Search
right lower quadrant pain
Etiology:
1) pain may originate within the distal intestinal tract
a) appendicitis
b) when occuring together with diarrhea suggests
1] colitis
2] ileitis
c) intestinal causes may be:
1] infectious (see enterocolitis)
2] ischemic bowel
3] inflammatory bowel disease
4] malignant, colon cancer
5] medication induced
2) pain may radiate down from upper abdominal structures (see abdominal pain)
3) pain may radiate up from pelvis (see pelvic pain)
Clinical manifestations:
- diarrhea would suggest colitis, ileitis
Laboratory:
- complete blood count (CBC)
- iron studies if anemia identified
- pregnancy test in women (also see pelvic pain)
- urinalysis
- stool studies
a) stool ova & parasites
b) fecal leukocytes
c) stool culture for enteric pathogens
d) C-difficile toxin
e) fecal occult blood
- see abdominal pain
- see pelvic pain
Special laboratory:
- colonoscopy if needed to establish diagnosis
Radiology:
- computed tomography
- see abdominal pain
Differential diagnosis:
- appendicitis (24%)
- diagnoses other than appendicitis (32%)
- spectrum of pelvic pain
- adnexal abnormalities in women (33%)
- inflammatory enteritis or adenitis (17%)
- urolithiasis (12%)
- diverticulitis (8%)
- constipation (7%)
- small bowel obstruction (4%)
- inflammatory bowel disease (4%)
- abdominal pain (referred pain) from upper abdomen
- cholecystitis (4%)
- no specific diagnoses (35%) [1]
Notes:
- visceral pain localizes poorly in the abdomen
- consider all possible sources of abdominal pain
Related
right lower quadrant (RLQ)
General
abdominal pain
References
- Pooler BD et al.
Alternative diagnoses to suspected appendicitis at CT.
Radiology 2012 Dec; 265:733.
PMID: 23023965
- Agency for Healthcare Research and Quality (AHRQ)
Diagnosis of Right Lower Quadrant Pain and Suspected Acute
Appendicitis.
Research Review - Final - Dec. 14, 2015
http://www.effectivehealthcare.ahrq.gov/ehc/products/528/2158/appendicitis-report-151214.pdf