Differential Diagnosis for Intermittent Pain in the Right Upper Quadrant
Single Most Likely Diagnosis
- Biliary Colic: This condition is characterized by intermittent, severe pain in the right upper quadrant or epigastric region, often radiating to the right shoulder or back. It is usually caused by gallstones obstructing the cystic duct or common bile duct. The pain typically occurs after eating fatty foods and can last from minutes to hours.
Other Likely Diagnoses
- Peptic Ulcer Disease: Peptic ulcers can cause intermittent pain in the right upper quadrant, especially if the ulcer is located in the duodenum. The pain is often described as burning or gnawing and can be relieved by eating or taking antacids.
- Gastroesophageal Reflux Disease (GERD): While GERD typically causes heartburn and regurgitation, some patients may experience pain in the right upper quadrant due to the reflux of stomach acid into the esophagus.
- Hepatitis: Inflammation of the liver can cause right upper quadrant pain, which may be intermittent. Hepatitis can be caused by viral infections, alcohol use, or other factors.
Do Not Miss Diagnoses
- Cholecystitis: Inflammation of the gallbladder, often caused by gallstones, can lead to severe, persistent pain in the right upper quadrant. If left untreated, it can lead to serious complications like gangrene or perforation of the gallbladder.
- Pneumonia: Right lower lobe pneumonia can cause referred pain in the right upper quadrant due to the proximity of the diaphragm to the lung. Missing this diagnosis can lead to severe respiratory complications.
- Myocardial Infarction: Although less common, myocardial infarction (heart attack) can cause pain that radiates to the right upper quadrant, especially if the inferior wall of the heart is involved.
Rare Diagnoses
- Hepatic Abscess: A rare condition where a pocket of pus forms in the liver, causing intermittent pain in the right upper quadrant, fever, and other systemic symptoms.
- Liver Cancer: Primary or metastatic liver cancer can cause intermittent pain in the right upper quadrant, often accompanied by weight loss, jaundice, and other symptoms.
- Diaphragmatic Hernia: A rare condition where part of the stomach or intestine herniates through the diaphragm, causing intermittent pain in the right upper quadrant and other symptoms like dysphagia or shortness of breath.