Differential Diagnosis for Severe Right Upper Quadrant Pain

The following differential diagnosis is organized into categories to help guide the thought process:

• Single Most Likely Diagnosis

  • Cholecystitis: This is the most likely diagnosis due to the location of the pain, which is commonly associated with gallbladder inflammation. The pain is often severe and may radiate to the right shoulder or back.

• Other Likely Diagnoses

  • Biliary colic: This condition occurs when the gallbladder contracts in response to a gallstone blocking the cystic duct, causing severe pain.
  • Peptic ulcer disease: Although the pain is typically more epigastric, peptic ulcers can sometimes cause right upper quadrant pain, especially if the ulcer is located in the duodenum.
  • Hepatitis: Inflammation of the liver can cause right upper quadrant pain, and it's essential to consider this diagnosis, especially if the patient has a history of liver disease or risk factors for hepatitis.

• Do Not Miss Diagnoses

  • Appendicitis (with an atypical presentation): Although appendicitis typically presents with pain in the lower right abdomen, it can occasionally present with right upper quadrant pain, especially if the appendix is located in a retrocecal position.
  • Myocardial infarction (MI): MI can sometimes cause referred pain to the right upper quadrant, especially if the inferior wall of the heart is involved.
  • Pneumonia (right lower lobe): Pneumonia can cause pleuritic chest pain that may be referred to the right upper quadrant.
  • Pulmonary embolism: This is a life-threatening condition that can cause sudden onset of chest pain and may be referred to the right upper quadrant.

• Rare Diagnoses

  • Fitz-Hugh-Curtis syndrome: This is a rare condition characterized by inflammation of the liver capsule and adjacent peritoneal surfaces, often due to a bacterial infection.
  • Hepatic artery aneurysm: A rare condition that can cause severe right upper quadrant pain due to rupture or thrombosis of the aneurysm.
  • Pancreatic cancer: Although rare, pancreatic cancer can cause right upper quadrant pain, especially if the tumor is located in the head of the pancreas.