Right lower quadrant abdominal pain - Revision history

Ostermayer: Prepared the page for translation

2026-01-04T23:57:00Z

Prepared the page for translation

← Older revision		Revision as of 23:57, 4 January 2026
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			<languages/>
			<translate>

	==Background==		==Background==

	*This page describes the general approach to RLQ pain in adults		*This page describes the general approach to RLQ pain in adults

			</translate>
	{{Abdominal pain location}}		{{Abdominal pain location}}
			<translate>


	==Clinical Features==		==Clinical Features==

	*Right lower quadrant abdominal pain		*Right lower quadrant abdominal pain


	==Differential Diagnosis==		==Differential Diagnosis==

			</translate>
	{{Abd DDX RLQ}}		{{Abd DDX RLQ}}
			<translate>


	==Evaluation==		==Evaluation==


	===Appendicitis Risk Scores===		===Appendicitis Risk Scores===

			</translate>
	{{Alvarado scoring system}}		{{Alvarado scoring system}}
			<translate>


	===Workup===		===Workup===

	*Include genital exam (pelvic exam or testicular), if appropriate		*Include genital exam (pelvic exam or testicular), if appropriate

	====Labs====		====Labs====

	*Abdominal panel		*Abdominal panel
	**CBC		**CBC
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	**Consider LFTs + lipase		**Consider LFTs + lipase
	**Consider coagulation studies (PT, PTT, INR), as a marker of liver function		**Consider coagulation studies (PT, PTT, INR), as a marker of liver function
	*[[Urinalysis]]		*[[Special:MyLanguage/Urinalysis\|Urinalysis]]
	**Leukocytes will be present in 40% of patients<ref>Baird DLH, Simillis C, Kontovounisios C, Rasheed S, Tekkis PP. Acute appendicitis. BMJ. 2017;357:j1703. Published 2017 Apr 19. doi:10.1136/bmj.j1703</ref>		**Leukocytes will be present in 40% of patients<ref>Baird DLH, Simillis C, Kontovounisios C, Rasheed S, Tekkis PP. Acute appendicitis. BMJ. 2017;357:j1703. Published 2017 Apr 19. doi:10.1136/bmj.j1703</ref>
	**Urine pregnancy test (if age and sex appropriate)		**Urine pregnancy test (if age and sex appropriate)


	===Imaging===		===Imaging===


	====Male====		====Male====
	*Typically start with CT abdomen/pelvis (to rule out [[appy]])
			*Typically start with CT abdomen/pelvis (to rule out [[Special:MyLanguage/appy\|appy]])


	====Female====		====Female====

	*Frequently utilize bimanual pelvic exam to determine first study:		*Frequently utilize bimanual pelvic exam to determine first study:
	**More consistent with pelvic origin		**More consistent with pelvic origin
	***Pelvic [[ultrasound]] (rule out [[ovarian torsion]])		***Pelvic [[Special:MyLanguage/ultrasound\|ultrasound]] (rule out [[Special:MyLanguage/ovarian torsion\|ovarian torsion]])
	****If negative, consider CT abdomen/pelvis^ (to rule out [[appy]])		****If negative, consider CT abdomen/pelvis^ (to rule out [[Special:MyLanguage/appy\|appy]])
	**More consistent with intra-abdominal origin		**More consistent with intra-abdominal origin
	***CT abdomen/pelvis^ (to rule out [[appy]])		***CT abdomen/pelvis^ (to rule out [[Special:MyLanguage/appy\|appy]])
	****If negative, consider pelvic [[ultrasound]] (rule out [[ovarian torsion]])		****If negative, consider pelvic [[Special:MyLanguage/ultrasound\|ultrasound]] (rule out [[Special:MyLanguage/ovarian torsion\|ovarian torsion]])
	''^If pregnant, consider substituting MRI for CT''		''^If pregnant, consider substituting MRI for CT''


