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:
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.
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
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.
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.
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.