Differential Diagnosis for Right Upper Quadrant Pain with Abnormal Liver and Bilirubin Labs
Single Most Likely Diagnosis
- Viral Hepatitis: This is a common cause of abnormal liver and bilirubin labs, and right upper quadrant pain is a frequent symptom. The diagnosis can be confirmed with viral hepatitis serologies.
Other Likely Diagnoses
- Gallbladder Disease (Cholecystitis or Cholelithiasis): Gallstones or inflammation of the gallbladder can cause right upper quadrant pain and abnormal liver function tests, especially if there is common bile duct obstruction.
- Alcoholic Hepatitis: In patients with a history of alcohol use, alcoholic hepatitis should be considered, especially if there are signs of liver dysfunction and right upper quadrant pain.
- Non-Alcoholic Fatty Liver Disease (NAFLD): Although often asymptomatic, NAFLD can cause abnormal liver function tests and right upper quadrant discomfort, particularly in obese or diabetic patients.
Do Not Miss Diagnoses
- Hepatic Abscess: Although less common, a hepatic abscess can present with right upper quadrant pain and abnormal liver function tests. It requires prompt diagnosis and treatment to prevent serious complications.
- Budd-Chiari Syndrome: This rare condition, caused by hepatic vein thrombosis, can present with acute abdominal pain, liver dysfunction, and ascites. It is critical to diagnose early due to its high mortality rate if left untreated.
- Acute Biliary Obstruction: Obstruction of the biliary tree, which can be due to stones, tumors, or other causes, is a medical emergency that requires immediate intervention to prevent liver damage and sepsis.
Rare Diagnoses
- Wilson's Disease: A genetic disorder leading to copper accumulation in the liver, which can cause liver dysfunction and occasionally presents with right upper quadrant pain.
- Autoimmune Hepatitis: An autoimmune condition causing liver inflammation, which can present with a wide range of symptoms including right upper quadrant pain and abnormal liver function tests.
- Primary Biliary Cholangitis (PBC): An autoimmune disease of the bile ducts that can cause chronic liver disease and occasionally presents with right upper quadrant pain, although it more commonly causes fatigue and pruritus.