Differential Diagnosis for Right Upper Quadrant Pain
Single Most Likely Diagnosis
- Gallbladder disease (cholecystitis or cholelithiasis): This is the most common cause of right upper quadrant (RUQ) pain, especially in females. The pain is often postprandial, worsening after fatty meals, and may radiate to the right shoulder.
Other Likely Diagnoses
- Peptic ulcer disease: Gastric or duodenal ulcers can cause RUQ pain, which may be related to food intake and can radiate to the back.
- Hepatitis: Inflammation of the liver can cause RUQ pain, jaundice, and elevated liver enzymes.
- Pyelonephritis or kidney stones: Infection or obstruction of the right kidney can cause flank pain that may radiate to the RUQ.
- Pneumonia (right lower lobe): Basilar pneumonia can cause referred pain to the RUQ due to the shared innervation of the diaphragm.
Do Not Miss Diagnoses
- Appendicitis (with an atypical presentation): Although appendicitis typically presents with right lower quadrant pain, an atypically located appendix can cause RUQ pain.
- Myocardial infarction: Cardiac ischemia can cause referred pain to the RUQ, especially in women or diabetic patients.
- Pulmonary embolism: A large pulmonary embolism can cause sudden onset of RUQ pain due to lung infarction.
- Aortic dissection: A tear in the aortic wall can cause severe, tearing pain that may radiate to the RUQ.
Rare Diagnoses
- Hepatic artery aneurysm or thrombosis: These vascular abnormalities can cause RUQ pain, jaundice, and elevated liver enzymes.
- Pancreatic cancer or pancreatitis: Although more commonly associated with epigastric pain, pancreatic pathology can cause RUQ pain.
- Inflammatory bowel disease (Crohn's disease or ulcerative colitis): These conditions can cause chronic RUQ pain, diarrhea, and weight loss.
- Right adrenal gland pathology (e.g., tumor or hemorrhage): Rarely, adrenal gland disorders can cause RUQ pain and other systemic symptoms.