Abdominal pain region
Reading File
Finding Sources
Searching the Web
abdominal pain regions quadrants anatomy differential diagnosis
Finding Sources
Loading Image
Loading Image
Reading File
Reading File
Here is a complete breakdown of abdominal pain by region, using both the 9-region and 4-quadrant systems.
Abdominal Pain by Region
The 9-Region System (Clinical Standard)
The abdomen is divided by two horizontal planes (transpyloric and transtubercular) and two vertical (mid-clavicular) lines into 9 regions:
Region-by-Region Differential Diagnosis
1. Right Hypochondriac (Right Upper)
- Gallstones / biliary colic
- Cholecystitis / cholangitis
- Hepatitis / liver abscess / hepatoma
- Hepatomegaly (congestive heart failure)
- Right lower lobe pneumonia / empyema
- Herpes zoster (shingles)
- Referred cardiac pain
2. Epigastric (Central Upper)
- Peptic/duodenal ulcer (including perforation)
- Acute pancreatitis
- Gastroesophageal reflux / esophagitis
- Acute cholecystitis (early - before migrating to RUQ)
- Myocardial infarction (referred)
- Epigastric hernia
Yamada's Gastroenterology notes: RUQ pain is most commonly from liver, gallbladder, and biliary tract, and less commonly pancreas, right kidney/ureter, right lung, or chest wall.
3. Left Hypochondriac (Left Upper)
- Splenic abscess / acute splenomegaly / splenic rupture
- Left lower lobe pneumonia / empyema
- Kidney pain / renal infarction
- Herpes zoster
4. Right Lumbar (Right Flank)
- Ureteric/renal colic
- Pyelonephritis
- Right-sided Crohn's disease
5. Umbilical (Central)
- Early appendicitis (visceral pain before localizing to RLQ)
- Mesenteric lymphadenitis
- Meckel's diverticulitis
- Lymphoma
- Mesenteric ischemia (severe, out of proportion to exam)
- Peritonitis / bowel obstruction
- Abdominal aortic aneurysm (AAA)
- Diabetic ketoacidosis, sickle cell crisis (medical causes)
6. Left Lumbar (Left Flank)
- Ureteric/renal colic
- Pyelonephritis
- Left-sided colitis
7. Right Iliac (Right Lower)
- Appendicitis (classic - migratory RLQ pain + anorexia/nausea)
- Crohn's disease (ileocecal)
- Cecal obstruction
- Ovarian cyst/torsion
- Ectopic pregnancy
- Psoas abscess
- Ureteral stones
- Inguinal hernia
8. Hypogastric/Suprapubic (Central Lower)
- Cystitis / urinary retention
- Testicular torsion
- Endometriosis / pelvic inflammatory disease
- Inflammatory bowel disease
- Appendicitis (pelvic appendix)
- Placental abruption
9. Left Iliac (Left Lower)
- Diverticulitis (classic)
- Ulcerative colitis / ischemic colitis
- Ovarian cyst/torsion
- Ectopic pregnancy
- Constipation
- Endometriosis
- Inguinal hernia
- Salpingitis / mittelschmerz
4-Quadrant Summary
| Quadrant | Key Causes |
|---|---|
| RUQ | Gallbladder disease, hepatitis, liver abscess, CHF hepatomegaly, retrocecal appendicitis, right kidney, pneumonia |
| LUQ | Spleen (rupture, infarct, abscess), left kidney, gastric ulcer, pancreatitis (tail), pneumonia |
| RLQ | Appendicitis, Crohn's, ovarian torsion, ectopic pregnancy, ureteral stones, hernia |
| LLQ | Diverticulitis, colitis, ovarian pathology, ectopic pregnancy, ureteral stones, hernia |
| Epigastric | PUD, GERD, pancreatitis, cholecystitis, MI (referred) |
| Suprapubic | UTI, uterine/bladder pathology, IBD, gynecological causes |
| Diffuse/Generalized | Peritonitis, mesenteric ischemia, bowel obstruction, ruptured AAA, DKA, sickle cell, sepsis |
Key Clinical Tips
-
Migratory pain (periumbilical → RLQ) = classic appendicitis
-
Pain out of proportion to exam = mesenteric ischemia until proven otherwise
-
RUQ + fever + jaundice = Charcot's triad (cholangitis)
-
Epigastric + radiation to the back = pancreatitis
-
Always rule out ectopic pregnancy in women of childbearing age with lower abdominal pain (urine hCG is mandatory)
-
Extra-abdominal causes of abdominal pain: MI, pneumonia (lower lobes), DKA, Addisonian crisis, herpes zoster, porphyria
-
Yamada's Textbook of Gastroenterology, 7th ed., p. 770-771
This is a shared conversation. Sign in to Orris to start your own chat.