Right hypochondrial pain

Differential diagnosis for patients presenting with right upper quadrant abdominal pain are:

• biliary pain - constant, nonparoxysmal pain which rapidly increases in intensity then plateaus, lasts four to six hours, occasionally radiates to the right subscapular area
• acute cholecystitis - longer lasting (more than six hours) biliary pain with tenderness, fever, and/or leukocytosis
• dyspepsia - bloating, nausea, belching, intolerance to fatty foods
• duodenal ulcer - pain two hours after meals, relieved by taking food or antacids
• hepatic abscess - pain associated with fever and chills; palpable liver and subcostal tenderness
• acute myocardial infarction - right upper quadrant or epigastrium discomfort; may be similar to biliary pain (1)

Other possible causes of right upper quadrant pain include:

• duodenal ulcer
• acute pancreatitis
• pneumonia
• subphrenic abscess

Reference:

• (1) Bellows CF, Berger DH, Crass RA. Management of gallstones. Am Fam Physician. 2005;72(4):637-42