The evaluation of a patient with right upper quadrant abdominal pain begins with a careful history and physical. Noting the character, location, duration, radiation, and intensity of symptoms as well as aggravating, alleviating, and associated findings will lead to a reasonable differential diagnosis. For example, RUQ pain that is post-prandial, that begins 30 minutes after a meal and lasts for 2 hours, radiates around the back, is dull in nature, and abates spontaneously is most likely biliary colic due to gallstones.
Symptoms associated with acute cholecystitis are usually more acute and persistent.
The patient may have a history of biliary colic, with the pain starting in the epigastrium, associated bloating or belching. Subsequently, the pain may worsen and radiate to the right upper quadrant. Patients may confuse these symptoms with heartburn. Pertinent history can include use of antacids without relief of symptoms. There also may be an associated fever.