Right upper quadrant abdominal pain
(Redirected from RUQ Pain)
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
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