Differential Diagnosis for RUQ Abdominal Pain
Single Most Likely Diagnosis
- Gallbladder disease (cholecystitis or cholelithiasis): This is the most common cause of RUQ abdominal pain, especially in females over 40 years old. The pain is often postprandial, worsening after fatty meals, and may radiate to the right shoulder.
Other Likely Diagnoses
- Peptic ulcer disease (PUD): Gastric or duodenal ulcers can cause RUQ pain, especially if the ulcer is located in the duodenum. The pain is often described as burning or gnawing and may be relieved by food or antacids.
- Hepatitis: Viral or alcoholic hepatitis can cause RUQ pain, jaundice, and elevated liver enzymes. The pain is often dull and aching.
- Pyelonephritis or kidney stones: Right-sided pyelonephritis or kidney stones can cause RUQ pain, often radiating to the flank or groin. The pain may be accompanied by urinary symptoms such as dysuria or frequency.
Do Not Miss Diagnoses
- Appendicitis (with atypical presentation): Although appendicitis typically presents with RLQ pain, it can occasionally present with RUQ pain, especially if the appendix is retrocecal. Missing this diagnosis can lead to perforation and peritonitis.
- Hepatic abscess or tumor: A hepatic abscess or tumor can cause RUQ pain, jaundice, and weight loss. These conditions require prompt diagnosis and treatment to prevent serious complications.
- Cholangitis: Infection of the biliary tree can cause RUQ pain, jaundice, and sepsis. This diagnosis is often associated with a high mortality rate if not recognized and treated promptly.
Rare Diagnoses
- Hepatic artery aneurysm or thrombosis: These conditions can cause RUQ pain, jaundice, and elevated liver enzymes. They are often associated with underlying vascular disease or trauma.
- Right-sided diverticulitis: Diverticulitis of the right colon can cause RUQ pain, often accompanied by changes in bowel habits or bleeding.
- Inflammatory bowel disease (IBD): Crohn's disease or ulcerative colitis can cause RUQ pain, diarrhea, and weight loss. These conditions often require endoscopic evaluation and biopsy for diagnosis.