Differential Diagnosis for Right Upper Abdominal Pain

The patient's presentation of right upper abdominal pain can be approached by considering various diagnoses, categorized based on their likelihood and potential impact on the patient's health.

• Single Most Likely Diagnosis

  • Peptic Ulcer Disease (PUD): This is a common cause of upper abdominal pain, which can sometimes radiate to the right upper quadrant. The pain is typically described as burning or gnawing and can be related to food intake. Given the prevalence of PUD and its potential to cause significant discomfort, it stands as a leading consideration.
  • Cholecystitis (inflammation of the gallbladder): This condition often presents with right upper quadrant pain, especially after eating fatty foods, and is a common cause of acute abdominal pain in adults. The pain can be constant and severe, making it a likely diagnosis for right upper abdominal pain.

• Other Likely Diagnoses

  • Biliary Colic: This condition occurs when the gallbladder contracts in response to a gallstone blocking the cystic duct. It presents with intermittent, severe right upper quadrant pain, often triggered by fatty meals.
  • Gastritis: Inflammation of the stomach lining can cause upper abdominal pain that may be perceived in the right upper quadrant. It can be acute or chronic and is associated with various factors, including NSAID use, alcohol consumption, and Helicobacter pylori infection.
  • Hepatitis: Inflammation of the liver can cause right upper quadrant pain, among other symptoms like jaundice and fatigue. Viral hepatitis, drug-induced hepatitis, and alcoholic hepatitis are common causes.

• Do Not Miss Diagnoses

  • Appendicitis (if pain has shifted): Although appendicitis typically presents with pain in the lower right abdomen, it can occasionally start in the upper abdomen and then migrate. Missing this diagnosis can lead to perforation and severe complications.
  • Pancreatitis: Inflammation of the pancreas can cause severe upper abdominal pain that radiates to the back. It is crucial to identify pancreatitis early due to its potential for serious complications, including organ failure.
  • Liver Abscess or Tumor: These conditions can present with right upper quadrant pain and are critical to diagnose due to their potential for severe outcomes if not treated promptly.
  • Cholangitis (infection of the bile ducts): This condition can present with right upper quadrant pain, fever, and jaundice (Charcot's triad). It is a medical emergency requiring prompt antibiotic treatment and possible drainage.

• Rare Diagnoses

  • Pneumonia (right upper lobe): Sometimes, pulmonary issues can refer pain to the abdomen. A right upper lobe pneumonia could potentially cause right upper quadrant abdominal pain, especially if the diaphragm is involved.
  • Diaphragmatic Hernia: Although rare, a diaphragmatic hernia can cause abdominal contents to herniate into the thoracic cavity, leading to referred pain in the right upper quadrant.
  • Intestinal Obstruction: While more commonly associated with lower abdominal pain, an obstruction in the small intestine can occasionally cause upper abdominal pain, including in the right upper quadrant.