Right Upper Quadrant Abdominal Pain

Aka: Right Upper Quadrant Abdominal Pain, RUQ Abdominal Pain, RUQ Pain

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II. Causes: Gastrointestinal

  1. Gall Bladder or Billiary Tract Disease
  2. Hepatitis
  3. Hepatic Abscess
  4. Hepatomegaly due to Congestive Heart Failure
  5. Peptic Ulcer
  6. Pancreatitis
  7. Retrocecal Appendicitis

III. Causes: Cardiopulmonary

  1. Myocardial Ischemia
  2. Pericarditis
  3. Pneumonia
  4. Empyema

IV. Causes: Miscellaneous

  1. Renal pain
  2. Herpes Zoster
  3. Fitz-Hugh-Curtis Syndrome
    1. Liver capsule inflammation secondary to Pelvic Inflammatory Disease

V. Evaluation

  1. Colicky Abdominal Pain (e.g. Biliary Colic, Nephrolithiasis)
    1. Urinalysis
    2. Liver Function Tests
    3. Right Upper Quadrant Abdominal Ultrasound
  2. Urinary symptoms (e.g. Urinary Tract Infection, Nephrolithiasis)
    1. Urinalysis
    2. Consider Abdominal CT without contrast (stone protocol)
  3. Respiratory symptoms (e.g. Pneumonia, Pulmonary Embolism)
    1. Chest XRay
    2. Consider helical chest CT

VI. Imaging

  1. Right Upper Quadrant Abdominal Ultrasound (preferred)
  2. Consider CT Abdomen and Pelvis (if non-diagnostic RUQ Ultrasound)
    1. Differential diagnosis includes high riding appendix adjacent to the liver

VII. References

  1. Yew (2023) Am Fam Physician 107(6): 585-96 [PubMed]

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