11. The Problem of Right Upper Quadrant Pain

  1. John N. Plevris MD, PhD, FRCPE, FEBGH3 and
  2. Colin W. Howden MD, FRCP (Glasg.), FACP, AGAF, FACG4
  1. Malcolm B. Barnes MBBS (Hons), FRACP1 and
  2. Simon Glance MDBBS (Hons)2

Published Online: 29 NOV 2011

DOI: 10.1002/9781444346381.ch11

Problem-Based Approach to Gastroenterology and Hepatology

Problem-Based Approach to Gastroenterology and Hepatology

How to Cite

Barnes, M. B. and Glance, S. (2012) The Problem of Right Upper Quadrant Pain, in Problem-Based Approach to Gastroenterology and Hepatology (eds J. N. Plevris and C. W. Howden), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781444346381.ch11

Editor Information

  1. 3

    Centre for Liver and Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK

  2. 4

    Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA

Author Information

  1. 1

    Monash Medical Centre, Victoria, Australia

  2. 2

    The Northern Hospital, Melbourne, Australia

Publication History

  1. Published Online: 29 NOV 2011
  2. Published Print: 17 JAN 2012

ISBN Information

Print ISBN: 9781405182270

Online ISBN: 9781444346381



  • cholangitis;
  • urgent ERCP;
  • sphincterotomy;
  • sphincter of Oddi dysfunction;
  • MRCP;
  • EUS


Right upper quadrant (RUQ) pain is a common reason to present for medical assessment, often involving both physicians and surgeons in diagnosis and management. In western societies, the most common cause of RUQ pain is gallstones, manifesting as cholecystitis or choledocholithiasis, with potential complications such as cholangitis and acute biliary pancreatitis. Case 1 involves a 62-year-old man with fevers, rigors, and RUQ pain on a background of a prosthetic mitral valve requiring anticoagulant therapy. The management issues covered in the form of MCQs includes the role of conservative medical therapy, the timing of an urgent ERCP, and the place of cholecystectomy post-ERCP. In case 2, a 42-year-old woman with episodic RUQ pain and abnormal liver enzymes is assessed, facilitating discussion of modern imaging modalities such as MRCP and EUS in addition to functional biliary disorders. The two cases serve as a template for discussing a modern, evidence-based approach to the diagnosis and management of RUQ pain.