Differential Diagnosis of Right Hypochondriac Pain

The right hypochondriac region is the area below the right ribs, and pain in this area can be caused by various conditions. Here's a differential diagnosis organized into categories:

• Single Most Likely Diagnosis

  • Gallbladder Disease: This includes conditions like cholecystitis (inflammation of the gallbladder) and cholelithiasis (gallstones). The gallbladder is located under the right ribs, and diseases affecting it often cause pain in the right hypochondriac region. The pain is typically sharp and may radiate to the right shoulder.

• Other Likely Diagnoses

  • Peptic Ulcer Disease: Ulcers in the stomach or duodenum can cause pain that is felt in the right hypochondriac area, especially if the ulcer is located high in the stomach or near the pylorus.
  • Hepatitis: Inflammation of the liver can cause right hypochondriac pain due to the liver's location under the right ribs. The pain may be accompanied by jaundice and other symptoms of liver dysfunction.
  • Right Lower Lobe Pneumonia: Infections in the lower part of the right lung can cause referred pain in the right hypochondriac region due to the proximity of the lung to the diaphragm and the sharing of nerve roots.
  • Musculoskeletal Issues: Strains or injuries to the muscles or ribs in the right hypochondriac area can cause localized pain.

• Do Not Miss Diagnoses

  • Appendicitis: Although appendicitis typically presents with pain in the right lower quadrant, it can occasionally cause pain that is perceived in the right hypochondriac region, especially if the appendix is located higher than usual.
  • Myocardial Infarction: In some cases, a heart attack can cause referred pain in the right hypochondriac area, especially if the inferior wall of the heart is involved.
  • Pulmonary Embolism: A blood clot in the lungs can cause sudden onset of pain that may be felt in the right hypochondriac region if the clot is located in the lower parts of the right lung.
  • Cholecystenteric Fistula: A fistula between the gallbladder and the intestine can lead to gallstone ileus, which is a life-threatening condition.

• Rare Diagnoses

  • Hepatic Abscess: A collection of pus in the liver can cause right hypochondriac pain, fever, and other systemic symptoms.
  • Hepatocellular Carcinoma: Liver cancer can cause pain in the right hypochondriac region, especially if the tumor is large or has invaded nearby structures.
  • Right Diaphragmatic Hernia: A hernia through the diaphragm can cause bowel or other organs to protrude into the thoracic cavity, leading to pain and other symptoms.
  • Intrahepatic Duct Stones: Stones within the bile ducts inside the liver can cause recurrent pain in the right hypochondriac region, similar to gallstones.