Differential Diagnosis for RUQ and Epigastric Pain without Gallstones

• Single most likely diagnosis
  • Peptic ulcer disease: This is a common cause of epigastric pain and can sometimes radiate to the right upper quadrant (RUQ). The absence of gallstones makes this diagnosis more likely, as gallstones are a common cause of RUQ pain.
• Other Likely diagnoses
  • Gastroesophageal reflux disease (GERD): Although more commonly associated with chest pain and heartburn, GERD can cause epigastric pain that may be referred to the RUQ.
  • Functional dyspepsia: This condition involves recurring signs and symptoms of indigestion that have no obvious cause. It can cause both epigastric and RUQ pain.
  • Hepatitis: Inflammation of the liver can cause RUQ pain and may also cause epigastric discomfort.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed)
  • Myocardial infarction: Although classically presenting with chest pain, myocardial infarctions can sometimes present with epigastric or RUQ pain, especially in women or diabetic patients.
  • Pancreatitis: Inflammation of the pancreas can cause severe epigastric pain that radiates to the back and can also cause RUQ pain.
  • Aortic dissection: A tear in the aorta's inner layer can cause severe, tearing pain that can be referred to the epigastric area or RUQ, depending on the dissection's location.
  • Cholangitis: Infection of the bile ducts can cause RUQ pain, jaundice, and fever, and is a medical emergency.
• Rare diagnoses
  • Duodenal diverticulitis: Inflammation of a duodenal diverticulum can cause epigastric and RUQ pain.
  • Intestinal ischemia: Reduced blood flow to the intestines can cause severe abdominal pain, including in the epigastric and RUQ areas.
  • Gastric cancer: Although rare, gastric cancer can cause epigastric pain and weight loss, and should be considered in patients with persistent or severe symptoms.