<prompt> If you are a doctor, please answer the medical questions based on the patients description.55 yr old female. I have been having pain in the upper right abdominal area under and below ribs also to the back - 4 days now. The pain is worse when I burp or hiccup diaphragm spasms?. Deep breaths also are difficult. Pain sometimes radiates or refers to the collar bone area.  <response>: HI. Thanks for a perfect book-picture type symptoms you have noted. There is an inflammation of the Liver and or under-surface of the diaphragm. The most common cause of an abscess in the upper part of the liver. Another causes are irritation on the diaphragm by abscess. There is a possibility of a Cancer of the liver. This is also causing the referred pain to the collar bone area, worsening on burping or hiccough. I would advise the following:Blood tests - routine, WBC for infection, blood sugar to rule out diabetes. Kidney functions, liver function to determine the damage to the liver. Urine StoolUltrasonography to start with and may be necessary as a guidance for biopsy and or aspiration of the abscess mass. CT scan to confirm and to plan the treatment. 