II. Causes: Gastrointestinal
- Gall Bladder or Billiary Tract Disease
- Hepatitis
- Hepatic Abscess
- Hepatomegaly due to Congestive Heart Failure
- Peptic Ulcer
- Pancreatitis
- Retrocecal Appendicitis
III. Causes: Cardiopulmonary
- Myocardial Ischemia
- Pericarditis
- Pneumonia
- Empyema
IV. Causes: Miscellaneous
- Renal pain
- Herpes Zoster
-
Fitz-Hugh-Curtis Syndrome
- Liver capsule inflammation secondary to Pelvic Inflammatory Disease
V. Evaluation
-
Colicky Abdominal Pain (e.g. Biliary Colic, Nephrolithiasis)
- Urinalysis
- Liver Function Tests
- Right Upper Quadrant Abdominal Ultrasound
- Urinary symptoms (e.g. Urinary Tract Infection, Nephrolithiasis)
- Urinalysis
- Consider Abdominal CT without contrast (stone protocol)
- Respiratory symptoms (e.g. Pneumonia, Pulmonary Embolism)
- Chest XRay
- Consider helical chest CT
VI. Imaging
- Right Upper Quadrant Abdominal Ultrasound (preferred)
- Consider CT Abdomen and Pelvis (if non-diagnostic RUQ Ultrasound)
- Differential diagnosis includes high riding appendix adjacent to the liver