RUQ Differential Diagnosis

The right upper quadrant (RUQ) of the abdomen is a common location for various pathological conditions. Here's a differential diagnosis for RUQ pain, categorized for clarity:

• Single Most Likely Diagnosis

  • Gallbladder disease (cholecystitis or cholelithiasis): This is often the most common cause of RUQ pain due to the high prevalence of gallstones and the potential for inflammation of the gallbladder. Symptoms such as postprandial pain, especially after fatty meals, and Murphy's sign on physical examination support this diagnosis.

• Other Likely Diagnoses

  • Peptic ulcer disease: Both gastric and duodenal ulcers can cause RUQ pain, especially if the ulcers are located in the duodenum or if there is associated gastritis.
  • Hepatitis: Inflammation of the liver from viral, alcoholic, or autoimmune causes can lead to RUQ pain, often accompanied by jaundice and elevated liver enzymes.
  • Pyelonephritis or kidney stones: While these conditions primarily affect the flank, they can radiate pain to the RUQ, especially if the right kidney is involved.

• Do Not Miss Diagnoses

  • Appendicitis (especially with an atypical presentation): Although appendicitis typically presents with pain in the lower right quadrant, an inflamed appendix can sometimes be located in the RUQ, leading to atypical presentations.
  • Hepatic abscess or liver tumor: These conditions can cause significant morbidity if not promptly diagnosed and treated. They might present with systemic symptoms like fever and weight loss, in addition to RUQ pain.
  • Cholangitis: Infection of the bile ducts can be life-threatening and requires urgent intervention. It often presents with the Charcot's triad of fever, jaundice, and RUQ pain.

• Rare Diagnoses

  • Right-sided pneumonia or pleurisy: These conditions can cause referred pain to the RUQ, especially if the diaphragm is involved.
  • Intestinal obstruction or volvulus: While these are more likely to cause diffuse abdominal pain, they can occasionally present with localized pain in the RUQ, depending on the segment of intestine involved.
  • Right adrenal gland pathology (e.g., tumor or hemorrhage): This is a rare cause of RUQ pain but should be considered in the differential diagnosis, especially if other causes have been ruled out.