Differential Diagnosis for RUQ Pain Worse After Fatty Food but Normal MRCP

• Single Most Likely Diagnosis
  • Gallbladder dyskinesia: This condition is characterized by a gallbladder that does not empty properly, often causing right upper quadrant (RUQ) pain, especially after eating fatty foods. A normal MRCP does not rule out this diagnosis since it primarily assesses the structure of the biliary system rather than its function.
• Other Likely Diagnoses
  • Biliary dyspepsia or sphincter of Oddi dysfunction: These conditions can cause similar symptoms to gallbladder disease but might not be evident on MRCP. They involve functional issues rather than structural abnormalities.
  • Peptic ulcer disease: Although not directly related to fatty food intake, peptic ulcers can cause RUQ pain and might be considered if other symptoms like nausea or bloating are present.
• Do Not Miss Diagnoses
  • Pancreatic cancer: Although less likely, pancreatic cancer can present with vague abdominal pain and might not always be visible on MRCP, especially if it's a small tumor or located in a difficult-to-visualize area.
  • Cholangiocarcinoma: A cancer of the bile duct, which could potentially not be seen on MRCP if it's very small or if the imaging was not of high quality.
• Rare Diagnoses
  • Chronic intestinal pseudo-obstruction: A rare condition characterized by impairment of the muscle contractions that move food, fluid, and air through the intestines, which could potentially cause pain after eating.
  • Eosinophilic gastroenteritis: A rare inflammatory condition that could cause abdominal pain, including RUQ pain, although it's less commonly associated with fatty food intake specifically.