Right upper quadrant abdominal pain: Difference between revisions
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==Background== | ==Background== | ||
*This page outlines the general approach to RUQ pain | *This page outlines the general approach to RUQ pain | ||
{{Abdominal pain location}} | |||
==Clinical Features== | ==Clinical Features== | ||
*Right upper quadrant pain | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{DDX RUQ}} | {{DDX RUQ}} | ||
==Workup== | ==Evaluation== | ||
*CBC | [[File:Gallbladder (organ).png|thumb|Gallbladder anatomy (overview).]] | ||
* | [[File:GallbladderAnatomy-en.svg|thumb|Gallbladder anatomy]] | ||
*LFTs | ===Workup=== | ||
* | ====Labs==== | ||
* | *Abdominal panel | ||
**CBC | |||
**Chemistry | |||
**LFTs + lipase | |||
**Coagulation studies (PT, PTT, INR), as a marker of liver function | |||
*[[Urinalysis]] | *[[Urinalysis]] | ||
*Urine pregnancy ( | **Leukocytes will be present in 40% of patients<ref>Baird DLH, Simillis C, Kontovounisios C, Rasheed S, Tekkis PP. Acute appendicitis. BMJ. 2017;357:j1703. Published 2017 Apr 19. doi:10.1136/bmj.j1703</ref> | ||
**Urine pregnancy test (if age and sex appropriate) | |||
====Imaging==== | |||
*[[Biliary ultrasound]] | *[[Biliary ultrasound]] | ||
* | *Consider [[CXR]] to assess for free air under the diaphram | ||
** | **If at risk for a perforated ulcer (e.g., age >55) | ||
* | *Consider [[ECG]] | ||
**If may be cardiac in nature | **If may be cardiac in nature | ||
===Diagnosis=== | |||
*Definitive diagnosis may be determined via a combination of history, labs, and imaging | |||
*If no definitive diagnosis at end of ED workup, but no signs of emergent pathology, may be empirically treated (e.g., for [[GERD]]) with further workup as an outpatient | |||
==Management== | ==Management== | ||
Latest revision as of 23:09, 14 February 2024
Background
- This page outlines the general approach to RUQ pain
Classification by Abdominal pain location
| RUQ pain | Epigastric pain | LUQ pain |
| Flank pain | Diffuse abdominal pain | Flank pain |
| RLQ pain | Pelvic pain | LLQ pain |
Clinical Features
- Right upper quadrant pain
Differential Diagnosis
RUQ Pain
- Gallbladder disease
- Pancreatitis
- Acute hepatitis
- Pancreatitis
- GERD
- Appendicitis (retrocecal)
- Pyogenic liver abscess
- Bowel obstruction
- Cirrhosis
- Budd-Chiari syndrome
- GU
- Other
- Hepatomegaly due to CHF
- Peptic ulcer disease with or without perforation
- Pneumonia
- Herpes zoster
- Myocardial ischemia
- Pulmonary embolism
- Abdominal aortic aneurysm
Evaluation
.png)
Workup
Labs
- Abdominal panel
- CBC
- Chemistry
- LFTs + lipase
- Coagulation studies (PT, PTT, INR), as a marker of liver function
- Urinalysis
- Leukocytes will be present in 40% of patients[1]
- Urine pregnancy test (if age and sex appropriate)
Imaging
- Biliary ultrasound
- Consider CXR to assess for free air under the diaphram
- If at risk for a perforated ulcer (e.g., age >55)
- Consider ECG
- If may be cardiac in nature
Diagnosis
- Definitive diagnosis may be determined via a combination of history, labs, and imaging
- If no definitive diagnosis at end of ED workup, but no signs of emergent pathology, may be empirically treated (e.g., for GERD) with further workup as an outpatient
Management
- Treat underlying disease process
Disposition
- Disposition per underlying disease process
See Also
External Links
References
- ↑ Baird DLH, Simillis C, Kontovounisios C, Rasheed S, Tekkis PP. Acute appendicitis. BMJ. 2017;357:j1703. Published 2017 Apr 19. doi:10.1136/bmj.j1703