Pain in Different Abdominal Regions

CLINICAL DIAGNOSTIC MANUAL

Abdominal pain can vary in location, intensity, and nature, reflecting a wide range of underlying conditions that may originate from gastrointestinal, genitourinary, vascular, or musculoskeletal sources, among others. The evaluation of this symptom should be systematic and methodical to avoid overlooking potentially serious conditions. Pain can be classified as acute, chronic, or recurrent, and may be localised, diffuse, or referred.

Pathology	Symptoms and Clinical Signs	Suspected Diagnosis	Confirmation Diagnosis
Cholelithiasis	Acute pain in RUQ, biliary colic, nausea, vomiting. May radiate to the back or right scapula.	Clinical history, physical exam.	Abdominal ultrasound.
Hepatitis	Fatigue, malaise, jaundice, dark urine, pale stools, pain in RUQ.	Symptoms, risk history.	Serological tests for hepatitis viruses.
Liver abscess	Fever, pain in RUQ, malaise, weight loss, jaundice.	Clinical history, signs of fever and pain.	CT or abdominal ultrasound, aspiration culture.
Acute cholecystitis	Severe pain in RUQ, fever, nausea, vomiting, Murphy’s sign tenderness.	Symptoms, physical exam.	Abdominal ultrasound, blood tests (leukocytosis).
Gastritis	Burning epigastric pain, nausea, vomiting, gastric fullness.	Clinical history, symptoms.	Endoscopy with biopsy.
Peptic ulcer	Epigastric pain relieved by food or antacids, nausea, vomiting, weight loss.	Clinical history, symptoms.	Endoscopy with biopsy.
Acute pancreatitis	Severe epigastric pain radiating to the back, nausea, vomiting, abdominal distension, fever.	Clinical history, symptoms.	Elevated pancreatic enzymes, abdominal CT.
Splenic rupture	Acute pain in LUQ, signs of shock, abdominal distension, tenderness on palpation.	Recent trauma, acute symptoms.	Abdominal CT.
Acute appendicitis	Pain starting in epigastrium or periumbilical area migrating to RLQ, fever, nausea, vomiting, anorexia.	Symptoms, physical exam.	CT or abdominal ultrasound.
Crohn’s disease	Chronic pain in RLQ, diarrhoea (possibly bloody), weight loss, fever.	Symptoms, clinical history.	Colonoscopy with biopsy.
Salpingitis	Pain in RLQ or LLQ, fever, abnormal vaginal discharge, pain during intercourse or urination.	Clinical history, symptoms.	Pelvic ultrasound, laboratory tests.
Ovarian torsion	Acute pain in RLQ or LLQ, signs of shock, nausea, vomiting.	Acute pain, physical exam.	Pelvic ultrasound with Doppler.
Diverticulitis	Pain in LLQ, fever, nausea, changes in bowel habits, tenderness in the affected area.	Symptoms, history of diverticulosis.	Abdominal CT.
Ulcerative colitis	Pain in LLQ, bloody diarrhoea, faecal urgency, tenesmus, weight loss.	Clinical history, symptoms.	Colonoscopy with biopsy.
Pelvic inflammatory disease	Pain in LLQ, fever, abnormal vaginal discharge, pain during intercourse or urination.	Clinical history, symptoms.	Pelvic ultrasound, laboratory tests.
Colon cancer	Changes in bowel habits, blood in stools, pain in LLQ, unintended weight loss.	Symptoms, clinical history.	Colonoscopy with biopsy.