Right upper quadrant abdominal pain

Background

• This page outlines the general approach to RUQ pain

Classification by Abdominal pain location

Side-by-side comparison of quadrants and regions.

Chart of commonly reported referred pain sites.

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
  • Symptomatic cholelithiasis (biliary colic)
  • Choledocholithiasis
  • Acute cholecystitis
  • Ascending cholangitis
  • Acalculous cholecystitis
• Pancreatitis
• Acute hepatitis
• Pancreatitis
• GERD
• Appendicitis (retrocecal)
• Pyogenic liver abscess
• Bowel obstruction
• Cirrhosis
• Budd-Chiari syndrome
• GU
  • Pyelonephritis
  • Kidney stone
  • Fitz-Hugh-Curtis Syndrome
• Other
  • Hepatomegaly due to CHF
  • Peptic ulcer disease with or without perforation
  • Pneumonia
  • Herpes zoster
  • Myocardial ischemia
  • Pulmonary embolism
  • Abdominal aortic aneurysm

Evaluation

Gallbladder anatomy (overview).

Gallbladder anatomy

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
  • 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

• Abdominal Pain
• Abdominal Pain (Peds)