Which finding would support biliary/hepatic referral pain presenting as shoulder pain?

Which finding would support biliary/hepatic referral pain presenting as shoulder pain?

• A. Absent lung sounds
• B. RUQ tenderness
• C. Left shoulder pain
• D. Decreased heart rate

Answer: (B)

Referred shoulder pain from biliary or hepatic disease happens when irritation of the diaphragmatic peritoneum or phrenic nerve (C3–C5) is sensed in the shoulder region, commonly the right shoulder. Finding tenderness in the right upper quadrant points to gallbladder or liver involvement, which makes diaphragmatic irritation—and thus shoulder pain—more likely to be a referred symptom rather than primary shoulder pathology. The other signs don’t fit this pattern: absent lung sounds would suggest a pulmonary issue; left shoulder pain is less typical for biliary referral; and a decreased heart rate isn’t a feature of biliary/hepatic pathology. So right upper quadrant tenderness best supports biliary/hepatic referral presenting as shoulder pain.

Referred shoulder pain from biliary or hepatic disease happens when irritation of the diaphragmatic peritoneum or phrenic nerve (C3–C5) is sensed in the shoulder region, commonly the right shoulder. Finding tenderness in the right upper quadrant points to gallbladder or liver involvement, which makes diaphragmatic irritation—and thus shoulder pain—more likely to be a referred symptom rather than primary shoulder pathology. The other signs don’t fit this pattern: absent lung sounds would suggest a pulmonary issue; left shoulder pain is less typical for biliary referral; and a decreased heart rate isn’t a feature of biliary/hepatic pathology. So right upper quadrant tenderness best supports biliary/hepatic referral presenting as shoulder pain.