15. Right Upper Quadrant Pain

Question 1

What are the main differentials for RUQ pain?

Answer 1

Biliary colic, cholecystitis, duodenal ulcer, pancreatitis, basal pneumonia, ascending cholangitis

Question 2

What other symptoms should you ask about in someone with RUQ pain?

Answer 2

Top to bottom abdo symptoms
FLAWS
Changes in stool
If the patient is female, is there any possibility they are pregnant

Question 3

What key features would you look out for on examination in someone with RUQ pain?

Answer 3

Jaundice, cullen’s or grey turner’s, murphy’s sign, signs of peritonitis- lying still and rigid, signs of SBO- distended abdomen, absent or tinkling bowel signs

Question 4

What is cullen’s and grey turner’s sign?

Answer 4

Bruising around the umbilicus- cullen’s

Bruising around the flank- Grey Turner’s (need to ‘turn’ to see it’

Question 5

What does a pulsatile and laterally expansile central mass suggest?

Answer 5

Abdominal aortic aneurysm

Question 6

What is murphy’s sign?

Answer 6

Ask the patient to breath in and palpate just below the tip of the right ninth costal cartilage, when they breath out their breath will catch because the tender gallbladder presses against your fingers- cholecystitis

Question 7

What is the non-operative management of cholecystitis?

Answer 7

clear fluids, IV fluids, analgesia and antibiotics

Question 8

What may ultrasound of the pancreas, common bile duct and gallbladder show?

Answer 8

It can show how thick the gallbladder is, any gallstones, intra/extra hepatic duct dilatation