	===Diagnosis===		===Diagnosis===

	*Definitive diagnosis may be determined via a combination of history, labs, and/or imaging		*Definitive diagnosis may be determined via a combination of history, labs, and/or imaging
	*About one-third of patients do not have a definitive diagnosis by end of ED workup<ref>Hosiniejad SM, et al. Arch Acad Emerg Med. 2019; 7(1): e44. Published online 2019 Aug 17. One Month Follow-Up of Patients with Unspecified Abdominal Pain Referring to the Emergency Department; a Cohort Study.</ref>		*About one-third of patients do not have a definitive diagnosis by end of ED workup<ref>Hosiniejad SM, et al. Arch Acad Emerg Med. 2019; 7(1): e44. Published online 2019 Aug 17. One Month Follow-Up of Patients with Unspecified Abdominal Pain Referring to the Emergency Department; a Cohort Study.</ref>


	==Management==		==Management==

	*Treat underlying disease process		*Treat underlying disease process
	**If imaging studies are negative, but bimanual was positive, consider empiric treatment for [[PID]]		**If imaging studies are negative, but bimanual was positive, consider empiric treatment for [[Special:MyLanguage/PID\|PID]]


	==Disposition==		==Disposition==

	*Per underlying disease process		*Per underlying disease process


	==See Also==		==See Also==
	*[[Abdominal Pain]]
	*[[Abdominal Pain (Peds)]]		*[[Special:MyLanguage/Abdominal Pain\|Abdominal Pain]]
			*[[Special:MyLanguage/Abdominal Pain (Peds)\|Abdominal Pain (Peds)]]


	==External Links==		==External Links==


	==References==		==References==

	<references/>		<references/>

	[[Category:GI]]		[[Category:GI]]
	[[Category:Symptoms]]		[[Category:Symptoms]]
			</translate>

Rossdonaldson1: /* Diagnosis */

2024-02-14T23:13:06Z

Diagnosis

← Older revision		Revision as of 23:13, 14 February 2024
Line 43:		Line 43:
	*Definitive diagnosis may be determined via a combination of history, labs, and/or imaging		*Definitive diagnosis may be determined via a combination of history, labs, and/or imaging
	*About one-third of patients do not have a definitive diagnosis by end of ED workup<ref>Hosiniejad SM, et al. Arch Acad Emerg Med. 2019; 7(1): e44. Published online 2019 Aug 17. One Month Follow-Up of Patients with Unspecified Abdominal Pain Referring to the Emergency Department; a Cohort Study.</ref>		*About one-third of patients do not have a definitive diagnosis by end of ED workup<ref>Hosiniejad SM, et al. Arch Acad Emerg Med. 2019; 7(1): e44. Published online 2019 Aug 17. One Month Follow-Up of Patients with Unspecified Abdominal Pain Referring to the Emergency Department; a Cohort Study.</ref>
	*If bimanual pelic exam is positive and other imaging studies are negative, consider empiric antibiotic coverage for [[PID]]

	==Management==		==Management==

Rossdonaldson1: /* Diagnosis */

2024-02-14T23:12:50Z

Diagnosis

← Older revision		Revision as of 23:12, 14 February 2024
Line 43:		Line 43:
	*Definitive diagnosis may be determined via a combination of history, labs, and/or imaging		*Definitive diagnosis may be determined via a combination of history, labs, and/or imaging
	*About one-third of patients do not have a definitive diagnosis by end of ED workup<ref>Hosiniejad SM, et al. Arch Acad Emerg Med. 2019; 7(1): e44. Published online 2019 Aug 17. One Month Follow-Up of Patients with Unspecified Abdominal Pain Referring to the Emergency Department; a Cohort Study.</ref>		*About one-third of patients do not have a definitive diagnosis by end of ED workup<ref>Hosiniejad SM, et al. Arch Acad Emerg Med. 2019; 7(1): e44. Published online 2019 Aug 17. One Month Follow-Up of Patients with Unspecified Abdominal Pain Referring to the Emergency Department; a Cohort Study.</ref>
	*If bimanual is positive and other imaging studies are negative, consider empiric antibiotic coverage for [[PID]]		*If bimanual pelic exam is positive and other imaging studies are negative, consider empiric antibiotic coverage for [[PID]]

