Differential Diagnosis for RUQ Pain with Nausea, Vomiting, and Positive Murphy's Sign

• Single Most Likely Diagnosis
  • Cholecystitis: The presence of RUQ pain, nausea, vomiting, and a positive Murphy's sign are classic symptoms for cholecystitis. The ultrasound findings of non-shadowing echogenic foci in the gallbladder (GB) suggest the presence of gallstones, which are a common cause of cholecystitis.
• Other Likely Diagnoses
  • Gallstone disease without cholecystitis: While the patient has a positive Murphy's sign, which is more specific for cholecystitis, the presence of gallstones can also cause biliary colic, which presents with similar symptoms but without inflammation of the gallbladder.
  • Biliary dyskinesia: This condition involves abnormal contraction of the gallbladder, which can cause similar symptoms to cholecystitis, including RUQ pain and nausea, but it is not associated with gallstones or inflammation.
• Do Not Miss Diagnoses
  • Perforated gallbladder or empyema: These are complications of cholecystitis that can lead to severe consequences, including peritonitis and sepsis, if not promptly diagnosed and treated.
  • Mirizzi syndrome: A rare complication of gallstone disease where a stone becomes impacted in the cystic duct, causing obstruction of the common bile duct, which can lead to jaundice and potentially life-threatening complications.
• Rare Diagnoses
  • Gallbladder cancer: Although very rare, gallbladder cancer can present with similar symptoms to cholecystitis, including RUQ pain and weight loss. The presence of a mass in the gallbladder on ultrasound would raise suspicion for this diagnosis.
  • Porcelain gallbladder: A condition where the gallbladder wall becomes calcified, which can increase the risk of gallbladder cancer. It may present with chronic RUQ pain and can be identified on imaging studies, including ultrasound.