Differential Diagnosis for Right Upper Quadrant Pain

The following is a differential diagnosis for right upper quadrant pain, categorized for clarity and emphasis on potential severity.

• Single Most Likely Diagnosis
  • Cholecystitis: This is the most common cause of right upper quadrant pain, often associated with gallstones causing inflammation of the gallbladder. Symptoms can include sharp pain, tenderness, and sometimes fever.
• Other Likely Diagnoses
  • Biliary colic: Pain from gallstones that have not yet caused inflammation, typically presenting as intermittent, sharp pain.
  • Peptic ulcer disease: Ulcers in the stomach or duodenum can cause pain in the right upper quadrant, especially if the ulcer is located near the pylorus.
  • Hepatitis: Inflammation of the liver, which can be viral, toxic, or autoimmune in nature, leading to right upper quadrant pain and tenderness.
  • Pancreatitis: Although more central, pancreatic inflammation can radiate to the right upper quadrant, especially if the head of the pancreas is involved.
• Do Not Miss Diagnoses
  • Appendicitis (with an atypical presentation): Although appendicitis typically presents with lower right quadrant pain, an retrocecal appendix can cause right upper quadrant pain.
  • Myocardial infarction: Cardiac issues can sometimes refer pain to the right upper quadrant, especially if the inferior wall of the heart is involved.
  • Pneumonia (right lower lobe): Basilar pneumonias can cause referred pain to the right upper quadrant due to the shared innervation of the diaphragm and abdominal organs.
  • Pulmonary embolism: Similar to pneumonia, a pulmonary embolism can cause sudden onset of pain that might be referred to the right upper quadrant.
• Rare Diagnoses
  • Fitz-Hugh-Curtis syndrome: A rare condition where pelvic inflammatory disease causes inflammation of the liver capsule, leading to right upper quadrant pain.
  • Liver abscess: A collection of pus in the liver, which can be caused by bacterial, parasitic, or fungal infections.
  • Hepatic artery aneurysm: A rare condition where an aneurysm of the hepatic artery can cause right upper quadrant pain, potentially life-threatening if ruptured.
  • Right upper quadrant tumors: Various tumors (hepatic, gallbladder, or biliary) can cause pain in this region, often associated with weight loss and other systemic symptoms.