{"id":810,"date":"2017-12-02T13:18:07","date_gmt":"2017-12-02T13:18:07","guid":{"rendered":"https:\/\/emedicalupdates.com\/?p=810"},"modified":"2022-01-12T10:32:09","modified_gmt":"2022-01-12T10:32:09","slug":"abdominal-pain","status":"publish","type":"post","link":"https:\/\/emedicalupdates.com\/abdominal-pain\/","title":{"rendered":"Abdominal Pain"},"content":{"rendered":"

Abdominal Pain<\/h1>\n

Anatomy – Introduction & Divisions<\/h2>\n

The abdomen, justly called as a \u2018Magic Box\u2019, has a lot of organs stuffed inside in particular positions and well-designed manner. It is in fact very difficult to identify the cause of an abdominal pain because of the multiple organs within.<\/p>\n

As you can see in the below images, abdomen is the area between the diaphragm above and the pelvic bones below. Pelvis though learned separately, is a part of abdomen.<\/p>\n

\"abdominal<\/p>\n

Image 1 – Ref: viarevision.wikia.com<\/p>\n

The images showing the 9 regions and 4 quadrants of the abdomen.<\/p>\n

Abdomen can be divided in two ways, i.e. into 9 regions or 4 quadrants<\/strong><\/span>. Understanding the terms \u2018Hypo\u2019 that means \u2018below\u2019 and \u2018Epi\u2019 that means \u2018above\u2019 makes it easier to know about the regions [2<\/strong>]<\/sup>. \u2018Chondros\u2019 means cartilage and \u2018Gastrium\u2019 is stomach. The right and left hypochondriac regions are just below the cartilaginous parts of the rib cage.<\/p>\n

The epigastric and hypogastric regions can be explained in relation to the stomach. Umbilical region is the area surrounding the umbilicus (Navel). The right and left lumbar regions are on the sides of umbilical region and the iliac regions lay over the right and left iliac bones.<\/p>\n

The quadrants are much easier to understand and remember. Two imaginary planes that pass through the umbilicus (navel) divide the abdomen into 4 quadrants. The meeting point of the planes is at umbilicus (navel) [1<\/strong>]<\/sup>. Understanding the regions and quadrants would make it easier to diagnose any pain in the abdomen.<\/p>\n

ICD 9<\/span> code for abdominal pain – 789.0<\/span><\/strong><\/h3>\n

ICD 10<\/span> code for abdominal pain –\u00a0R10.9<\/span><\/span><\/strong><\/h3>\n

Contents of the Abdomen<\/h2>\n
    \n
  • Tubular structures-<\/strong> Blood vessels, lymphatics, nerves<\/li>\n
  • Bones- Lumbar and sacral vertebrae<\/li>\n
  • Organs-<\/strong> Lower part of oesophagus (food pipe), Stomach, small intestine, large intestine, appendix, liver, gall bladder, pancreas, spleen, kidneys, adrenal glands, ureters, urinary bladder, uterus, fallopian tubes, ovaries.<\/li>\n
  • Membrane-<\/strong> Peritoneum[3<\/strong>]<\/sup><\/li>\n<\/ul>\n

    Content of Different Regions<\/h2>\n

    \"abdominal<\/p>\n

     <\/p>\n

    Image 2 – Ref: http:\/\/etc.usf.edu<\/em><\/p>\n

    Contents and Locations of Different Organs in 9 Regions of abdomen<\/h2>\n\n\n\n\n\n
    \n

    RIGHT HYPOCHONDRIAC<\/strong><\/span><\/p>\n

      \n
    • Ascending Colon<\/span><\/li>\n
    • Gall bladder<\/span><\/li>\n
    • Liver<\/span><\/li>\n
    • Right Kidney<\/span><\/li>\n
    • Small Intestine<\/span><\/li>\n
    • Transverse colon<\/span><\/li>\n<\/ul>\n<\/td>\n
    		 <\/p>\n

