Differential Diagnosis for Right Upper Quadrant Abdominal Pain

The following differential diagnosis is organized into categories to help guide the thought process:

• Single Most Likely Diagnosis

  • Gallbladder disease (cholecystitis or cholelithiasis): This is often the most common cause of right upper quadrant (RUQ) abdominal pain, especially if the pain is severe and persistent. The pain is typically localized to the RUQ, may radiate to the right shoulder, and can be exacerbated by fatty foods.

• Other Likely Diagnoses

  • Peptic ulcer disease: Both gastric and duodenal ulcers can cause RUQ pain, which may be related to eating or have a burning quality.
  • Hepatitis: Inflammation of the liver can cause RUQ pain, and it may be accompanied by jaundice, fatigue, and loss of appetite.
  • Pyelonephritis or kidney stones: While these conditions primarily affect the kidneys, they can cause flank pain that may radiate to the RUQ, especially if the right kidney is involved.
  • Right lower lobe pneumonia: Sometimes, pulmonary issues can refer pain to the abdomen, and a right lower lobe pneumonia could potentially cause RUQ pain due to referred pain.

• Do Not Miss Diagnoses

  • Appendicitis (if pain has migrated): Although appendicitis typically presents with pain in the right lower quadrant, in some cases, especially if the appendix is retrocecal, the pain can be higher and may be confused with RUQ pain.
  • Cholangitis: Infection of the bile ducts, which can be life-threatening if not promptly treated. It often presents with jaundice, fever, and RUQ pain.
  • Hepatic abscess: A collection of pus in the liver, which can be a complication of bacterial, parasitic, or fungal infections. It requires urgent medical attention.
  • Pulmonary embolism: While not typically causing RUQ pain directly, a pulmonary embolism can cause sudden onset of chest pain and shortness of breath, and in rare cases, may refer pain to the abdomen.

• Rare Diagnoses

  • Fitz-Hugh-Curtis syndrome: A rare condition where pelvic inflammatory disease causes inflammation of the liver capsule, leading to RUQ pain.
  • Right adrenal gland pathology (e.g., hemorrhage or tumor): These conditions are rare but can cause RUQ or flank pain.
  • Intestinal obstruction or volvulus: Although these conditions more commonly present with diffuse or lower abdominal pain, in some cases, they can cause RUQ pain, especially if the obstruction or volvulus involves the small intestine or the hepatic flexure of the colon.