Lower Abdominal and Right-Sided Pain: Differential Diagnosis and Urgency Assessment

Lower abdominal and right-sided pain has a broad differential. Severity, duration, and associated symptoms determine urgency.

Right Lower Quadrant (RLQ) – Surgical Emergencies

• Appendicitis: Periumbilical → RLQ migration, anorexia, nausea, fever, rebound tenderness
• Ovarian torsion (women): Sudden severe pain, nausea; intermittent if partial
• Ruptured ovarian cyst: Sudden sharp pain, often mid-cycle
• Ectopic pregnancy: Amenorrhea + pain + bleeding; β-hCG + ultrasound
• Cecal volvulus, Meckel's diverticulitis

Right Upper Quadrant (RUQ)

• Biliary colic/cholecystitis: Postprandial RUQ pain, nausea, Murphy's sign
• Hepatitis, liver abscess
• Renal colic (right kidney): Flank → groin, hematuria

Suprapubic / Midline

• Cystitis: Dysuria, frequency, urgency
• PID (women): Bilateral pain, discharge, fever, cervical motion tenderness
• Diverticulitis (usually LLQ but can be R-sided): Pain, fever, leukocytosis

Red Flags (Emergency Evaluation)

• Severe, unremitting pain
• Fever >38.5°C
• Hemodynamic instability (hypotension, tachycardia)
• Peritoneal signs (rigidity, rebound, guarding)
• Pregnancy + pain/bleeding
• Inability to pass gas/stool (obstruction)

Initial Workup

• History + focused exam (including pelvic/rectal if indicated)
• Urinalysis, urine β-hCG (women)
• CBC, CRP, LFTs, amylase/lipase
• Imaging: US (RLQ, RUQ, pelvic), CT abdomen/pelvis (gold standard for appendicitis, diverticulitis)

Do not self-diagnose severe abdominal pain. Timely evaluation prevents perforation, sepsis, loss of organ.