Right upper quadrant abdominal pain. Diagnosis in patients without evident gallstones.

Right upper quadrant abdominal pain is often of biliary origin. Negative results on an ultrasound examination do not exclude biliary pathology. A logical diagnostic approach to the patient should be based on clues obtained from careful history taking, physical examination, and review of routine laboratory studies. Endoscopy, radiography, and nuclear medicine studies may identify specific causes for pain. The use of sophisticated tests, such as endoscopic retrograde cholangiopancreatography with sphincter manometry, may enable diagnosis in refractory cases. Therapy specific for a correctly diagnosed cause provides rewarding results and avoids unnecessary and unsuccessful procedures.