Differential Diagnosis for RUQ Pain 1 Year Post Cholecystectomy

Single Most Likely Diagnosis

• Biliary Dyskinesia or Sphincter of Oddi Dysfunction: This condition is a common cause of post-cholecystectomy pain, especially if the patient had a history of biliary colic or sphincter of Oddi dysfunction before the surgery. The pain is usually intermittent, located in the right upper quadrant (RUQ), and may be accompanied by nausea and vomiting.

Other Likely Diagnoses

• Adhesions or Adhesive Bowel Obstruction: Post-surgical adhesions can cause intermittent bowel obstruction, leading to RUQ pain, nausea, vomiting, and changes in bowel habits.
• Hepatic or Common Bile Duct Stones: Although less common after cholecystectomy, stones can still form in the bile ducts, causing RUQ pain, jaundice, and potentially cholangitis.
• Peptic Ulcer Disease: Gastritis or peptic ulcers can cause RUQ pain, especially if the patient has a history of NSAID use or Helicobacter pylori infection.
• Gastroesophageal Reflux Disease (GERD): GERD can cause epigastric pain that may radiate to the RUQ, especially after eating or at night.

Do Not Miss Diagnoses

• Hepatic Artery Thrombosis or Stenosis: A rare but potentially life-threatening complication of liver transplantation or other hepatic surgeries, which can cause RUQ pain, liver dysfunction, and potentially lead to liver failure.
• Cholangiocarcinoma: A rare but aggressive cancer of the bile ducts, which can cause RUQ pain, jaundice, weight loss, and potentially fatal if not diagnosed early.
• Hepatic Abscess: A rare but potentially life-threatening infection of the liver, which can cause RUQ pain, fever, and potentially sepsis if not treated promptly.

Rare Diagnoses

• Primary Sclerosing Cholangitis: A rare chronic liver disease characterized by inflammation and scarring of the bile ducts, which can cause RUQ pain, jaundice, and potentially lead to liver failure.
• Budd-Chiari Syndrome: A rare condition caused by thrombosis of the hepatic veins, which can cause RUQ pain, ascites, and potentially lead to liver failure.
• Gallbladder Remnant or Residual Stones: A rare condition where a portion of the gallbladder is left behind during surgery or stones are retained, causing ongoing RUQ pain and potentially leading to cholecystitis or cholangitis.