Right lower quadrant abdominal pain: Difference between revisions
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==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===

Revision as of 22:07, 14 February 2024

Background

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

Classification by Abdominal pain location

Side-by-side comparison of quadrants and regions.
Chart of commonly reported referred pain sites.
RUQ pain Epigastric pain LUQ pain
Flank pain Diffuse abdominal pain Flank pain
RLQ pain Pelvic pain LLQ pain

Clinical Features

  • Right lower quadrant abdominal pain

Differential Diagnosis

RLQ Pain

Evaluation

Appendicitis Risk Scores

Alvarado Clinical Scoring System

Right Lower Quadrant Tenderness +2
Elevated Temperature (37.3°C or 99.1°F) +1
Rebound Tenderness +1
Migration of Pain to the Right Lower Quadrant +1
Anorexia +1
Nausea or Vomiting +1
Leukocytosis > 10,000 +2
Leukocyte Left Shift +1

Clinical scoring system, where a score (Total=10) is composed on presence/absence of 3 signs, 3 symptoms and 2 lab values to help guide in case management.

  • ≤3 = Appendicitis unlikely
  • ≥7 = Surgical consultation
  • 4-6 = Consider CT

MANTRELS Mnemonic: Migration to the right iliac fossa, Anorexia, Nausea/Vomiting, Tenderness in the right iliac fossa, Rebound pain, Elevated temperature (fever), Leukocytosis, and Shift of leukocytes to the left (factors listed in the same order as presented above).

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[1]
    • Urine pregnancy test (if age and sex appropriate)

Imaging

Male

  • Typically start with CT abdomen/pelvis (to rule out appy)

Female

  • Frequently utilize bimanual pelvic exam to determine first study:
    • More consistent with pelvic origin
    • More consistent with intra-abdominal origin --> CT abdomen/pelvis (to rule out appy)

^Consider MRI to substitute for CT if pregnant

Diagnosis

Management

  • Treat underlying disease process

Disposition

  • Per underlying disease process

See Also

External Links

References

  1. ↑ 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
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