RUQ | Clinical features | Comments |
Biliary | ||
Biliary colic | Intense, dull discomfort located in the RUQ or epigastrium. Associated with nausea, vomiting, and diaphoresis. Generally lasts at least 30 minutes, plateauing within one hour. Benign abdominal examination. | Patients are generally well-appearing. |
Acute cholecystitis | Prolonged (>4 to 6 hours) RUQ or epigastric pain, fever. Patients will have abdominal guarding and Murphy's sign. | |
Acute cholangitis | Fever, jaundice, RUQ pain. | May have atypical presentation in older adults or immunosuppressed patients. |
Sphincter of Oddi dysfunction | RUQ pain similar to other biliary pain. | Biliary type pain without other apparent causes. |
Hepatic | ||
Acute hepatitis | RUQ pain with fatigue, malaise, nausea, vomiting, and anorexia. Patients may also have jaundice, dark urine, and light-colored stools. | Variety of etiologies include hepatitis A, alcohol, and drug-induced. |
Perihepatitis (Fitz-Hugh-Curtis syndrome) | RUQ pain with a pleuritic component, pain is sometimes referred to the right shoulder. | Aminotransferases are usually normal or only slightly elevated. |
Liver abscess | Fever and abdominal pain are the most common symptoms. | Risk factors include diabetes, underlying hepatobiliary or pancreatic disease, or liver transplant. |
Budd-Chiari syndrome | Symptoms include fever, abdominal pain, abdominal distention (from ascites), lower extremity edema, jaundice, gastrointestinal bleeding, and/or hepatic encephalopathy. | Variety of causes. |
Portal vein thrombosis | Symptoms include abdominal pain, dyspepsia, or gastrointestinal bleeding. | Clinical manifestations depend on extent of obstruction and speed of development. Most commonly associated with cirrhosis. |
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