Right Upper Quadrant Pain

Posted by e-Medical PPT
 Pain in the right upper quadrant (RUQ) can be caused by a wide variety of conditions. The age, sex and general condition of the patient will influence the likely diagnosis. History and examination will also focus the differential diagnosis. Features such as acute or chronic onset, weight loss, pyrexia, general malaise, and urinary or bowel symptoms may all help point to a diagnosis. It is important to decide if there is an acute abdomen.
Differential diagnosis
The crude differential diagnosis is vast but after adequate history and examination it should be very much smaller. The following order is not intended to indicate likelihood:
Liver and gallbladder disease
    * Liver disease is usually only painful if it stretches the capsule of the liver, as in congestive heart failure. The liver can be damaged by blunt trauma. Hepato-splenomegaly can occur with malignancy such as lymphoma or chronic myeloid leukaemia or with autoimmune disease including primary biliary cirrhosis.
    * The Budd-Chiari syndrome can present with RUQ pain.
    * Gallstones are common and become more common as years advance. Most are asymptomatic but they can cause pain at any time.
    * Other gallbladder disease includes carcinoma of the gallbladder, which is always associated with stones too.
    * Ascending cholangitis has a classic triad of pain, fever and jaundice.

Bowel lesions
    * Lesions of the hepatic flexure include carcinoma, diverticulosis, ischaemic colitis, constipation and Crohn's disease.
    * Atypical acute appendicitis must be considered.
    * Recurrent symptoms can be caused by irritable bowel syndrome.
    * Meckel's diverticulum can present in a variety of ways, usually in children. The diagnosis is usually made at laparotomy. There is often blood loss per rectum.

Renal disorders
    * Pyelonephritis.
    * Nephrolithiasis.
    * Hydronephrosis.
    * Renal carcinoma.
    * Other disease of the kidney or ureter, including obstruction of the urinary tract.

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