RUQ PAIN
Causes of right upper quadrant (RUQ) abdominal pain
| RUQ | Clinical features |
| Biliary | |
| Biliary colic | Intense, dull discomfort located in the RUQ or epigastrium. Associated with nausea, vomiting, and diaphoresis. Generally lasts at least 30 minutes, plateauing within one hour. Benign abdominal examination |
| Acute cholecystitis | Prolonged (>4 to 6 hours) RUQ or epigastric pain, fever. Patients will have abdominal guarding and Murphy's sign |
| Acute cholangitis | Fever, jaundice, RUQ pain |
| Sphincter of Oddi dysfunction | RUQ pain is similar to other biliary pain |
| Hepatic | |
| Acute hepatitis | RUQ pain with fatigue, malaise, nausea, vomiting, and anorexia. Patients may also have jaundice, dark urine, and light-colored stools |
| Perihepatitis (Fitz-Hugh-Curtis syndrome) | RUQ pain with a pleuritic component, pain is sometimes referred to the right shoulder |
| Liver abscess | Fever and abdominal pain are the most common symptoms |
| Budd-Chiari syndrome | Symptoms include fever, abdominal pain, abdominal distention (from ascites), lower extremity edema, jaundice, gastrointestinal bleeding, and/or hepatic encephalopathy |
| Portal vein thrombosis | Symptoms include abdominal pain, dyspepsia, or gastrointestinal bleeding |
Picmonic Acute Abdomen DDx Upper Quadrants
The causes within the right upper quadrant (RUQ) include cholecystitis, biliary colic, cholangitis, perforated duodenal ulcer, and acute hepatitis; and the causes within the left upper quadrant (LUQ) include splenic rupture and irritable bowel syndrome in conjunction with splenic flexure syndrome. Play Video + Quiz |
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LUQ PAIN
Causes of left upper quadrant (LUQ) abdominal pain
| LUQ | Clinical features |
| Splenomegaly | Pain or discomfort in LUQ, left shoulder pain, and/or early satiety |
| Splenic infarct | Severe LUQ pain |
| Splenic abscess | Associated with fever and LUQ tenderness |
| Splenic rupture | May complain of LUQ, left chest wall, or left shoulder pain that is worse with inspiration |
EPIGASTRIC PAIN
Causes of epigastric abdominal pain
| Epigastric | Clinical features |
| Acute myocardial infarction | May be associated with shortness of breath and exertional symptoms |
| Acute pancreatitis | Acute-onset, persistent upper abdominal pain radiating to the back |
| Chronic pancreatitis | Epigastric pain radiating to the back |
| Peptic ulcer disease | Epigastric pain or discomfort is the most prominent symptom |
| Gastroesophageal reflux disease | Associated with heartburn, regurgitation, and dysphagia |
| Gastritis/gastropathy | Abdominal discomfort/pain, heartburn, nausea, vomiting, and hematemesis |
| Functional dyspepsia | The presence of one or more of the following: postprandial fullness, early satiation, epigastric pain, or burning |
| Gastroparesis | Nausea, vomiting, abdominal pain, early satiety, postprandial fullness, and bloating |
Picmonic Acute Abdomen DDx Midepigatrium
Midepigastric pain can be due to pancreatitis, aortic dissection, peptic ulcer disease, and myocardial infarction. Causes within the lower quadrants include ovarian torsion, ectopic pregnancy, pyelonephritis, renal calculi and acute salpingitis. Appendicitis is most commonly associated with right lower quadrant (RLQ) pain; and causes within the left lower quadrant (LLQ) include sigmoid volvulus and sigmoid diverticulitis. Play Video + Quiz |
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LOWER ABDOMINAL PAIN
Causes of lower abdominal pain
| Lower abdomen | Localization | Clinical features |
| Appendicitis | Generally right lower quadrant | Periumbilical pain initially that radiates to the right lower quadrant. Associated with anorexia, nausea, and vomiting |
| Diverticulitis | Generally left lower quadrant; right lower quadrant more common in Asian patients | The pain is usually constant and present for several days prior to presentation. May have associated nausea and vomiting |
| Nephrolithiasis | Either | Pain most common symptom varies from mild to severe. Generally, flank pain, but may have back or abdominal pain |
| Pyelonephritis | Either | Associated with dysuria, frequency, urgency, hematuria, fever, chills, flank pain, and costovertebral angle tenderness |
| Acute urinary retention | Suprapubic | Present with lower abdominal pain and discomfort; inability to urinate |
| Cystitis | Suprapubic | Associated with dysuria, frequency, urgency, and hematuria |
| Infectious colitis | Either | Diarrhea is the predominant symptom, but may also have associated abdominal pain, which may be severe |
Picmonic Acute Abdomen DDx Midepigatrium
Causes within the lower quadrants include ovarian torsion, ectopic pregnancy, pyelonephritis, renal calculi and acute salpingitis. Appendicitis is most commonly associated with right lower quadrant (RLQ) pain; and causes within the left lower quadrant (LLQ) include sigmoid volvulus and sigmoid diverticulitis. Play Video + Quiz |
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