What symptoms are commonly associated with liver lesions?

Nausea and Vomiting

Nausea and vomiting are not diseases, but rather are symptoms that can be caused by a wide range of factors. Vomiting is an uncontrollable reflex that expels the contents of the stomach through the mouth.  Nausea the feeling of wanting to vomit, but aren’t actually vomiting.  It is rare for liver lesions to cause nausea and vomiting.  The most common cause of nausea or vomiting associated with right upper quadrant pain is biliary colic secondary to gallstones.


Pain in the right upper quadrant of the abdomen is common.  The pain can be caused by structures in the right upper quadrant or referred from other areas.  The organs in the right upper quadrant include;


  • Liver
  • Gallbladder
  • Duodenum (first part of the small bowel)
  • Pancreas
  • Right kidney
  • Colon (hepatic flexure)
What are the nerves that innervate the right upper quadrant?
The anterior abdominal wall and its inner lining (parietal peritoneum) is innervated by the somatic nervous system that provides sensory nerves to your skin.  Pain mediated by these nerves is usually very well localised and patients can usually describe the characteristics of the pain well.  All of the other structures within the abdomen are innervated by visceral nerves.  The activation of these nerves can only be achieved by inflammation (infection), ischemia (lack of oxygenation) or distension of a hollow tube (colic).  The pain mediated by visceral nerves is vague, making it hard to localise, and patients usually describe it as feeling more diffuse.  Within the solid organs there are no nerves mediating pain, so they are said to be insensate.  It is therefore rare for conditions affecting the solid organs in the right upper quadrant (liver, kidney, pancreas) to cause pain. 
What is the most common cause of right upper quadrant pain?

In adults, gallstones are the most common cause of right upper quadrant pain.  If a gallstone becomes lodged within the neck of the gallbladder it may cause biliary colic (distension of the gallbladder).  This is characterised by sudden onset of pain in the RUQ, associated with restlessness and nausea/vomiting.  Gallstones are common, however only a minority of patients with gallstones have symptoms.  Once you develop symptoms attributed to gallstones, surgical removal of the gallbladder (laparoscopic cholecystectomy) is usually indicated to prevent complications.  Complications of gallstones includes acute cholecystitis, cholangitis, pancreatitis or gallbladder cancer.


Conditions affecting the right kidney can cause pain in the RUQ.  The pain is usually more posteriorly in the loin but may involve the RUQ.  Kidney stones can cause severe pain that comes in waves and is usually associated with nausea/vomiting.  Infection of the kidney (pyelonephritis) is usually a more constant pain that is associated with fever and passing more frequent urine.


It is rare for conditions affecting your liver to cause pain.  Only the liver capsule is innervated.  Only liver lesions situated that involve the liver capsule will cause pain.  Lesions within the liver itself rarely cause pain.  Generalised infection of the liver causing inflammation (hepatitis) is a rare cause of pain in the right upper quadrant. 


Conditions affecting the small or large bowel within the region of the right upper quadrant can cause pain.  This includes duodenal ulcer, gastroenteritis, gastro-oesphageal reflux or conditions that affect the gut motility (irritable bowel syndrome, biliary dyskinesia).


Musculoskeletal conditions are a group of disorders that affect the anterior abdominal wall.  Common causes of musculoskeletal pain in the right upper quadrant includes, trauma (muscle strain, hematoma), shingles (herpes zoster infection), nerve root compression (spinal), herniation or infection (abscess). 


Rarely right upper quadrant pain can be referred from conditions affecting the heart (myocardial infarct) or lung (pneumonia, pulmonary embolus).


If I have upper right quadrant pain should I see a doctor?

If the pain is severe or doesn’t settle then it would be advisable to seek medical attention to help determine the cause of the pain.  You should seek urgent attention if the pain is;

  • Very severe
  • Associated with vomiting
  • You have a fever or rigors (uncontrolled shaking)
  • You are jaundiced (yellow) or your urine is dark and your bowel motions are pale
  • It is associated with unintentional loss of weight
  • You are struggling to get your beath (short of breath)
What are the usual investigations performed for right upper quadrant pain?
The investigations will depend upon your history and clinical examination.  It is likely that you will require blood tests and some form of imaging.  Ultrasound evaluation of the right upper quadrant is the most frequently performed test.  Depending on the findings however, you may require imaging by computered tomography (CT) or magnetic resonance imaging (MRI).  If the pain is thought to be coming from your intestine then you may require either an upper or lower GI-endoscopy.  
What treatment will I need?

The majority of patients with right upper quadrant pain do not require any treatment.  It is usually transient and of no concern.  If treatment is required, then it will depend upon the cause of the symptoms.  The doctor will discuss this with you once the cause of the pain has been diagnosed.

Pain in the right upper quadrant of the abdomen is common.  The pain can be caused by structures in the right upper quadrant or referred from other areas.  The organs in the right upper quadrant include;

  • Liver
  • Gallbladder
  • Duodenum (first part of the small bowel)
  • Pancreas
  • Right kidney
  • Colon (hepatic flexure)

Weight Loss

It is not uncommon for ones weight to fluctuate.  Persistent unintentional weight loss of more than 5% of your weight over 6-12 months is usually a cause for concern.  Unintentional weight loss is a symptom that does not always have an identifiable cause, and can be the result of numerous factors.  A number of conditions associated with lesions in the liver can result in unintentional weight loss.  A careful history, examination and further investigations are required to establish the cause.  

Jaundice (yellow pigmentation)

Jaundice is a condition that causes the skin and whites of the eyes (sclera) to turn yellow due to the accumulation of bilirubin in the blood.  Bilirubin is the breakdown product of haemoglobin (oxygen carrying component of red blood cells) that is formed within the liver.  If the is excessive breakdown of haemoglobin (hemolysis) or a reduction in the ability of the liver to clear bilirubin either as result of synthetic failure (cirrhosis) or obstruction, bilirubin accumulates and results in jaundice.  A number of conditions affecting the liver can be associated with the presence of jaundice.  Patients with jaundice should seek medical attention to have further investigations and/or treatment.


A fever is when your core body temperature is higher than normal (36.4 - 37.4oC).  Most clinicians would consider a fever to be 38oC or higher.  A fever is not an illness, but rather a symptom of an underlying condition.  Most commonly fever in association with a liver lesion is the result of an infection (viral, bacterial) but can result from a number of other rare conditions.  If the fever is persistently high (>40oC), associated with uncontrolled shivering or shaking, vomiting, confusion or difficulty breathing then you should seek immediate medical attention.