Right upper quadrant abdominal pain - Revision history

Danbot: Strip excess bold

2026-03-22T09:30:12Z

Strip excess bold

← Older revision		Revision as of 09:30, 22 March 2026
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	*This page outlines the general approach to right upper quadrant (RUQ) pain		*This page outlines the general approach to right upper quadrant (RUQ) pain
	*RUQ contains: liver, gallbladder, hepatic flexure of colon, right kidney, duodenum, head of pancreas		*RUQ contains: liver, gallbladder, hepatic flexure of colon, right kidney, duodenum, head of pancreas
	*~~'''~~Biliary disease~~'''~~ ([[cholelithiasis]], [[cholecystitis]], [[choledocholithiasis]], [[cholangitis]]) is the most common cause of RUQ pain		*Biliary disease ([[cholelithiasis]], [[cholecystitis]], [[choledocholithiasis]], [[cholangitis]]) is the most common cause of RUQ pain
	*Key EM considerations: RUQ pain can also be from hepatic pathology, pneumonia (right lower lobe), or cardiac disease (right heart failure, pericarditis)		*Key EM considerations: RUQ pain can also be from hepatic pathology, pneumonia (right lower lobe), or cardiac disease (right heart failure, pericarditis)
	*[[HELLP syndrome]] and [[preeclampsia]] must be considered in pregnant patients with RUQ pain		*[[HELLP syndrome]] and [[preeclampsia]] must be considered in pregnant patients with RUQ pain
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	[[File:Gallbladder (organ).png\|thumb\|Gallbladder anatomy (overview).]]		[[File:Gallbladder (organ).png\|thumb\|Gallbladder anatomy (overview).]]
	[[File:GallbladderAnatomy-en.svg\|thumb\|Gallbladder anatomy.]]		[[File:GallbladderAnatomy-en.svg\|thumb\|Gallbladder anatomy.]]
	*~~'''~~Murphy sign~~'''~~: inspiratory arrest during RUQ palpation — highly suggestive of cholecystitis		*Murphy sign: inspiratory arrest during RUQ palpation — highly suggestive of cholecystitis
	*Hepatomegaly, liver tenderness		*Hepatomegaly, liver tenderness
	*Jaundice, scleral icterus		*Jaundice, scleral icterus
	*~~'''~~Charcot triad~~'''~~ (fever + RUQ pain + jaundice) = [[cholangitis]]		*Charcot triad (fever + RUQ pain + jaundice) = [[cholangitis]]
	*~~'''~~Reynolds pentad~~'''~~ (Charcot triad + hypotension + AMS) = severe/suppurative cholangitis		*Reynolds pentad (Charcot triad + hypotension + AMS) = severe/suppurative cholangitis
	*CVA tenderness (pyelonephritis)		*CVA tenderness (pyelonephritis)
	*Decreased breath sounds at right base (pneumonia, pleural effusion)		*Decreased breath sounds at right base (pneumonia, pleural effusion)
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	===Must Not Miss===		===Must Not Miss===
	*~~'''~~[[Cholangitis]]~~'''~~: biliary sepsis, can rapidly decompensate		*[[Cholangitis]]: biliary sepsis, can rapidly decompensate
	*~~'''~~[[HELLP syndrome]]~~'''~~: pregnant patient with RUQ pain, elevated LFTs, thrombocytopenia		*[[HELLP syndrome]]: pregnant patient with RUQ pain, elevated LFTs, thrombocytopenia
	*~~'''~~[[Hepatic abscess]]~~'''~~: fever, RUQ pain, sepsis		*[[Hepatic abscess]]: fever, RUQ pain, sepsis
	*~~'''~~Right lower lobe [[pneumonia]]~~'''~~: referred RUQ pain		*Right lower lobe [[pneumonia]]: referred RUQ pain
	*~~'''~~Ruptured hepatic adenoma/[[hepatocellular carcinoma]]~~'''~~: hemorrhage		*Ruptured hepatic adenoma/[[hepatocellular carcinoma]]: hemorrhage
	*~~'''~~[[Budd-Chiari syndrome]]~~'''~~: acute hepatic vein thrombosis		*[[Budd-Chiari syndrome]]: acute hepatic vein thrombosis

