Differential Diagnosis for Right Hypochondriac Pain
Single Most Likely Diagnosis
- Gallbladder disease (cholelithiasis or cholecystitis): This is often the first consideration for right hypochondriac pain due to the location of the gallbladder under the right rib cage. Symptoms can include sharp pain, especially after eating fatty foods, and may radiate to the right shoulder.
Other Likely Diagnoses
- 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 or if there is associated inflammation.
- Hepatitis: Inflammation of the liver can cause right upper quadrant pain, and it may be accompanied by jaundice, fatigue, and loss of appetite.
- Right lower lobe pneumonia: Although pneumonia typically presents with respiratory symptoms, right lower lobe pneumonia can cause referred pain to the right upper quadrant due to the proximity of the diaphragm to the lung base.
- Musculoskeletal issues (e.g., costochondritis, rib fracture): Pain from musculoskeletal sources can mimic visceral pain and should be considered, especially if there is a history of trauma or overuse.
Do Not Miss Diagnoses
- Appendicitis (if pain has shifted): Although appendicitis typically presents with pain in the right lower quadrant, it can start higher and then move down. Missing appendicitis can lead to perforation and severe complications.
- Myocardial infarction: Cardiac ischemia can cause referred pain to the right upper quadrant, especially if the inferior wall of the heart is involved. This is a medical emergency.
- Pulmonary embolism: Similar to myocardial infarction, a pulmonary embolism can cause sudden onset of pain that might be referred to the right upper quadrant, especially if the embolism affects the lower lobes of the lung.
Rare Diagnoses
- Hepatic artery aneurysm or thrombosis: These are rare vascular conditions that can cause severe pain in the right upper quadrant.
- Right adrenal gland pathology (e.g., tumor, hemorrhage): Diseases affecting the right adrenal gland can cause pain in the right upper quadrant, though these conditions are uncommon.
- Diaphragmatic disorders (e.g., diaphragmatic hernia): Abnormalities of the diaphragm can cause pain and discomfort in the right upper quadrant, depending on the location and nature of the disorder.