15. Right Upper Quadrant Pain

Question 1

What are the 6 main differentials for RUQ pain?

Answer 1

Biliary colic
Cholecystitis
Duodenal ulcer
Pancreatitis
Basal pneumonia
Ascending cholangitis

Question 2

What 3 symptoms should you ask about in someone with RUQ pain?

Answer 2

Fever, weight loss, night sweats
Changes in bowel habits
Pregnancy

Question 3

What 5 key features would you look out for on examination in someone with RUQ pain?

Answer 3

Jaundice
Cullen’s or grey turner’s sign
Murphy’s sign
Signs of peritonitis: lying still + rigid, guarding
Signs of SBO: distended abdomen, absent or tinkling bowel signs

Question 4

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

Answer 4

Cullens: Bruising around the umbilicus

Grey Turner’s: Bruising around the flank

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 patient to breath in + palpate just below the tip of the right 9th CC
Causes liver + gallbladder to descend + press against your fingers
Patient will arrest inspiration as tender in Cholecystitis

Question 7

What is the non-operative management of cholecystitis?

Answer 7

Clear fluids
IV fluids
Analgesia
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