	==Evaluation==		==Evaluation==
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	*[[CBC]] with differential		*[[CBC]] with differential
	*[[BMP]]		*[[BMP]]
	*~~'''~~[[LFTs]]~~'''~~: AST, ALT, alkaline phosphatase, bilirubin (direct and total)		*[[LFTs]]: AST, ALT, alkaline phosphatase, bilirubin (direct and total)
	*~~'''~~Lipase~~'''~~ (pancreatitis)		*Lipase (pancreatitis)
	*Coagulation studies (PT/INR — marker of liver synthetic function)		*Coagulation studies (PT/INR — marker of liver synthetic function)
	*[[Urinalysis]]		*[[Urinalysis]]
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	===Imaging===		===Imaging===
	*~~'''~~[[RUQ US]]~~'''~~ (first-line for RUQ pain): gallstones, gallbladder wall thickening, pericholecystic fluid, CBD dilation, Murphy sign on ultrasound		*[[RUQ US]] (first-line for RUQ pain): gallstones, gallbladder wall thickening, pericholecystic fluid, CBD dilation, Murphy sign on ultrasound
	*~~'''~~[[POCUS]]~~'''~~: can identify gallstones and free fluid at bedside		*[[POCUS]]: can identify gallstones and free fluid at bedside
	*~~'''~~[[CT abdomen pelvis]]~~'''~~ with IV contrast: when diagnosis unclear, or to evaluate complications (abscess, perforation, mass)		*[[CT abdomen pelvis]] with IV contrast: when diagnosis unclear, or to evaluate complications (abscess, perforation, mass)
	*~~'''~~[[CXR]]~~'''~~: right lower lobe pneumonia, pleural effusion, free air		*[[CXR]]: right lower lobe pneumonia, pleural effusion, free air
	*~~'''~~MRCP~~'''~~ or ~~'''~~ERCP~~'''~~: for suspected choledocholithiasis or cholangitis (ERCP is both diagnostic and therapeutic)		*MRCP or ERCP: for suspected choledocholithiasis or cholangitis (ERCP is both diagnostic and therapeutic)
	*~~'''~~HIDA scan~~'''~~: if cholecystitis suspected but ultrasound equivocal		*HIDA scan: if cholecystitis suspected but ultrasound equivocal

	==Management==		==Management==
	*IV fluids, analgesia (NSAIDs effective for biliary colic), antiemetics		*IV fluids, analgesia (NSAIDs effective for biliary colic), antiemetics
	*~~'''~~[[Biliary colic]]~~'''~~: pain management, outpatient surgical referral for cholecystectomy		*[[Biliary colic]]: pain management, outpatient surgical referral for cholecystectomy
	*~~'''~~[[Cholecystitis]]~~'''~~: IV antibiotics, surgical consultation for cholecystectomy (usually within 24-72 hours)		*[[Cholecystitis]]: IV antibiotics, surgical consultation for cholecystectomy (usually within 24-72 hours)
	*~~'''~~[[Choledocholithiasis]]~~'''~~: GI consultation for ERCP		*[[Choledocholithiasis]]: GI consultation for ERCP
	*~~'''~~[[Cholangitis]]~~'''~~: emergent ERCP for biliary drainage, IV antibiotics, ICU monitoring if hemodynamically unstable		*[[Cholangitis]]: emergent ERCP for biliary drainage, IV antibiotics, ICU monitoring if hemodynamically unstable
	*~~'''~~[[Hepatitis]]~~'''~~: supportive care, identify etiology		*[[Hepatitis]]: supportive care, identify etiology
	*~~'''~~Hepatic abscess~~'''~~: IV antibiotics, IR-guided drainage, ID consultation		*Hepatic abscess: IV antibiotics, IR-guided drainage, ID consultation
	*~~'''~~HELLP/Preeclampsia~~'''~~: OB consultation, delivery planning, magnesium sulfate		*HELLP/Preeclampsia: OB consultation, delivery planning, magnesium sulfate

	==Disposition==		==Disposition==

Danbot: Expanded with EM-focused content: Charcot triad/Reynolds pentad, must-not-miss diagnoses, biliary evaluation, management, disposition

