Differential Diagnosis for Upper Right Sided Abdominal Pain
Single Most Likely Diagnosis
- Biliary Colic or Cholecystitis: The patient's presentation of constant, aching upper right abdominal pain, along with nausea, suggests a possible issue with the gallbladder. The lack of correlation with food intake and the absence of fever make biliary colic more likely than cholecystitis, but both conditions should be considered.
Other Likely Diagnoses
- Peptic Ulcer Disease: Although the pain does not correlate with food intake, peptic ulcer disease can cause constant abdominal pain and nausea. The patient's use of Tylenol without improvement does not rule out this diagnosis.
- Hepatitis: The patient's symptoms could be consistent with hepatitis, especially given the location of the pain and the presence of nausea. However, the absence of jaundice or fever makes this less likely.
- Gastroesophageal Reflux Disease (GERD): GERD can cause upper abdominal pain and nausea, although it typically is associated with food intake and relieved by antacids.
Do Not Miss Diagnoses
- Appendicitis: Although the pain is in the upper right abdomen, appendicitis can occasionally present with pain in this location, especially if the appendix is retrocecal. The absence of fever and vomiting makes this less likely, but it should not be missed due to its potential for serious complications.
- Hepatic Abscess or Liver Tumor: These conditions can cause upper right abdominal pain and should be considered, especially given the patient's lack of response to Tylenol.
- Pulmonary Embolism: In rare cases, a pulmonary embolism can cause referred pain to the upper abdomen. The patient's history of hypertension and hyperlipidemia increases her risk for thromboembolic events.
Rare Diagnoses
- Pancreatitis: The patient's symptoms do not strongly suggest pancreatitis, as the pain is not typically constant and aching, and there is no mention of radiating back pain.
- Inflammatory Bowel Disease: The patient's symptoms do not strongly suggest inflammatory bowel disease, as there is no mention of changes in bowel habits, blood in the stool, or weight loss.
- Abdominal Wall Hernia: An abdominal wall hernia could cause upper abdominal pain, but it would typically be more localized and possibly associated with a palpable mass.