    EPIGASTRIC<\/strong><\/span><\/p>\n

    		\n

    LEFT HYPOCHONDRIAC<\/strong><\/span><\/p>\n

    \n

    RIGHT LUMBAR<\/strong><\/span><\/p>\n

      \n
    • Ascending colon<\/span><\/li>\n
    • Liver<\/span><\/li>\n
    • Gall bladder<\/span><\/li>\n
    • Right Kidney<\/span><\/li>\n
    • Small intestine<\/span><\/li>\n<\/ul>\n<\/td>\n
    		\n

    UMBILICAL<\/strong><\/span><\/p>\n

      \n
    • Lower part of Right and left kidneys<\/span><\/li>\n
    • Right & left ureters<\/span><\/li>\n
    • Part of Stomach<\/span><\/li>\n
    • Small intestine<\/span><\/li>\n
    • Cisterna chyli<\/span><\/li>\n
    • Head of the pancreas<\/span><\/li>\n<\/ul>\n<\/td>\n
    		\n

    LEFT LUMBAR<\/strong><\/span><\/p>\n

      \n
    • Part of Descending colon<\/span><\/li>\n
    • Tip of Left Kidney<\/span><\/li>\n
    • Part of Small intestine<\/span><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
    \n

    RIGHT ILIAC<\/strong><\/span><\/p>\n

    		\n

    HYPOGASTRIC<\/strong><\/span><\/p>\n

      \n
    • Prostate (in males)<\/span><\/li>\n
    • Rectum<\/span><\/li>\n
    • Sigmoid colon<\/span><\/li>\n
    • Right and left fallopian tubes (in females)<\/span><\/li>\n
    • Right and left ureters<\/span><\/li>\n
    • Seminal vesicle (in males)<\/span><\/li>\n
    • Small intestine<\/span><\/li>\n
    • Urinary bladder<\/span><\/li>\n
    • Uterus (in females)<\/span><\/li>\n
    • Vas deferens (in males)<\/span><\/li>\n<\/ul>\n<\/td>\n
    		\n

    LEFT ILIAC<\/strong><\/span><\/p>\n

      \n
    • Left ovary and fallopian tube (in females)<\/span><\/li>\n
    • Part of Small intestine<\/span><\/li>\n
    • Part of Descending colon<\/span><\/li>\n
    • Sigmoid colon<\/span><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

       <\/p>\n

      Contents and Locations of Different Organs in Quadrants of the abdomen<\/h2>\n\n\n\n\n
      \n

      RIGHT UPPER QUADRANT<\/strong><\/span><\/p>\n

        \n
      • Liver<\/span><\/li>\n
      • Gall bladder<\/span><\/li>\n
      • Duodenum<\/span><\/li>\n
      • Head of pancreas<\/span><\/li>\n
      • Right adrenal gland<\/span><\/li>\n
      • Upper lobe of right kidney<\/span><\/li>\n
      • Hepatic flexure of colon<\/span><\/li>\n
      • Part of ascending colon<\/span><\/li>\n
      • Part of transverse colon<\/span><\/li>\n<\/ul>\n<\/td>\n
      		\n

      LEFT UPPER QUADRANT<\/strong><\/span><\/p>\n

        \n
      • Left lower part of liver<\/span><\/li>\n
      • Upper part of left kidney<\/span><\/li>\n
      • Splenic flexure of colon<\/span><\/li>\n
      • Part of transverse colon<\/span><\/li>\n
      • Part of descending colon<\/span><\/li>\n
      • Stomach<\/span><\/li>\n
      • Spleen<\/span><\/li>\n
      • Pancreas<\/span><\/li>\n
      • Left adrenal gland<\/span><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
      \n

      RIGHT LOWER QUADRANT<\/strong><\/span><\/p>\n

        \n
      • Lower lobe of right kidney<\/span><\/li>\n
      • Part of ascending colon<\/span><\/li>\n
      • Right ovary and fallopian tube (in female)<\/span><\/li>\n
      • Right spermatic cord (in male)<\/span><\/li>\n
      • Caecum appendix<\/span><\/li>\n
      • Right ureter<\/span><\/li>\n
      • Uterus (in female)<\/span><\/li>\n
      • Urinary bladder<\/span><\/li>\n
      • Appendix<\/span><\/li>\n<\/ul>\n<\/td>\n
      		\n

