Differential Diagnosis for Colic Sensation in Right Upper Quadrant
- Single most likely diagnosis
- Cholelithiasis (gallstones): This is the most common cause of colic sensation in the right upper quadrant, often due to a gallstone obstructing the cystic duct or common bile duct, leading to severe, episodic pain.
- Other Likely diagnoses
- Cholecystitis: Inflammation of the gallbladder, often secondary to gallstones, can cause colic pain in the right upper quadrant, along with fever and leukocytosis.
- Peptic ulcer disease: Ulcers in the duodenum or stomach can cause colic pain, especially if they penetrate or perforate, leading to peritonitis.
- Hepatitis: Inflammation of the liver, whether viral, alcoholic, or autoimmune, can cause right upper quadrant pain, although it's often more of a dull ache than colic.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Appendicitis (with atypical presentation): Although appendicitis typically presents with pain in the right lower quadrant, an atypical presentation with the appendix located in the right upper quadrant can occur, and missing this diagnosis can lead to perforation and peritonitis.
- Myocardial infarction (with referred pain): In some cases, myocardial infarction can present with referred pain to the right upper quadrant, especially if the inferior wall of the heart is involved.
- Pneumonia (right upper lobe): Basilar pneumonia, especially if involving the right upper lobe, can cause referred pain to the right upper quadrant due to diaphragmatic irritation.
- Rare diagnoses
- Fitz-Hugh-Curtis syndrome: A rare condition characterized by perihepatitis due to gonococcal or chlamydial infection, causing right upper quadrant pain.
- Hepatic artery aneurysm: A rare vascular anomaly that can cause colic pain in the right upper quadrant if it ruptures or thromboses.
- Biliary dyskinesia: A motility disorder of the gallbladder or biliary tree, which can cause biliary-type pain without evidence of gallstones or inflammation.