2026-03-20T23:45:22Z

Expanded with EM-focused content: Charcot triad/Reynolds pentad, must-not-miss diagnoses, biliary evaluation, management, disposition

Show changes

Ostermayer: Prepared the page for translation

2026-01-04T23:57:16Z

Prepared the page for translation

← Older revision		Revision as of 23:57, 4 January 2026
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			<languages/>
			<translate>

	==Background==		==Background==

	*This page outlines the general approach to RUQ pain		*This page outlines the general approach to RUQ pain

			</translate>
	{{Abdominal pain location}}		{{Abdominal pain location}}
			<translate>


	==Clinical Features==		==Clinical Features==

	*Right upper quadrant pain		*Right upper quadrant pain


	==Differential Diagnosis==		==Differential Diagnosis==

			</translate>
	{{DDX RUQ}}		{{DDX RUQ}}
			<translate>


	==Evaluation==		==Evaluation==

	[[File:Gallbladder (organ).png\|thumb\|Gallbladder anatomy (overview).]]		[[File:Gallbladder (organ).png\|thumb\|Gallbladder anatomy (overview).]]
	[[File:GallbladderAnatomy-en.svg\|thumb\|Gallbladder anatomy]]		[[File:GallbladderAnatomy-en.svg\|thumb\|Gallbladder anatomy]]

	===Workup===		===Workup===


	====Labs====		====Labs====

	*Abdominal panel		*Abdominal panel
	**CBC		**CBC
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	**LFTs + lipase		**LFTs + lipase
	**Coagulation studies (PT, PTT, INR), as a marker of liver function		**Coagulation studies (PT, PTT, INR), as a marker of liver function
	*[[Urinalysis]]		*[[Special:MyLanguage/Urinalysis\|Urinalysis]]
	**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>		**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)		**Urine pregnancy test (if age and sex appropriate)


	====Imaging====		====Imaging====
	*[[Biliary ultrasound]]
	*Consider [[CXR]] to assess for free air under the diaphram		*[[Special:MyLanguage/Biliary ultrasound\|Biliary ultrasound]]
			*Consider [[Special:MyLanguage/CXR\|CXR]] to assess for free air under the diaphram
	**If at risk for a perforated ulcer (e.g., age >55)		**If at risk for a perforated ulcer (e.g., age >55)
	*Consider [[ECG]]		*Consider [[Special:MyLanguage/ECG\|ECG]]
	**If may be cardiac in nature		**If may be cardiac in nature


	===Diagnosis===		===Diagnosis===

	*Definitive diagnosis may be determined via a combination of history, labs, and imaging		*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		*If no definitive diagnosis at end of ED workup, but no signs of emergent pathology, may be empirically treated (e.g., for [[Special:MyLanguage/GERD\|GERD]]) with further workup as an outpatient


	==Management==		==Management==

	*Treat underlying disease process		*Treat underlying disease process


	==Disposition==		==Disposition==

	*Disposition per underlying disease process		*Disposition per underlying disease process


	==See Also==		==See Also==
	*[[Abdominal Pain]]
	*[[Abdominal Pain (Peds)]]		*[[Special:MyLanguage/Abdominal Pain\|Abdominal Pain]]
			*[[Special:MyLanguage/Abdominal Pain (Peds)\|Abdominal Pain (Peds)]]


	==External Links==		==External Links==


	==References==		==References==

	<references/>		<references/>

	[[Category:GI]]		[[Category:GI]]
	[[Category:Symptoms]]		[[Category:Symptoms]]
			</translate>

Rossdonaldson1: /* Diagnosis */

2024-02-14T23:09:48Z

Diagnosis

← Older revision		Revision as of 23:09, 14 February 2024
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	===Diagnosis===		===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==

Rossdonaldson1: /* Imaging */

2024-02-14T22:20:45Z

Imaging

← Older revision		Revision as of 22:20, 14 February 2024
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	*[[Biliary ultrasound]]		*[[Biliary ultrasound]]
	*Consider [[CXR]] to assess for free air under the diaphram		*Consider [[CXR]] to assess for free air under the diaphram
	**If at risk for [[perforated ulcer]] (e.g., age >55)		**If at risk for a perforated ulcer (e.g., age >55)
	*Consider [[ECG]]		*Consider [[ECG]]
	**If may be cardiac in nature		**If may be cardiac in nature

