Upper Abdominal pain:
The organ in the quadrant:
Liver and gall bladder
Hepatic flexure of colon
The abdominal presenting with upper pain:
1)perforated duodenal ulcer:
Pain: sudden ,sever pain in epigastrium then to the
whole abdomen ,the patient cant move and so breath because of the pain
,radiate to back , relieved by leaning forward.
History: pervious history of peptic ulcer or long intake of non-steroidal anti-
inflammatory drugs like aspirin.
The patient look distressed ,cant move taking shallow breathing.
Investigations: plain abdomen x-ray show free gas under the diaphragm or
2)Acute cholecystitis most common):
Pain :severe, constant, throbbing ,sudden last for >6 hours, radiate to back and
to tip of the right scapula, precipitated by fatty food.releived only by analgesic.
History: pervious history of biliary colic or gall stones.
Murphy’s sigh positive
Pyrexia and tachycardia.
Boa’s sigh positive.
3)Biliary or Gall stones colic:
Pain: very sever constant pain with exacerbation peaks of pain and no free-pain
period can last from 2-6 hours.
Accompanied by nausea and vomiting and may with also mild jaundice
Relieved only by strong analgesia.
Pain: very severe, sudden, constant, radiate to back,and to flanks(speards of
blood) relieved by leaning forward.
Nausea and vomiting.
History: history of drinking habit or biliary disease or mumps.
Examination : the patient in shock hypovolemic (tachycardia hypotension,
sweating and pallor)
General abdominal rigidity
Abdominal discoloration umbilical and flanks
Investigations: serum amylase over 1000 i.u/L
Right upper quadrant pain and liver tenderness
High LFT : AST
Rapidly progressive jaundice.
Fever with shaking chills(rigors).
Sometimes high retro-caecal appendicitis may give the pain felt in right upper
quadrant but can be differentiated by the lack of radiation character.
1)Myocardial Infraction :
2)Acute right lung consolidation:
Plain chest x-ray.