      LEFT LOWER QUADRANT<\/strong><\/span><\/p>\n

        \n
      • Lower lobe of left kidney<\/span><\/li>\n
      • Descending colon<\/span><\/li>\n
      • Left spermatic cord (male)<\/span><\/li>\n
      • Uterus (in female)<\/span><\/li>\n
      • Sigmoid colon<\/span><\/li>\n
      • Left ureter<\/span><\/li>\n
      • Left ovary and fallopian tube (in female)<\/span><\/li>\n
      • Urinary bladder<\/span><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

        \u00a0<\/strong><\/p>\n

        Pain Abdomen<\/h2>\n

        Abdominal pain can occur due to infection, inflammation, distension, loss of blood supply, muscular cramps or injury to any abdominal organs. It can sometimes be felt as a diffuse pain throughout the abdomen. Few of the times it can be pin pointed to particular location on the abdomen.<\/p>\n

        However, the diagnosis can be done only after a proper history and examination of the patient. There can be variations in onset of the pain, the character, location, triggering factors, relieving factors or associated features. [7<\/strong>]<\/sup><\/p>\n

        The pain usually is related to the location of the organ. Sometimes the pain may be felt in areas non-related to the organs, which is known as referred pain.<\/p>\n

        \"Free<\/p>\n

        Image 3- Ref: en.wikipedia.org<\/p>\n

        The image shows an X-ray film. Free air is seen under the right dome of diaphragm, indicating air leakage into the peritoneal space most probably due to a perforation in the gastrointestinal tract.<\/p>\n

         <\/p>\n

        \n

        In the tables below, the most common causes of pain in each quadrant has been explained along with diffuse abdominal pain.<\/strong><\/em><\/p>\n<\/blockquote>\n