Rossdonaldson1: /* Evaluation */

2024-02-14T22:20:23Z

Evaluation

← Older revision		Revision as of 22:20, 14 February 2024
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	[[File:GallbladderAnatomy-en.svg\|thumb\|Gallbladder anatomy]]		[[File:GallbladderAnatomy-en.svg\|thumb\|Gallbladder anatomy]]
	===Workup===		===Workup===
	*CBC		====Labs====
	*~~Chem~~		*Abdominal panel
	*[[LFTs]]		**CBC
	*~~Lipase~~		**Chemistry
	*~~Coags~~		**LFTs + lipase
			**Coagulation studies (PT, PTT, INR), as a marker of liver function
	*[[Urinalysis]]		*[[Urinalysis]]
	*Urine pregnancy (~~females~~)		**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]]
	*?CXR		*Consider [[CXR]] to assess for free air under the diaphram
	**~~Consider if~~ at risk for perforated ulcer		**If at risk for [[perforated ulcer]] (e.g., age >55)
	*?ECG		*Consider [[ECG]]
	**If may be cardiac in nature		**If may be cardiac in nature

Rossdonaldson1 at 22:37, 31 January 2024

2024-01-31T22:37:39Z

← Older revision		Revision as of 22:37, 31 January 2024
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	==Background==		==Background==
	~~[[File:Gallbladder (organ).png\|thumb\|Gallbladder anatomy (overview).]]~~
	~~[[File:GallbladderAnatomy-en.svg\|thumb\|Gallbladder anatomy]]~~
	*This page outlines the general approach to RUQ pain		*This page outlines the general approach to RUQ pain

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	==Clinical Features==		==Clinical Features==
	~~[[File:Abdominal Quadrant Regions.jpg\|thumb\|Side-by-side comparison of quadrants and regions.]]~~		*Right upper quadrant pain
	~~[[File:1506 Referred Pain Chart.jpg\|thumb\|Chart of commonly reported referred~~ pain ~~sites.]]~~

	==Differential Diagnosis==		==Differential Diagnosis==
	{{DDX RUQ}}		{{DDX RUQ}}

	==Workup==		==Evaluation==
			[[File:Gallbladder (organ).png\|thumb\|Gallbladder anatomy (overview).]]
			[[File:GallbladderAnatomy-en.svg\|thumb\|Gallbladder anatomy]]
			===Workup===
	*CBC		*CBC
	*Chem		*Chem
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	*?ECG		*?ECG
	**If may be cardiac in nature		**If may be cardiac in nature

			===Diagnosis===

	==Management==		==Management==

Rossdonaldson1: /* Background */

2024-01-31T22:36:41Z

Background

← Older revision		Revision as of 22:36, 31 January 2024
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	[[File:GallbladderAnatomy-en.svg\|thumb\|Gallbladder anatomy]]		[[File:GallbladderAnatomy-en.svg\|thumb\|Gallbladder anatomy]]
	*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==

Rossdonaldson1: /* Clinical Features */

2024-01-31T22:17:14Z

Clinical Features

← Older revision		Revision as of 22:17, 31 January 2024
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	==Clinical Features==		==Clinical Features==
			[[File:Abdominal Quadrant Regions.jpg\|thumb\|Side-by-side comparison of quadrants and regions.]]
			[[File:1506 Referred Pain Chart.jpg\|thumb\|Chart of commonly reported referred pain sites.]]

	==Differential Diagnosis==		==Differential Diagnosis==

Rossdonaldson1: /* Background */

2020-09-17T21:18:33Z

Background

← Older revision		Revision as of 21:18, 17 September 2020
Line 1:		Line 1:
	==Background==		==Background==
			[[File:Gallbladder (organ).png\|thumb\|Gallbladder anatomy (overview).]]
			[[File:GallbladderAnatomy-en.svg\|thumb\|Gallbladder anatomy]]
	*This page outlines the general approach to RUQ pain		*This page outlines the general approach to RUQ pain