Abdominal Pain in Lower Quadrants

Lower abdominal pain is a common complaint that must be evaluated carefully and systematically to reach the appropriate diagnosis in timely manner. All diagnoses must be considered, with the most emergent etiologies rapidly ruled out, followed by a careful evaluation and treatment for the most common diagnoses, and followed, if necessary, by a search for less common etiologies.

Differential Diagnosis

Right lower quadrant

• Appendicitis
• Diverticulitis
• Salpingitis/Pelvic inflammatory disease
• Endometritis
• Endometriosis
• Ectopic pregnancy
• Hemorrhage or rupture of ovarian cyst
• Renal calculus
• Intussusception
  Pelvic/hypogastric region
• Cystitis
• Salpingitis/Pelvic inflammatory disease
• Ectopic pregnancy
• Diverticulitis
• Strangulated hernia
• Endometriosis
• Appendicitis
• Ovarian cyst
• Ovarian torsion
• Testicular torsion
• Bladder distension
• Nephrolithiasis
• Prostatitis
• Malignancy
• Abdominal aortic aneurysm
  Left lower quadrant
• Diverticulitis
• Intestinal obstruction
• Colitis
• Strangulated hernia
• Inflammatory bowel disease
• Gastroenteritis
• Pyelonephritis
• Nephrolithiasis
• Mesenteric lymphadenitis or thrombosis
• Aortic aneurysm
• Volvulus
• Salpingitis/Pelvic inflammatory disease

Workup and Diagnosis

• Complete history and examination
  –Note progression of symptoms (duration, rapidity of onset, intensity), associated complaints (e.g., anorexia, diarrhea, fever), urinary complaints, exposure to illness and medication, and past medical history including prior episodes
  –Note body positioning that tends to relieve pain; signs of dehydration or fever
  –Vitals and full pulmonary, cardiac, abdominal, back, pelvic, and rectal examinations
  –Abdominal examination should include bowel sounds, distension, tympany, tenderness, palpation for masses and organomegaly, rebound tenderness, and guarding
• Initial evaluation includes CBC with differential cell counts, electrolytes, BUN/creatinine, glucose, calcium, urinalysis, urine culture, and β-hCG level

• Abdominal/pelvic ultrasound and/or CT, obstructive series, and KUB may be indicated
• Consider endocervical gonorrhea/chlamydia cultures in sexually active females, laparoscopy, barium enema, intravenous pyelogram, stool cultures, and/or fecal fat

Treatment

• Hemodynamically unstable patients require immediate resuscitation
  –Replace volume with normal saline and possibly a blood transfusion
  –Evidence of hemorrhage (e.g., ruptured AAA, ruptured ectopic pregnancy) or early sepsis (e.g., perforated diverticulitis, perforated bowel) may be a life-threatening emergency that requires urgent surgical intervention
• Place nasogastric tube for obstruction or persistent vomiting
• Administer broad-spectrum empiric antibiotics if a perforated viscus or intra-abdominal infection is suspected
• Direct treatment toward the specific condition
• Consider gynecology or surgery referral

Book Source Details

• Book Title: In a Page: Signs and Symptoms
• Author(s): Scott Kahan, Ellen G. Smith
• Year of Publication: 2004
• Copyright Details: In a Page: Signs and Symptoms, Copyright © 2004 Lippincott Williams & Wilkins.

Other Book Chapters Related to Liver pain

Read excerpts from these other book chapters related to Liver pain:

Copyright Details: In a Page: Signs and Symptoms, Copyright © 2008 Williams & Wilkins.

More About Causes of Liver pain

• Back to symptom: Liver pain: Introduction (review 28 causes)
• Next Book Extract About Liver pain: Abdominal Pain in Upper Quadrants (In a Page: Signs and Symptoms)
• All Book Extracts: All Online Book Extracts for Liver pain

More About This Book: Title: In a Page: Signs and Symptoms Authors: Scott Kahan, Ellen G. Smith Publisher: Lippincott Williams & Wilkins Copyright: 2004 ISBN: 1-4051-0368-X

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