Differential Diagnosis for RUQ Swelling with Pain in an Obese Female with Normal Liver Enzymes
Single Most Likely Diagnosis
- Gallbladder disease (e.g., cholecystitis, cholelithiasis): The patient's symptoms of right upper quadrant (RUQ) swelling and pain, combined with obesity (a risk factor for gallstones), make gallbladder disease a highly plausible diagnosis. Normal liver enzymes do not rule out gallbladder pathology.
Other Likely Diagnoses
- Hepatic steatosis (fatty liver disease): Although liver enzymes are normal, fatty liver disease is common in obese individuals and can cause hepatomegaly (enlargement of the liver) and RUQ discomfort.
- Peptic ulcer disease: Gastritis or peptic ulcers can cause RUQ pain and are more common in obese individuals due to increased pressure on the stomach.
- Right kidney pathology (e.g., pyelonephritis, nephrolithiasis): Pain from the right kidney can radiate to the RUQ and should be considered, especially if there are urinary symptoms.
Do Not Miss Diagnoses
- Hepatocellular carcinoma or other liver malignancies: Although less common, liver cancer can present with RUQ pain and swelling, even with normal liver enzymes. Obesity is a risk factor for liver cancer.
- Cholangitis: Infection of the bile ducts can cause severe pain, jaundice, and potentially life-threatening complications if not promptly treated.
- Appendicitis (if pain is more right lower quadrant): While the primary complaint is RUQ pain, appendicitis can sometimes present atypically, especially in obese patients, and is a surgical emergency.
Rare Diagnoses
- Amyloidosis: A condition characterized by the deposition of amyloid proteins in various organs, including the liver, which can cause hepatomegaly and pain.
- Polycystic liver disease: A rare genetic disorder leading to the growth of numerous cysts filled with fluid in the liver, which can cause hepatomegaly and abdominal pain.
- Intra-abdominal malignancies (e.g., lymphoma): Other cancers within the abdomen can cause nonspecific symptoms including RUQ pain and swelling.