Differential Diagnosis for Mid Right Abdominal Pain
Given the symptoms of mid right abdominal pain on deep palpation, chronic nature, absence of bloody diarrhea, a recent normal colonoscopy, and a disproportionately enlarged abdomen, the following differential diagnoses can be considered:
Single most likely diagnosis
- Chronic Cholecystitis or Gallbladder Dysfunction: The location of the pain (mid right abdomen) and the chronic nature of the symptoms could suggest gallbladder pathology, especially if the pain is exacerbated by fatty meals or occurs after eating. The absence of bloody diarrhea and a normal colonoscopy reduces the likelihood of lower gastrointestinal causes.
Other Likely diagnoses
- Peptic Ulcer Disease: Although more commonly associated with epigastric pain, peptic ulcers can sometimes cause right upper quadrant or mid abdominal pain, especially if the ulcer is located in the duodenum.
- Inflammatory Bowel Disease (IBD) without Bloody Diarrhea: While IBD often presents with bloody diarrhea, some patients may have non-bloody diarrhea or abdominal pain as predominant symptoms. A normal colonoscopy does not entirely rule out IBD, as it can be patchy or involve the small intestine.
- Abdominal Wall Pain or Muscle Strain: Chronic pain in the abdominal wall or muscle strain could cause localized tenderness and might be considered, especially if the pain is reproducible with specific movements or palpation.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed)
- Appendicitis: Although the pain is chronic and not typically associated with appendicitis, atypical presentations can occur, especially in retrocecal appendicitis, which might not have the classic migration of pain.
- Ovarian Torsion or Ovarian Cyst: In female patients, ovarian torsion or a large ovarian cyst could cause chronic pain and an enlarged abdomen. These conditions are emergencies and require prompt diagnosis and treatment.
- Hepatic or Renal Pathology: Conditions affecting the liver (e.g., liver abscess, hepatoma) or kidneys (e.g., renal cell carcinoma, polycystic kidney disease) could cause chronic abdominal pain and an enlarged abdomen due to mass effect or organ enlargement.
Rare diagnoses
- Intestinal Lymphoma: A rare cause of chronic abdominal pain and an enlarged abdomen, intestinal lymphoma could be considered, especially if there are systemic symptoms like weight loss or fever.
- Abdominal Lymphangioma or Mesenteric Cyst: These are rare benign tumors that could cause chronic pain and abdominal distension due to their size and location.
- Chronic Intestinal Pseudo-obstruction: A condition characterized by impaired intestinal motility leading to abdominal distension, pain, and symptoms of obstruction without any mechanical cause.