Differential Diagnosis for Constant Upper Right Abdomen Pain Increased with Deep Breathing
- Single most likely diagnosis
- Gallbladder disease (cholecystitis or cholelithiasis): The location of the pain in the upper right abdomen and its exacerbation with deep breathing are classic symptoms for gallbladder disease. The increase in pain with deep breathing may be due to the movement of the diaphragm irritating the inflamed gallbladder.
- Other Likely diagnoses
- Peptic ulcer disease: Although peptic ulcers typically cause epigastric pain, some ulcers, especially those in the duodenum, can cause right upper quadrant pain. The pain can worsen with deep breathing if the ulcer is near the diaphragm.
- Hepatitis: Inflammation of the liver can cause right upper quadrant pain, which may worsen with deep breathing due to the liver's location near the diaphragm.
- Pneumonia or pleurisy: Inflammation of the lung or pleura can cause pain that worsens with deep breathing. If the pneumonia or pleurisy is located in the right upper lobe, it could cause referred pain to the right upper abdomen.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Pulmonary embolism: Although less common, a pulmonary embolism can cause sudden onset of chest pain that worsens with deep breathing. If the embolism is large, it can cause referred pain to the abdomen.
- Myocardial infarction: In some cases, a heart attack can cause referred pain to the abdomen, especially if the inferior wall of the heart is involved.
- Appendicitis (if the appendix is located in a retrocecal position): Although appendicitis typically causes lower right quadrant pain, a retrocecal appendix can cause right upper quadrant pain.
- Rare diagnoses
- Diaphragmatic hernia: A hernia through the diaphragm can cause abdominal organs to protrude into the thoracic cavity, leading to pain that worsens with deep breathing.
- Intra-abdominal shunt or vascular malformation: Rare vascular anomalies can cause abdominal pain that worsens with deep breathing due to changes in blood flow or pressure.