, ALT, alkaline phosphatase, bilirubin)
  • Pancreatic enzymes (amylase, lipase)
  • White blood cell count, inflammatory markers
• Imaging
  • Abdominal ultrasound: first-line for gallstones, cholecystitis, liver size.
  • CT scan: detailed view of liver, pancreas, kidneys, lungs.
  • Chest X-ray: to rule out pneumonia or rib fractures.
• Elastography and Serum Markers
  • For suspected liver fibrosis or cirrhosis, transient elastography (FibroScan) and serum markers provide a non-invasive assessment of liver stiffness (Castera et al., 2005).
• Endoscopic Procedures
  • ERCP (endoscopic retrograde cholangiopancreatography) to diagnose or treat bile duct issues.

Management and Treatment

Treatment depends on the underlying cause:

• Gallbladder Disease
  • Pain control with NSAIDs or opioids.
  • Antibiotics if infected.
  • Cholecystectomy (gallbladder removal), often recommended in elderly once stable.
• Liver Conditions
  • Ascites: low-salt diet, diuretics, paracentesis.
  • Hepatic abscess: antibiotics, possible drainage.
  • Cirrhosis: manage complications per EASL guidelines.
• Kidney Stones
  • Pain relief, hydration, possible lithotripsy.
• Infections (Pneumonia, Pyelonephritis, Cholangitis)
  • Targeted antibiotics, supportive care.
• Musculoskeletal Pain
  • Rest, ice or heat, pain relievers, physical therapy for chronic cases.
• Cardiac Events
  • Immediate aspirin, nitroglycerin, emergency cardiac care.
• Shingles
  • Antiviral medications within 72 hours of rash onset, pain management.

Self-Care and Monitoring

• Keep a pain diary noting onset, duration, intensity, triggers.
• Stay hydrated and maintain a balanced diet—avoid fatty, greasy foods that can trigger gallbladder pain.
• If you have known liver disease, follow fluid and salt restrictions.
• Practice gentle stretching if musculoskeletal strain is suspected.

Next Steps

If you're uncertain about your symptoms or experiencing pain that radiates to your arm along with discomfort under your ribs, consider using Ubie's free AI symptom checker for arm pain at https://ubiehealth.com/symptoms/arm-pain to help determine whether your symptoms require urgent attention. This tool can provide guidance on potential causes, but it does not replace professional evaluation.

Always follow up with your healthcare provider for a definitive diagnosis and to discuss treatment options.

Speak to a doctor about anything that could be life threatening or serious. Your physician can evaluate risk factors, order appropriate tests, and help you manage any condition—keeping you safer and more comfortable.