Differential Diagnosis
- Single most likely diagnosis
- Hepatitis: The patient's symptoms of right upper quadrant pain, fever, and vomiting, along with the recent travel history to South America, suggest a possible diagnosis of hepatitis. The pain increasing with deep breathing could indicate peritoneal irritation.
- Other Likely diagnoses
- Cholecystitis: The right upper quadrant pain and tenderness, along with fever and vomiting, could indicate cholecystitis, especially if a gallstone is present.
- Pyelonephritis: Although the patient does not have costovertebral angle tenderness, pyelonephritis could still be a possibility, especially given the fever, chills, and vomiting.
- Pelvic Inflammatory Disease (PID): The patient's history of irregular menses, occasional spotting, and being sexually active without contraception could suggest PID, especially if the pain has migrated from the lower abdomen to the right upper quadrant.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Ectopic Pregnancy: Although the urine pregnancy test is negative, it is essential to consider ectopic pregnancy, especially given the patient's symptoms of abdominal pain, vomiting, and irregular menses.
- Ruptured Hepatic Abscess: A ruptured hepatic abscess could present with severe right upper quadrant pain, fever, and vomiting, and would require prompt surgical intervention.
- Appendicitis: Although the patient's pain initially began in the lower abdomen, appendicitis could still be a possibility, especially if the appendix is retrocecal.
- Rare diagnoses
- Amoebic Liver Abscess: Given the patient's recent travel history to South America, an amoebic liver abscess could be a rare but possible diagnosis, especially if the patient has a history of exposure to contaminated water or food.
- Fitz-Hugh-Curtis Syndrome: This rare condition, characterized by perihepatic inflammation, could present with right upper quadrant pain and fever, especially in a sexually active woman without contraception.