Differential Diagnosis for Right Upper Quadrant (RUQ) Pain
Single Most Likely Diagnosis
- Gallbladder disease (cholecystitis or cholelithiasis): This is often the most common cause of RUQ pain, especially in patients with a history of gallstones or those who are at higher risk due to factors like female gender, obesity, or family history of gallstones.
Other Likely Diagnoses
- Peptic ulcer disease: Both gastric and duodenal ulcers can cause RUQ pain, especially if the ulcers are located in areas that irritate the surrounding tissues or if there is associated inflammation.
- Hepatitis: Inflammation of the liver, whether viral, alcoholic, or autoimmune in nature, can cause pain in the RUQ due to liver enlargement or capsular stretching.
- Pyelonephritis or kidney stones: While these conditions primarily affect the flank, they can radiate pain to the RUQ, especially if the right kidney is involved.
Do Not Miss Diagnoses
- Appendicitis (especially with an atypical presentation): Although appendicitis typically presents with pain in the lower right quadrant, an inflamed appendix can sometimes be located in a retrocecal position, leading to RUQ pain.
- Cholangitis: Infection of the bile ducts, which can be life-threatening if not promptly treated, may present with RUQ pain, jaundice, and fever (Charcot's triad).
- Hepatic abscess: A collection of pus in the liver can cause severe RUQ pain, fever, and can be life-threatening if not diagnosed and treated properly.
- Pulmonary embolism: While primarily a respiratory issue, a large pulmonary embolism can cause referred pain to the RUQ, especially if there is associated pleurisy.
Rare Diagnoses
- Liver cancer or metastases: Primary or secondary liver tumors can cause RUQ pain due to liver enlargement or capsular invasion.
- Amyloidosis: A condition characterized by the deposition of amyloid proteins in various organs, including the liver, which can lead to hepatomegaly and RUQ pain.
- Porphyria: A group of disorders that can lead to acute episodes of abdominal pain, including RUQ pain, among other symptoms.
- Intra-abdominal malignancies (e.g., pancreatic cancer): Although these cancers more commonly present with mid-abdominal or back pain, they can occasionally cause RUQ pain, especially if there is liver metastasis or direct invasion into the liver or gallbladder.