Differential diagnosis for right upper quadrant pain

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Differential diagnosis for right upper quadrant pain
(Image by Flickr.com, courtesy of Bruce)

The abdomen is a large portion of the body containing vital organs. For examination purposes, the abdomen is divided into four quadrants: right upper, right lower, left upper and left lower. When describing pain or other symptoms, health care providers refer to the corresponding quadrant as this helps to narrow the focus on particular organs or possible conditions.

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Significance

The right upper quadrant of the abdomen contains the liver, gallbladder and portions of the large and small intestines and stomach. The health care provider will consider differential diagnoses related to the structures in this region. In other words, the provider will review the initial symptoms and develop a list of possible causes for the pain.

The examination will consist of listening to the right upper quadrant with a stethoscope, touching, or palpating, for masses or unusual firmness, and determining the presence of other symptoms such as fever, nausea, vomiting or bowel changes. It is possible that some conditions may cause pain in the right upper quadrant of the abdomen, but the condition is related to structures in other parts of the body, such as the chest.

Types

If the right upper quadrant pain is not related to a traumatic event, the provider may seek to first rule out any emergency cardiopulmonary conditions such as severe pneumonia or heart attack. The physician will also test for urgent conditions involving the organs in this quadrant. Acute cholecystitis, or inflammation of the gallbladder, is a common cause of right upper quadrant pain. Another serious condition to consider would be hepatitis or liver infection; it is less common in occurrence than cholecystitis in relation to causing acute pain. Other differential diagnoses include gallstones, retrocecal appendicitis, abscess of liver, stomach ulcer, and liver enlargement.

Features

In order to rule out the various differential diagnoses associated with right upper quadrant pain, the health care provider will obtain a complete history, order blood and urine specimens for labs, and possibly order imaging studies, such as ultrasounds or CT scans. It is not unusual to have additional exams ordered once the initial results are returned. This is necessary to either reduce the number of possible diagnoses or to determine how to best treat the determined diagnosis. Abdomen pain is not taken lightly as it may be an indication of a serious condition requiring urgent treatment.

Effects

Should the more common differential diagnoses be ruled out, the provider will have to consider the some of the least likely causes for right upper quadrant pain. This may require a hospitalisation in order to conduct additional tests and evaluate response to preliminary treatment. Other diagnoses to consider include hernia, intestinal obstruction, blockage of the ducts of the pancreas, gallbladder or liver, and cancer.

Considerations

Severe or recurring right upper quadrant pain should be evaluated by a health care provider in order to rule out any causes that would require emergency care. The onset, duration and description of the pain can help to create a short list of differential diagnoses. It is possible that some medications could cause pain in this quadrant of the abdomen; a list of all medication, whether prescription or over the counter, can help the provider. The more complete information provided, the more specific the exam which would possibly lead to a positive diagnosis of the cause of the right upper quadrant pain.

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