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Gallstones are anything but rare. In the United States, 10 to 20 percent of the adult population at any time has gallstones. American surgeons perform about 500,000 cholecystectomies (gallbladder removal operations) every year. However, every pain underneath the rib cage on the right side is not caused by gallbladder problems. Here are some other problems that cause similar symptoms.

  • Acute aortic aneurysm (AAA). This "blowout" of the aorta causes intense pain, but also a kind of ballooning out of the abdomen that is hard to miss.
  • Acute gastritis. This condition can also cause intense pain after a meal, and it can also involve belching and acid reflux. What acute gastritis does that a gallbladder attack does not is causing acute tenderness above the waist.
  • Acute mesenteric ischemia. This condition usually causes intense pain on the left side under the rib cage, but it can also occur on the right. Typically it's triggered by extreme exercise causing dehydration or drinking ice cold drinks, or both.
  • Acute pyelonephritis. This condition is usually preceded by a bladder infection or a UTI, and changes in the volume and frequency of urination.
  • Appendicitis. When the appendix is the source of pain, usually pain radiates out from the belly button.
  • Biliary colic, biliary disease, cholagiocarcinoma, cholangitis. All of these diseases are dysfunctions of the bile duct, which carries liquid bile from the liver to the gallbladder. These conditions can cause a "green at the gills" look or jaundice, along with fevers. It's possible to have both bile duct and gallbladder issues at the same time.
  • Gallbladder cancer causes an "all over" kind of abdominal pain that doesn't let up. It may also cause ascites, a severe accumulation of fluid over the abdomen.
  • Benign gallbladder tumors cause many of the same symptoms of gallbladder cancer.
  • Peptic ulcer disease. Ulcers occurring in both the stomach and duodenum usually cause their worst pain at night, although if the ulcers are located just in the stomach, this may not be the case.

It's really best not to guess whether you have symptoms or not. It's best to go to a doctor and let the doctor sort things out.

Costochondritis, by the way, has a very different set of symptoms. It's more of a chest pain than abdominal pain, and it's not usually limited to the left or right side of the body. It is worse on exertion, even on deep breathing, but often it's possible to relieve the pain just by changing position or taking shallow breaths. There will always be joint pain. If you don't have tenderness at at least some of the joints where your rib cage joins your spine, you don't have costochondritis. 

Fibromyalgia can cause pain that overlaps with the pain caused by gallbladder disease. However, it's associated with pressure points that gallbladder pain is not.

Tietze syndrome usually affects one or more of the upper ribs and spreads outward and downward. It won't cause lower right quadrant pain without also causing arm and shoulder pain (unless you happen to have neuropathy).

"Pleurisy" or pleurodynia can cause intense pain in some of the same locations where gallstone pain can occur, but it also can cause pain at other locations or all over the chest. It usually follows a viral infection.

So  what are the symptoms of gallbladder attacks?

  • You're likely to experience gallstone/gallbladder attacks an hour or two after you eat a fatty or spicy meal.
  • The pain of gallbladder attacks is a little like having rocks roll around inside you, because that's usually what is happening.
  • The pain is more likely to radiate down than to your left. You may have right leg pain in addition to right upper quadrant abdominal pain.
  • By the time you're turning green, you have a really serious condition. Always involve your doctor at the earliest possible time.

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