Differential Diagnosis for Right Upper Quadrant Pain in a 36-year-old Pregnant Woman
- Single most likely diagnosis
- Gallbladder disease (cholelithiasis or cholecystitis): The patient's symptoms of intermittent right upper quadrant pain radiating to the back, worsening over time, and tenderness to deep palpation in the right upper quadrant are classic for gallbladder disease. The increased risk due to pregnancy, especially with a BMI of 40 kg/m2, further supports this diagnosis.
- Other Likely diagnoses
- Peptic ulcer disease: Although less common in pregnancy, peptic ulcer disease can cause similar symptoms and should be considered, especially with epigastric tenderness.
- Pregnancy-related conditions (e.g., preeclampsia, HELLP syndrome): While the patient does not have the typical symptoms of preeclampsia (hypertension and proteinuria), the condition can sometimes present atypically, and the presence of a midsystolic murmur and mild hypertension warrants consideration.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Pulmonary embolism: Despite the lack of typical symptoms like fever, cough, or headaches, and the presence of clear lungs, pulmonary embolism is a critical diagnosis to consider in any pregnant patient with dyspnea and fatigue, given the increased risk of thromboembolic events during pregnancy.
- Hepatic rupture or infarction: These are rare but potentially life-threatening conditions that could present with acute abdominal pain and should be considered, especially in the context of preeclampsia or HELLP syndrome.
- Rare diagnoses
- Hepatitis: Although less likely, hepatitis could cause right upper quadrant pain and should be considered, especially if there are elevations in liver enzymes.
- Pancreatitis: This condition can cause epigastric pain radiating to the back and should be considered, especially if there are elevations in pancreatic enzymes.