Differential Diagnosis for RUQ Pain Worse When Hungry

• Single Most Likely Diagnosis
  • Peptic Ulcer Disease: The pain associated with peptic ulcers, particularly duodenal ulcers, often worsens when the stomach is empty (i.e., when hungry) because the acidic environment of the stomach is not buffered by food. This condition is common and the symptoms match closely with the description provided.
• Other Likely Diagnoses
  • Cholecystitis: Inflammation of the gallbladder can cause right upper quadrant (RUQ) pain, which may worsen before eating due to the gallbladder's contraction in anticipation of food intake. However, the pain is typically more constant and may radiate to the right shoulder.
  • Biliary Colic: Similar to cholecystitis, biliary colic involves pain from the gallbladder, often triggered by eating, especially fatty foods, which can stimulate gallbladder contraction. The pain can be severe but is usually intermittent.
• Do Not Miss Diagnoses
  • Pancreatitis: While pancreatitis typically presents with mid-abdominal pain radiating to the back, it can sometimes cause RUQ pain. The pain is often constant and severe, and can be worsened by eating, particularly fatty foods. Missing this diagnosis can lead to severe complications.
  • Hepatic Abscess or Liver Tumors: These conditions can cause RUQ pain and, while less common, are critical to diagnose due to their potential for serious morbidity and mortality.
• Rare Diagnoses
  • Gastric Cancer: Though rare, especially in younger populations, gastric cancer can present with symptoms similar to peptic ulcer disease, including pain that worsens with hunger.
  • Intestinal Obstruction: While not typically associated with hunger, an obstruction in the small intestine can cause abdominal pain that may be perceived as worsening with hunger due to increased intestinal contractions.
  • Diabetic Gastroparesis: This condition involves delayed stomach emptying and can cause nausea, vomiting, and abdominal pain, which might be perceived as worsening before eating due to the prolonged emptying time and potential for increased stomach acid production.