Differential Diagnosis for Right Upper Quadrant Pain with Hepatomegaly and Fatty Liver on CT
- Single Most Likely Diagnosis
- Fatty Liver Disease (Steatosis): This is the most likely diagnosis given the presence of hepatomegaly and fatty liver on CT. Fatty liver disease is a common condition characterized by the accumulation of excess fat in liver cells, often associated with obesity, diabetes, and alcohol use. It can cause right upper quadrant pain due to liver enlargement.
- Other Likely Diagnoses
- Non-Alcoholic Steatohepatitis (NASH): A form of fatty liver disease that involves inflammation of the liver, which can cause right upper quadrant pain and is often associated with hepatomegaly.
- Alcoholic Liver Disease: If the patient has a history of significant alcohol use, alcoholic liver disease could be a likely diagnosis, causing both hepatomegaly and fatty liver changes.
- Viral Hepatitis: Acute or chronic viral hepatitis (e.g., hepatitis B or C) can cause liver inflammation, leading to hepatomegaly and potentially right upper quadrant pain.
- Do Not Miss Diagnoses
- Liver Cancer (Hepatocellular Carcinoma): Although less common, liver cancer can present with hepatomegaly and right upper quadrant pain. It's crucial to consider this diagnosis, especially in patients with risk factors such as chronic hepatitis or cirrhosis.
- Cholangitis or Biliary Obstruction: Conditions affecting the bile ducts, such as cholangitis or obstruction, can cause right upper quadrant pain and hepatomegaly. These conditions require prompt diagnosis and treatment to prevent serious complications.
- Budd-Chiari Syndrome: A rare condition caused by thrombosis of the hepatic veins, leading to liver enlargement and pain. It's a critical diagnosis to consider due to its potential for severe outcomes if not treated.
- Rare Diagnoses
- Wilson's Disease: A genetic disorder leading to copper accumulation in the liver, which can cause liver damage, hepatomegaly, and potentially right upper quadrant pain.
- Alpha-1 Antitrypsin Deficiency: A genetic disorder that can lead to liver disease and hepatomegaly, presenting with right upper quadrant pain among other symptoms.
- Glycogen Storage Diseases: Rare genetic disorders affecting glycogen metabolism, which can lead to liver enlargement and potentially right upper quadrant pain.