Differential Diagnosis for RUQ Pain after Cholecystectomy
Single Most Likely Diagnosis
- Bile Duct Stones or Residual Stones: This is a common issue after cholecystectomy, especially if the bile ducts were not thoroughly cleared during the surgery. Symptoms can include recurrent RUQ pain, jaundice, and potentially cholangitis.
Other Likely Diagnoses
- Hepatitis: Inflammation of the liver can cause RUQ pain and can be due to various causes including viral, alcoholic, or drug-induced hepatitis.
- Peptic Ulcer Disease: Although more commonly associated with epigastric pain, peptic ulcers can sometimes cause pain that radiates to the RUQ.
- Gastroesophageal Reflux Disease (GERD): While typically causing heartburn, severe GERD can lead to referred pain in the RUQ.
- Adhesions or Bowel Obstruction: Post-surgical adhesions can cause bowel obstruction, leading to pain, nausea, vomiting, and constipation.
Do Not Miss Diagnoses
- Hepatic Artery Thrombosis or Stenosis: A potentially life-threatening complication after liver surgery or transplantation, requiring prompt intervention.
- Biliary Stricture: Narrowing of the bile ducts can cause obstructive jaundice, cholangitis, and severe pain, necessitating urgent medical attention.
- Cholangitis: An infection of the bile duct, which can be life-threatening if not promptly treated with antibiotics and possibly drainage.
- Liver Abscess: A collection of pus in the liver, which can be due to bacterial, parasitic, or fungal infections, requiring drainage and antibiotic therapy.
Rare Diagnoses
- Primary Sclerosing Cholangitis (PSC): A chronic liver disease that leads to scarring and narrowing of the bile ducts, more common in patients with inflammatory bowel disease.
- Hepatocellular Carcinoma: A type of liver cancer that can cause RUQ pain, more common in patients with cirrhosis or other underlying liver diseases.
- Gallbladder Remnant or Residual Gallbladder Disease: If a portion of the gallbladder was left behind during surgery, it can still cause symptoms.
- Mirizzi Syndrome: A rare condition where a gallstone becomes impacted in the cystic duct, causing obstruction of the common bile duct and potentially severe complications.