Differential Diagnosis for Chills, Vomiting, RUQ Pain, and Negative Ultrasound for Cholecystitis

• Single Most Likely Diagnosis
  • Peptic Ulcer Disease: This condition is a common cause of upper abdominal pain and can present with chills and vomiting if there is an associated infection or perforation. The negative ultrasound for cholecystitis does not rule out peptic ulcer disease, as the symptoms can overlap.
• Other Likely Diagnoses
  • Viral Gastroenteritis: This condition can cause chills, vomiting, and abdominal pain, including in the right upper quadrant (RUQ). The absence of cholecystitis on ultrasound does not exclude viral gastroenteritis.
  • Hepatitis: Inflammation of the liver can cause RUQ pain, chills, and vomiting. A negative ultrasound for cholecystitis does not rule out hepatitis, as the liver itself may not show significant abnormalities on ultrasound.
  • Biliary Dyskinesia: This condition involves abnormal contractions of the gallbladder and can cause biliary-type pain even in the absence of gallstones. It might not be directly visible on a standard ultrasound.
• Do Not Miss Diagnoses
  • Appendicitis: Although appendicitis typically presents with pain in the lower right abdomen, it can occasionally cause upper abdominal pain, especially if the appendix is retrocecal. Missing appendicitis can lead to severe consequences, including perforation and peritonitis.
  • Pancreatitis: Inflammation of the pancreas can cause severe abdominal pain, chills, and vomiting. While pancreatitis might not directly relate to RUQ pain, it's a critical condition that requires prompt diagnosis and treatment.
  • Cholangitis: Infection of the bile ducts can cause jaundice, chills, fever, and abdominal pain. A negative ultrasound for cholecystitis does not exclude cholangitis, especially if the bile ducts are not well visualized.
• Rare Diagnoses
  • Fitz-Hugh-Curtis Syndrome: A rare condition characterized by inflammation of the liver capsule and adjacent peritoneal surfaces, often due to pelvic inflammatory disease. It can cause RUQ pain and might not be immediately apparent on ultrasound.
  • Liver Abscess: A collection of pus in the liver can cause fever, chills, and RUQ pain. While less common, liver abscesses are important to consider, especially in patients with risk factors such as biliary disease or immunocompromised states.