Differential Diagnosis for Right Upper Quadrant Pain and Shoulder Pain

• Single Most Likely Diagnosis
  • Cholecystitis: This is the most likely diagnosis due to the common referral of gallbladder pain to the right shoulder. The pain is often sharp and may worsen after eating fatty foods.
• Other Likely Diagnoses
  • Peptic Ulcer Disease: Ulcers in the stomach or duodenum can cause pain that radiates to the right upper quadrant and shoulder.
  • Hepatitis: Inflammation of the liver can cause right upper quadrant pain and may be referred to the shoulder.
  • Pancreatitis: Although more commonly associated with mid-back pain, pancreatitis can cause pain that radiates to the right shoulder.
  • Pneumonia (right lower lobe): Referred pain from the diaphragm can cause shoulder pain and right upper quadrant discomfort.
• Do Not Miss Diagnoses
  • Myocardial Infarction: Although less common, myocardial infarctions can present with atypical pain, including right shoulder pain, and must be ruled out due to their high mortality rate.
  • Pulmonary Embolism: Similar to myocardial infarction, pulmonary embolism can present with sudden onset of shoulder pain and must be considered due to its potential for severe consequences.
  • Ruptured Hepatic or Splenic Vessels: These conditions are emergencies and can present with sudden onset of pain, making them crucial not to miss.
• Rare Diagnoses
  • Fitz-Hugh-Curtis Syndrome: A rare condition where pelvic inflammatory disease causes adhesions between the liver and abdominal wall, leading to right upper quadrant pain.
  • Diaphragmatic Irritation (from blood or other irritants): Can cause referred pain to the shoulder.
  • Tumors of the Liver, Gallbladder, or Pancreas: Although less common, these can cause chronic pain in the right upper quadrant and shoulder.