Differential Diagnosis
The patient's sudden stop in inspiratory effort during deep palpation of the right upper quadrant is suggestive of several possible diagnoses. Here is a categorized list of potential causes:
Single most likely diagnosis
- Gallbladder disease: The sudden stop in inspiratory effort, also known as Murphy's sign, is a classic indicator of gallbladder disease, particularly cholecystitis or gallstones. This occurs because the inflamed gallbladder is tender to palpation, causing the patient to catch their breath in response to the pain.
Other Likely diagnoses
- Hepatitis: Inflammation of the liver can cause tenderness in the right upper quadrant, leading to a similar response during palpation.
- Peptic ulcer disease: An ulcer in the duodenum or stomach can cause referred pain to the right upper quadrant, potentially triggering a pause in inspiratory effort.
- Right lower lobe pneumonia: Although less common, pneumonia in the right lower lobe can cause referred pain to the right upper quadrant, especially if the diaphragm is involved.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Pulmonary embolism: Although less likely, a pulmonary embolism can cause sudden, severe pain that may be referred to the right upper quadrant, especially if the embolism is large and involves the lung parenchyma.
- Myocardial infarction: In rare cases, a myocardial infarction can cause referred pain to the right upper quadrant, particularly if the inferior wall of the heart is involved.
Rare diagnoses
- Right-sided pyelonephritis or perinephric abscess: Infection or abscess formation in the right kidney can cause severe pain that may be referred to the right upper quadrant.
- Diaphragmatic rupture or hernia: A rare condition where the diaphragm is ruptured or herniated, potentially causing severe pain and respiratory distress.