Differential Diagnosis for Abdominal Discomfort and Positive Murphy's Sign
Single Most Likely Diagnosis
- Cholecystitis: The presence of a positive Murphy's sign, which is tenderness in the right upper quadrant of the abdomen that worsens with deep inspiration, is highly suggestive of cholecystitis, an inflammation of the gallbladder. The symptoms of intermittent abdominal discomfort, distention, and nausea also align with this diagnosis.
Other Likely Diagnoses
- Biliary colic: This condition involves pain due to gallstones obstructing the cystic duct or common bile duct. While it doesn't always present with a positive Murphy's sign, the symptoms of abdominal discomfort and nausea could be consistent with biliary colic, especially if the patient has a history of gallstones.
- Peptic ulcer disease: Although peptic ulcers typically cause more localized pain and are not directly associated with a positive Murphy's sign, they can cause abdominal discomfort and nausea. The pain can sometimes radiate or be referred to the right upper quadrant, potentially mimicking some symptoms of cholecystitis.
- Hepatitis: Inflammation of the liver can cause right upper quadrant pain and could potentially lead to a positive Murphy's sign due to the proximity of the liver to the gallbladder. However, hepatitis usually presents with additional symptoms such as jaundice and elevated liver enzymes.
Do Not Miss Diagnoses
- Appendicitis: Although appendicitis typically presents with pain that initially is diffuse or around the navel and then localizes to the right lower quadrant, in some cases (especially with a retrocecal appendix), the pain can be felt in the right upper quadrant. A positive Murphy's sign is not typical for appendicitis, but missing this diagnosis can lead to severe consequences if the appendix ruptures.
- Myocardial infarction: Sometimes referred to as a "heart attack," myocardial infarction can present atypically, especially in older adults, with symptoms that mimic other conditions, including abdominal pain. It's crucial to consider cardiac causes of abdominal pain, especially in patients with risk factors for coronary artery disease.
- Pancreatitis: Inflammation of the pancreas can cause severe abdominal pain that radiates to the back and may mimic the pain of cholecystitis. While pancreatitis does not typically cause a positive Murphy's sign, it is a serious condition that requires prompt diagnosis and treatment.
Rare Diagnoses
- Gallbladder cancer: This is a rare malignancy that can cause chronic inflammation and scarring of the gallbladder, potentially leading to symptoms similar to those of cholecystitis. However, it is much less common than benign gallbladder diseases.
- Mirizzi syndrome: A rare condition where a gallstone becomes impacted in the cystic duct and causes obstruction of the common bile duct, leading to jaundice and potentially symptoms similar to cholecystitis.