	==Management==		==Management==

Rossdonaldson1: /* Diagnosis */

2024-02-14T23:12:32Z

Diagnosis

← Older revision		Revision as of 23:12, 14 February 2024
Line 41:		Line 41:

	===Diagnosis===		===Diagnosis===
			*Definitive diagnosis may be determined via a combination of history, labs, and/or imaging
			*About one-third of patients do not have a definitive diagnosis by end of ED workup<ref>Hosiniejad SM, et al. Arch Acad Emerg Med. 2019; 7(1): e44. Published online 2019 Aug 17. One Month Follow-Up of Patients with Unspecified Abdominal Pain Referring to the Emergency Department; a Cohort Study.</ref>
			*If bimanual is positive and other imaging studies are negative, consider empiric antibiotic coverage for [[PID]]

	==Management==		==Management==

Rossdonaldson1: /* Imaging */

2024-02-14T22:16:37Z

Imaging

← Older revision		Revision as of 22:16, 14 February 2024
Line 35:		Line 35:
	***Pelvic [[ultrasound]] (rule out [[ovarian torsion]])		***Pelvic [[ultrasound]] (rule out [[ovarian torsion]])
	****If negative, consider CT abdomen/pelvis^ (to rule out [[appy]])		****If negative, consider CT abdomen/pelvis^ (to rule out [[appy]])
	*****If negative, consider empiric treatment for [[PID]]
	**More consistent with intra-abdominal origin		**More consistent with intra-abdominal origin
	***CT abdomen/pelvis^ (to rule out [[appy]])		***CT abdomen/pelvis^ (to rule out [[appy]])
	****If negative, consider pelvic [[ultrasound]] (rule out [[ovarian torsion]])		****If negative, consider pelvic [[ultrasound]] (rule out [[ovarian torsion]])
	*****If negative, consider empiric treatment for [[PID]]		''^If pregnant, consider substituting MRI for CT''
	^If pregnant, consider substituting MRI for CT

	===Diagnosis===		===Diagnosis===

Rossdonaldson1: /* Female */

2024-02-14T22:10:06Z

Female

← Older revision		Revision as of 22:10, 14 February 2024
Line 40:		Line 40:
	****If negative, consider pelvic [[ultrasound]] (rule out [[ovarian torsion]])		****If negative, consider pelvic [[ultrasound]] (rule out [[ovarian torsion]])
	*****If negative, consider empiric treatment for [[PID]]		*****If negative, consider empiric treatment for [[PID]]
	^~~Consider~~ MRI ~~to substitute~~ for CT ~~if pregnant~~		^If pregnant, consider substituting MRI for CT

	===Diagnosis===		===Diagnosis===

Rossdonaldson1: /* Management */

2024-02-14T22:09:27Z

Management

← Older revision		Revision as of 22:09, 14 February 2024
Line 46:		Line 46:
	==Management==		==Management==
	*Treat underlying disease process		*Treat underlying disease process
			**If imaging studies are negative, but bimanual was positive, consider empiric treatment for [[PID]]

