Differential Diagnosis for Right Upper Abdominal Pain, Nausea, and Vomiting

Single Most Likely Diagnosis

• Gallbladder disease (cholecystitis or cholelithiasis): This is often the first consideration for right upper abdominal pain, especially if it's colicky, radiates to the right shoulder, and is accompanied by nausea and vomiting. The pain typically occurs after eating fatty foods.

Other Likely Diagnoses

• Peptic ulcer disease: Gastric or duodenal ulcers can cause epigastric pain that may radiate to the right upper quadrant, along with nausea and vomiting.
• Hepatitis: Inflammation of the liver can cause right upper quadrant pain, nausea, and vomiting, often accompanied by jaundice.
• Gastroesophageal reflux disease (GERD): While more commonly associated with heartburn, severe GERD can cause upper abdominal pain and nausea.
• Pancreatitis: Though more central, pancreatic inflammation can sometimes present with right upper quadrant pain, especially if the head of the pancreas is involved.

Do Not Miss Diagnoses

• Appendicitis (if pain has migrated): Although appendicitis typically presents with pain in the lower right abdomen, it can start higher and migrate down. Missing appendicitis can lead to perforation and severe complications.
• Pneumonia (right lower lobe): Referred pain from a lower lobe pneumonia can sometimes be felt in the abdomen, and missing this diagnosis can have serious consequences.
• Myocardial infarction: Though classically presenting with chest pain, myocardial infarctions can occasionally present with epigastric discomfort or nausea and vomiting, especially in women or diabetic patients.
• Pulmonary embolism: Severe cases can cause pain that might be referred to the abdomen, along with nausea and vomiting, and is critical not to miss due to its high mortality rate.

Rare Diagnoses

• Hepatic artery aneurysm: A rare condition that can cause right upper quadrant pain due to rupture or impending rupture of the aneurysm.
• Budd-Chiari syndrome: Thrombosis of the hepatic veins can cause abdominal pain, nausea, and vomiting, along with ascites and liver dysfunction.
• Right upper quadrant tumors: Such as hepatocellular carcinoma or metastatic disease to the liver, which can cause pain, nausea, and vomiting, often with significant weight loss and other systemic symptoms.