Differential Diagnosis for Right Hypochondriac Pain
Single Most Likely Diagnosis
- Gallbladder disease (cholelithiasis or cholecystitis): This is often the first consideration for right hypochondriac pain due to the location of the gallbladder under the right rib cage. Symptoms can include sharp pain, especially after eating fatty foods, and may radiate to the right shoulder.
Other Likely Diagnoses
- Peptic ulcer disease: Ulcers in the stomach or duodenum can cause pain in the right upper quadrant, especially if the ulcer is located near the pylorus or if there is associated inflammation.
- Hepatitis: Inflammation of the liver can cause right upper quadrant pain, and it may be accompanied by jaundice, fatigue, and loss of appetite.
- Right lower lobe pneumonia: Although pneumonia typically presents with respiratory symptoms, right lower lobe pneumonia can cause referred pain to the right upper quadrant due to the proximity of the diaphragm to the lung base.
- Pyelonephritis or kidney stones: Infection or stones in the right kidney can cause flank pain that may radiate to the right upper quadrant.
Do Not Miss Diagnoses
- Appendicitis (if pain has shifted): Although appendicitis typically presents with pain in the right lower quadrant, it can start higher and then move down. Missing appendicitis can lead to perforation and severe complications.
- Myocardial infarction: Cardiac ischemia can sometimes present with atypical pain, including right upper quadrant pain, especially if the inferior wall of the heart is involved.
- Pulmonary embolism: A large pulmonary embolism can cause sudden onset of chest pain that might be referred to the right upper quadrant, along with shortness of breath and possibly syncope.
Rare Diagnoses
- Hepatic artery aneurysm: A rare condition where an aneurysm of the hepatic artery can cause right upper quadrant pain, potentially life-threatening if ruptured.
- Cholangiocarcinoma: A cancer of the bile duct that can cause obstructive jaundice and right upper quadrant pain, though it is much less common than other causes of these symptoms.
- Right diaphragmatic hernia: A rare condition where abdominal contents herniate through the diaphragm, potentially causing severe pain and respiratory distress.