	==Disposition==		==Disposition==

Rossdonaldson1: /* Female */

2024-02-14T22:08:28Z

Female

← Older revision		Revision as of 22:08, 14 February 2024
Line 34:		Line 34:
	**More consistent with pelvic origin		**More consistent with pelvic origin
	***Pelvic [[ultrasound]] (rule out [[ovarian torsion]])		***Pelvic [[ultrasound]] (rule out [[ovarian torsion]])
	****If negative, consider CT abdomen/pelvis (to rule out [[appy]])		****If negative, consider CT abdomen/pelvis^ (to rule out [[appy]])
			*****If negative, consider empiric treatment for [[PID]]
			**More consistent with intra-abdominal origin
			***CT abdomen/pelvis^ (to rule out [[appy]])
			****If negative, consider pelvic [[ultrasound]] (rule out [[ovarian torsion]])
	*****If negative, consider empiric treatment for [[PID]]		*****If negative, consider empiric treatment for [[PID]]
	**More consistent with intra-abdominal origin --> CT abdomen/pelvis (to rule out [[appy]])
	***If negative, consider pelvic [[ultrasound]] (rule out [[ovarian torsion]])
	****If negative, consider empiric treatment for [[PID]]
	^Consider MRI to substitute for CT if pregnant		^Consider MRI to substitute for CT if pregnant

Rossdonaldson1: /* Female */

2024-02-14T22:07:47Z

Female

← Older revision		Revision as of 22:07, 14 February 2024
Line 37:		Line 37:
	*****If negative, consider empiric treatment for [[PID]]		*****If negative, consider empiric treatment for [[PID]]
	**More consistent with intra-abdominal origin --> CT abdomen/pelvis (to rule out [[appy]])		**More consistent with intra-abdominal origin --> CT abdomen/pelvis (to rule out [[appy]])
	****If negative, consider pelvic [[ultrasound]] (rule out [[ovarian torsion]])		***If negative, consider pelvic [[ultrasound]] (rule out [[ovarian torsion]])
	*****If negative, consider empiric treatment for [[PID]]		****If negative, consider empiric treatment for [[PID]]
	^Consider MRI to substitute for CT if pregnant		^Consider MRI to substitute for CT if pregnant

Rossdonaldson1: /* Evaluation */

2024-02-14T22:07:19Z

Evaluation

← Older revision		Revision as of 22:07, 14 February 2024
Line 11:		Line 11:

	==Evaluation==		==Evaluation==
			===Appendicitis Risk Scores===
			{{Alvarado scoring system}}

	===Workup===		===Workup===
			*Include genital exam (pelvic exam or testicular), if appropriate
			====Labs====
			*Abdominal panel
			**CBC
			**Chemistry
			**Consider LFTs + lipase
			**Consider coagulation studies (PT, PTT, INR), as a marker of liver function
			*[[Urinalysis]]
			**Leukocytes will be present in 40% of patients<ref>Baird DLH, Simillis C, Kontovounisios C, Rasheed S, Tekkis PP. Acute appendicitis. BMJ. 2017;357:j1703. Published 2017 Apr 19. doi:10.1136/bmj.j1703</ref>
			**Urine pregnancy test (if age and sex appropriate)

			===Imaging===
	====Male====		====Male====
	*~~CBC~~		*Typically start with CT abdomen/pelvis (to rule out [[appy]])
	*Chem
	*[[Urinalysis]]
	*?CT ~~abd~~/pelvis (rule out [[appy]])
	*Testicular exam

	====Female====		====Female====
	*~~CBC~~		*Frequently utilize bimanual pelvic exam to determine first study:
	*~~Chem~~		**More consistent with pelvic origin
	*~~[[Urinalysis]]~~		***Pelvic [[ultrasound]] (rule out [[ovarian torsion]])
	*~~Urine pregnancy~~		****If negative, consider CT abdomen/pelvis (to rule out [[appy]])
	*?Pelvic [[ultrasound]] (rule out [[ovarian torsion]]) ~~and~~/or CT ~~abd~~/pelvis (rule out [[appy]])		*****If negative, consider empiric treatment for [[PID]]
	*~~Pelvic exam~~		**More consistent with intra-abdominal origin --> CT abdomen/pelvis (to rule out [[appy]])
			****If negative, consider pelvic [[ultrasound]] (rule out [[ovarian torsion]])
			*****If negative, consider empiric treatment for [[PID]]
			^Consider MRI to substitute for CT if pregnant

	===Diagnosis===		===Diagnosis===