Patient Information for Upper Right Abdominal Pain with Vomiting
When to Go to the Emergency Room Immediately
You should go to the emergency room right away if you experience any of these warning signs:
- Severe, persistent pain in your upper right abdomen that doesn't improve or worsens over hours 1
- Fever (temperature above 100.4°F/38°C) combined with your abdominal pain 2, 1
- Yellowing of your skin or eyes (jaundice) 2, 1
- Inability to keep down any fluids for more than 12-24 hours due to persistent vomiting 2
- Signs of dehydration: extreme thirst, dark urine, dizziness when standing, confusion 2
- Severe tenderness when touching your upper right abdomen, especially if the pain worsens when you take a deep breath (Murphy's sign) 2, 1
- Rapid heartbeat or low blood pressure 1
- Abdominal rigidity or signs your belly is very tight and tender all over (peritoneal signs) 1
- Chest pain after severe vomiting, which could indicate a serious esophageal tear 3
What Your Symptoms Might Mean (Given Your History)
With your history of liver disease or gallstones, upper right abdominal pain with vomiting most commonly indicates:
- Acute cholecystitis (inflamed gallbladder): This occurs when a gallstone blocks the cystic duct, causing severe inflammation 2, 1
- Bile duct obstruction: Stones can move from your gallbladder into the bile duct, causing blockage, jaundice, and infection 2, 4
- Acute cholangitis: A serious infection of the bile ducts that requires urgent treatment with antibiotics and drainage 2, 4
What to Expect at the Emergency Room
The medical team will perform these evaluations:
- Blood tests to check for infection (white blood cell count), liver function (ALT, AST, alkaline phosphatase, bilirubin), and pancreatic enzymes 1, 4
- Ultrasound of your abdomen as the first imaging test—this is 96% accurate for detecting gallstones and can identify gallbladder inflammation 2, 1
- Additional imaging (CT scan or MRCP) if ultrasound findings are unclear or if bile duct obstruction is suspected 2, 4
Treatment You May Receive
For acute cholecystitis (inflamed gallbladder):
- IV fluids to correct dehydration from vomiting 2
- IV antibiotics if infection is present 2
- Pain medication: Non-narcotic options like IV ketorolac are preferred first-line 2
- Anti-nausea medication such as ondansetron (can be given IV or as a dissolving tablet) 2
- Surgery (cholecystectomy) is typically recommended within 7-10 days of symptom onset for best outcomes 2
For bile duct obstruction:
- ERCP (endoscopic procedure) may be needed to remove stones from the bile duct 4
- Antibiotics and drainage if infection is present 2
Home Management While Waiting (If Symptoms Are Mild)
Only attempt home management if you do NOT have the emergency warning signs listed above:
- Sip electrolyte-rich fluids (sports drinks) in small amounts frequently 2
- Avoid solid foods until vomiting stops 2
- Rest in a quiet, dark room if possible 2
- Take anti-nausea medication if prescribed (ondansetron dissolving tablets work well even with active vomiting) 2
Critical Time Windows
Do not delay seeking care beyond 24 hours if your symptoms persist or worsen, as complications from untreated gallbladder disease can be life-threatening 2, 3. Early surgical intervention (within 7-10 days) for acute cholecystitis has better outcomes than delayed treatment 2.
Special Considerations for Your History
With pre-existing liver disease or known gallstones:
- You are at higher risk for complications including bile duct obstruction, infection, and liver dysfunction 2, 4
- Immunocompromised patients (including those with advanced liver disease) may require longer antibiotic courses (up to 7 days) and closer monitoring 2
- Do not wait to "see if it gets better" if you develop fever with your pain—this combination requires urgent evaluation 2, 1