Upper quadrant pain, right

The same patient described in the first encounter is now 57 years old. He presents to the clinic with right upper quadrant pain radiating to his back. He is also jaundiced and nauseated. 

Physical findings Right upper quadrant pain, hepatomegaly, and liver tenderness, with referred pain to the left or right shoulder (Note Erosion of liver abscesses may present as peritonitis)... 

Occupational exposure of 12 male workers, whose hands were in contact with MDA several hours per day, caused toxic hepatitis. The clinical pattern of the cases included right upper quadrant pain, high fever, and chills with subsequent jaundice. A skin rash was seen in five of the cases. Percutaneous absorption was considered to be the major route of exposure because workers in the same occupational setting who did not have direct skin contact with MDA were not affected. All patients recovered within 7 weeks, and follow-up more than 5 years later showed no biochemical or clinical evidence of chronic hepatic disease. 

Liver dysfunction occurs rarely and may be manifested as right upper quadrant pain, nausea, fatigue, lethargy, pruritus, jaundice or flulike symptoms. 

Finger clubbing Abdominal and right upper quadrant pain... 

Right upper quadrant pain and abdominal pain... 

Right upper quadrant pain can be caused by stimulation of nerve endings in the liver capsule as a result of being stretched when the liver is enlarged or inflamed. It can also be as a result of gallbladder or colon problems. Ascites can cause abdominal pain as the tension of fluid in the abdominal cavity accumulates. The extent of the pain does not give an indication of liver function. 

Experience with tauroursodeoxycholic acid is limited. It is less effective than ursodeoxycholic acid and causes more adverse effects. Two patients who took tauroursodeoxycholic acid for primary biliary cirrhosis developed severe right upper quadrant pain, and rechallenge with tauroursodeoxycholic acid was positive (7). 

A 60-year-old man received intramuscular morphine 10 mg with scopolamine 0.4 mg as premedication and 40 minutes later complained of sharp right upper quadrant pain radiating to the back. The symptoms were identical to the gallbladder pain he had experienced in the past and for which he had had a cholecystectomy 25 years before. He had complete relief from intravenous naloxone 0.9 mg. 

Summary 40-year-old female with history of intermittent right upper-quadrant pain worsening after greasy meals and now with constant midepigastric pain, nausea, and vomiting with elevated liver function tests and amylase. 

Another patient sought medical advice after having experienced right upper quadrant pain and jaundice for 4 wk. This 41 -yr-old woman had con-... 

Smith, L. "Right Upper Quadrant Pain in Diabetic", Patient Care, 1994,28 (12), 154. 

Intrahepatic rupture can result in hemobilia with or without biliary obstruction. These patients can present with right upper quadrant pain, jaundice, fever, melena, or hematemesis. Extrahepatic rupture usually presents acutely and can lead to exsanguination due to massive intraperitoneal hemorrhage. They can erode into adjacent structures such as the stomach, common bile duct, duodenum, or portal vein. Due to the high mortality from rupture, elective treatment of small asymptomatic aneurysms has been advocated. 

A 40-year-old Hispanic female who had been taking EFV/FTC/TDF for 8months but whose transaminitis and severe right upper quadrant pain resolved on discontinuing the EFV/FTC/TDF [184 ]. 

Symptoms and signs include right upper quadrant pain, jaundice, abdominal mass, nausea, and fever. Possible complication are calculi, cholangitis, pancreatitis, and rarely malignant degeneration into cholangiocarcinoma. 

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