Glenda has cholelithiasis (gallstones). You expect her to complain of:
A. Pain in the right upper quadrant, radiating to the shoulder.
B. Pain in the right lower quadrant, with rebound tenderness.
C. Pain in the left upper quadrant, with shortness of breath.
D. Pain in the left lower quadrant, with mild cramping.
Correct Answer: A. Pain in the right upper quadrant, radiating to the shoulder.
The gallbladder is located in the RUQ and a frequent sign of gallstones is pain radiating to the shoulder. Patients with gallstone disease typically present with symptoms of biliary colic (intermittent episodes of constant, sharp, right upper quadrant (RUQ) abdominal pain often associated with nausea and vomiting), normal physical examination findings, and normal laboratory test results.
Option B: Clinical symptoms and signs suggestive of appendicitis include a history of central abdominal pain migrating to the right lower quadrant (RLQ), anorexia, fever, and nausea/vomiting. On examination, RLQ tenderness, along with “classical” signs of peritoneal irritation (e.g., rebound tenderness, guarding, rigidity, referred pain), may be present.
Option C: LUQ pain can originate from the chest, abdomen, diaphragm/peritoneum, or from general ‘medical’ causes. Note that intra-abdominal organs may not localize pain accurately and diaphragmatic pain can be referred to the shoulder tip.
Option D: Crampy pain may be due to gas, indigestion, inflammation, or infection, or it may result from menstrual cramps, endometriosis, or pelvic inflammatory disease in women. Severe pain that comes in waves may be caused by kidney stones. Trauma to the body wall, hernias, and shingles can also cause left lower quadrant pain.
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