Acute and Chronic Right Lower (RLQ) Abdominal Pain – Diagnosis

ACUTE Right Lower (RLQ) Abdominal (Stomach) Pain

Acute (sudden, newly appearing) right lower abdominal (RLQ= Right Lower Quadrant) pain, lasting from few seconds to few weeks, may arise from:

1. Appendicitis

Typical symptoms and signs of appendicitis:

  • Sudden moderate to severe pain starting around the navel, moving toward the right hip, getting worse in the following hours and with moving around
  • Nausea or vomiting
  • Low-grade fever (not always)
  • Rebound tenderness: pressuring and relieving pressure on any part of the abdomen triggers pain in RLQ.
  • Guarding – reflex tension of abdominal wall in RLQ when pressuring on a painful spot

Diagnosis of appendicitis can be often made from the history alone. In doubtful cases CT is required. Ultrasound is not reliable in diagnosis of appendicitis. Blood test usually shows elevated white blood cells.

2. Inguinal Hernia

Protruding of a part of the small intestine through the cleft in the muscle of abdominal wall may appear with RLQ pain and pain in the scrotum. Diagnosis is made by physical examination.

3. Volvulus

Volvulus (twisting along long axis) of the cecum (starting part of the large intestine) is rare and occurs mostly in small children as sudden right lower pain, nausea, vomiting and bloating.

Diagnosis is made by X-ray with contrast (barium swallow).

4. Pain, Related to Female Reproductive Organs

Ovulation (mid-cycle pain, Mittleschmerz) may sometimes appear with pain at about 14th day of the menstrual cycle.

Rotation of the right ovary (twisted Fallopian tube), ruptured ovarian cyst, ectopic pregnancy or miscarriage may resemble pain in appendicitis (see above).

5. Pain, Related to Male Reproductive Organs

Right testis torsion, spermatic cord and testicular veins disorders (varicocele, hydrocele) appear with pain, tenderness and swelling in the scrotum; pain may radiate in RLQ.

6. Pain, Related to Abdominal Muscles

Psoas abscess

7. Skin Related Disorders

Herpes zoster appears as burning pain and rash appearing over the course of one or more spinal nerves (extending from the spine toward the middle line of the abdominal wall.

CHRONIC Right Lower Abdominal Pain

Chronic (long term or recurring) pain in the lower right abdomen, lasting from few months to years may arise from:

1. Crohn’s Disease

Crohn’s disease usually affect young to middle aged adults and may appear with RLQ pain, nausea, low-grade fever, diarrhea, blood in the stool, skin rash, mouth ulcers and other symptoms. Diagnosis is made by colonoscopy and examination of the small or large intestinal mucosa (obtained during colonoscopy) under the microscope, blood and stool tests.

2. Carcinoid

Carcinoid is a rare, slowly growing tumor appearing mostly in older adults and can cause LRQ pain if it grows in the appendix or cecum. Other symptoms may include nausea, diarrhea and hot flashes. Diagnosis is made by blood tests for histamine or serotonin and CT of appendix.

3. Endometriosis

Endometriosis is an abnormal growth of uterine mucosa outside of the uterus. For diagnosis endoscopy of the abdominal cavity (laparoscopy) is needed.

4. Polycystic Ovarian Syndrome – PCOS

Symptoms of PCOS include RLQ or LLQ pain, irregular periods, hirsutism (increased body hair grow), increased blood pressure and more.  In diagnosis transvaginal ultrasound may help.

About Jan Modric (249 Articles)
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  • Madison

    OK so here’s the deal i have been dealing with on again off again’s uti for a while i just urecentley discovered im preganet and i was having back pain and stomach pain and fatiuge, also naseaua but from morining too night i can’t keep anything down what so ever. my fever went up too 101.5 and since it was late and i wsas having serve pain. We went to the er they did basic blood work, urine, and a ultrasound and said it was a uti and sent me antibotics to go home with. But the pain is in my lower right abdomnal and it keeps getting worse also my fever went as high as 103.5, a lot worse pain and a different kind of pain then with the uti’s i have had. The pain is all in my rigt side and very tender when you push on it also i noticed when im on my right side sleeping i feel nausead easier then when im on my left side. I don’t waant to be a complainer i just feel like there is something else wrong. Please, would appericate the advice.

  • Dr. Chris

    Hi Madison

    UTIs are common in women and could account for many of the symptoms you are experiencing, in addition to the pregnancy contributing to this clinical presentation as well. However, the concern is that your infection may be progressing and could put your pregnancy in jeopardy. Even though you went to the ER, you should have still followed up with your family doctor and gynecologist. Please see these practitioners IMMEDIATELY. The ER is only there for emergency situations and the onus is on you to seek medical attention afterwards. Either way, since you are pregnancy, you will need constant antenatal assessment.