Medical Advisory BoardAll articles are reviewed for accuracy by our Medical Advisory Board
Educational purpose only • Exercise caution as content is pending human review
Article Review Status
Submitted
Under Review
Approved

Last updated: July 25, 2025 • View editorial policy

Personalize

Help us tailor your experience

Which best describes you? Your choice helps us use language that's most understandable for you.

Differential Diagnosis for 58-year-old Male with RUQ Abdominal Pain and Vomiting

Single Most Likely Diagnosis

  • Cholecystitis: The patient's presentation of right upper quadrant (RUQ) abdominal pain, positive Murphy's sign, and vomiting, along with the absence of fever, suggests acute cholecystitis, which is inflammation of the gallbladder, often due to gallstones.

Other Likely Diagnoses

  • Gallstone Disease: Given the symptoms of RUQ pain, vomiting, and the specific finding of pale stools (suggesting bile duct obstruction) and orange/brown urine (indicating bilirubinuria), gallstone disease is a strong consideration. This could include conditions like choledocholithiasis (stones in the common bile duct).
  • Peptic Ulcer Disease: Although less likely given the specific findings, peptic ulcer disease (PUD) can cause RUQ pain and vomiting. The absence of dyspepsia or a history of NSAID use makes this less likely but still a consideration.
  • Hepatitis: The orange/brown urine could suggest jaundice, which, combined with RUQ pain, might point towards hepatitis. However, the lack of fever and other systemic symptoms makes this less likely.

Do Not Miss Diagnoses

  • Biliary Obstruction: This could be due to stones (choledocholithiasis) or other causes like tumors. The presence of pale stools and dark urine suggests an obstruction of the bile ducts, which is a serious condition requiring prompt intervention.
  • Pancreatitis: Although the patient does not have the classic radiating back pain, pancreatitis can present with RUQ pain and vomiting. The absence of fever and significant abdominal tenderness makes this less likely, but it's a condition that could have severe consequences if missed.
  • Myocardial Infarction: Although the patient denies chest pain, atypical presentations of myocardial infarction (MI), especially in older adults, can include abdominal pain. The tachycardia (HR 108) could be a sign of cardiac stress.

Rare Diagnoses

  • Ampullary Tumor: A tumor at the ampulla of Vater could cause obstructive jaundice and RUQ pain, similar to what the patient is experiencing. This would be a rare cause but is worth considering if common causes are ruled out.
  • Sclerosing Cholangitis: This chronic liver disease causes scarring and narrowing of the bile ducts, leading to obstructive jaundice and potentially RUQ pain. It's less common and usually associated with inflammatory bowel disease or other autoimmune conditions.

Related Questions

At what age groups is a first-time Inflammatory Bowel Disease (IBD) diagnosis most likely to occur?
What are the treatments for COVID-19?
When is urological intervention justified in a renal abscess?
What is the most appropriate diagnostic test for a 28-year-old nulligravid woman with a 7-cm septated left adnexal mass and severe dysmenorrhea?

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

Have a follow-up question?

Our Medical A.I. is used by practicing medical doctors at top research institutions around the world. Ask any follow up question and get world-class guideline-backed answers instantly.

Ask Question