Differential Diagnosis for RUQ Pain at Night After Eating
- Single most likely diagnosis
- Cholecystitis: This condition, which is inflammation of the gallbladder, often presents with right upper quadrant (RUQ) pain that worsens at night and after eating, especially fatty foods. The pain can radiate to the right shoulder or back.
- Other Likely diagnoses
- Cholelithiasis (Gallstones): Gallstones can cause intermittent RUQ pain, known as biliary colic, which may occur at night and is exacerbated by eating, particularly fatty meals.
- Peptic Ulcer Disease: While peptic ulcers more commonly cause epigastric pain, they can also present with RUQ pain, especially if the ulcer is located in the duodenum. Pain from peptic ulcers can be worse at night and is classically relieved by eating, but some cases may worsen with eating certain foods.
- Hepatitis: Inflammation of the liver can cause RUQ pain, and while it's not typically worsened by eating, it can be constant and may have a nocturnal component.
- Do Not Miss diagnoses
- Myocardial Infarction: Although myocardial infarction typically presents with chest pain, it can occasionally manifest as RUQ pain, especially in women or diabetic patients. The pain may not necessarily be related to eating but can occur at rest, including at night.
- Pneumonia (especially right lower lobe): Referred pain from a lower lobe pneumonia can cause RUQ pain, and while it's not directly related to eating, it's a critical diagnosis not to miss due to its potential severity.
- Appendicitis (if the appendix is located in an atypical position): Although appendicitis typically causes lower right quadrant pain, an atypically located appendix can cause pain in the RUQ. The pain may not be directly related to eating but is a critical diagnosis due to the risk of perforation.
- 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 that may worsen with movement or eating.
- Hepatic Artery Aneurysm or Hepatic Artery Thrombosis: These vascular issues can cause RUQ pain and are rare but critical diagnoses due to their potential for severe complications, including rupture or liver infarction.