         <\/p>\n

        Diffuse Abdominal Pain<\/h2>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
        \u00a0Condition<\/strong><\/span><\/td>\n\u00a0Clinical Feature<\/strong><\/span><\/td>\n\u00a0Cause<\/strong><\/span><\/td>\n<\/tr>\n
        \u00a0Intestinal Obstruction<\/strong><\/span><\/td>\n\n
          \n
        • Nausea<\/span><\/li>\n
        • Vomiting<\/span><\/li>\n
        • Constipation<\/span><\/li>\n
        • Inability to pass stool<\/span><\/li>\n
        • Distended abdomen<\/span>[8, 12, 13, 14, 15<\/strong>]<\/sup><\/span><\/li>\n<\/ul>\n<\/td>\n
        		\n
          \n
        • \u00a0Fibrous bands or adhesions causing the obstruction<\/span><\/li>\n
        • colon cancer<\/span><\/li>\n
        • hernias<\/span><\/li>\n
        • diverticulitis<\/span><\/li>\n
        • volvulus<\/span><\/li>\n
        • Impacted faeces. [9<\/strong>]<\/sup><\/span><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
        \u00a0Gastro intestinal tract perforation<\/strong><\/span><\/td>\n\n
          \n
        • Sudden onset severe pain<\/span><\/li>\n
        • Nausea<\/span><\/li>\n
        • Vomiting<\/span><\/li>\n
        • Tenderness of the abdomen<\/span><\/li>\n
        • Rebound tenderness [10<\/strong>]<\/sup><\/span><\/li>\n<\/ul>\n<\/td>\n
        		\n
          \n
        • Peptic ulcer disease<\/span><\/li>\n
        • Malignancies<\/span><\/li>\n
        • Inflammatory bowel disease<\/span><\/li>\n
        • Medications such as non-steroidal anti-inflammatory drugs<\/span><\/li>\n
        • Penetrating or blunt abdominal trauma<\/span><\/li>\n
        • Injury during procedures like ERCP and colonoscopy. [11<\/strong>]<\/sup><\/span><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
        Acute mesenteric ischemia<\/strong><\/span><\/td>\n\n
          \n
        • Sudden onset, sever, diffuse pain in the abdomen<\/span><\/li>\n
        • Nausea, vomiting, anorexia<\/span><\/li>\n
        • Diarrhoea<\/span><\/li>\n
        • Abdominal distension<\/span><\/li>\n
        • Gastrointestinal bleeding<\/span><\/li>\n<\/ul>\n<\/td>\n
        		\n
          \n
        • Mesenteric arterial embolism<\/span><\/li>\n
        • Mesenteric arterial thrombosis<\/span><\/li>\n
        • Non occlusive mesenteric ischemia<\/span><\/li>\n
        • Mesenteric venous thrombosis [16<\/strong>]<\/sup><\/span><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
        \u00a0Chronic mesenteric ischemia<\/strong><\/span><\/td>\n\n
          \n
        • Generally no symptoms [21<\/strong>]<\/sup><\/span><\/li>\n
        • Anorexia<\/span><\/li>\n
        • Nausea<\/span><\/li>\n
        • Vomiting<\/span><\/li>\n
        • Diarrhoea<\/span><\/li>\n<\/ul>\n<\/td>\n
        		\n
          \n
        • Atherosclerosis of mesenteric vessels [17, 18<\/strong>]<\/sup><\/span><\/li>\n
        • Fibromuscular dysplasia<\/span><\/li>\n
        • Takayasu\u2019s disease [19<\/strong>]<\/sup><\/span><\/li>\n
        • Retroperitoneal fibrosis [20<\/strong>]<\/sup><\/span><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
        Ulcerative colitis<\/strong><\/span><\/td>\n\n
          \n
        • Abdominal cramps<\/span><\/li>\n
        • Diarrhoea<\/span><\/li>\n
        • Bleeding from rectum<\/span><\/li>\n
        • Anorexia<\/span><\/li>\n
        • Weight loss [22<\/strong>]<\/sup><\/span><\/li>\n<\/ul>\n<\/td>\n
        		\n
          \n
        • Cause unknown<\/span><\/li>\n
        • Thought to be because of immune system over reacting to normal bacteria in the intestinal tract.<\/span><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
        \u00a0Viral gastroenteritis<\/strong><\/span><\/td>\n\n
          \n
        • Diarrhoea<\/span><\/li>\n
        • Nausea<\/span><\/li>\n
        • Vomiting<\/span><\/li>\n<\/ul>\n<\/td>\n
        		\n
          \n
        • \u00a0Viral infection in the intestines<\/span><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
        Spontaneous Bacterial peritonitis<\/strong><\/span><\/td>\n\n
          \n
        • Fever<\/span><\/li>\n
        • Chills<\/span><\/li>\n
        • Nausea<\/span><\/li>\n
        • Vomiting<\/span><\/li>\n
        • Abdominal tenderness<\/span><\/li>\n
        • Malaise [26<\/strong>]<\/sup><\/span><\/li>\n<\/ul>\n<\/td>\n
        		\n
          \n
        • \u00a0Cirrhosis of liver [23<\/strong>]<\/sup><\/span><\/li>\n
        • Nephrotic syndrome [24, 25<\/strong>]<\/sup><\/span><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
        Colorectal cancer<\/strong><\/span><\/td>\n\n
          \n
        • \u00a0Diarrhoea<\/span><\/li>\n
        • Constipation<\/span><\/li>\n
        • Blood in stool<\/span><\/li>\n
        • Vomiting<\/span><\/li>\n
        • Fatigue<\/span><\/li>\n
        • Unexplained weight loss [27, 28<\/strong>]<\/sup><\/span><\/li>\n<\/ul>\n<\/td>\n
        		Predisposition may be seen in<\/span><\/p>\n
          \n
        • Elderly<\/span><\/li>\n
        • Overweight<\/span><\/li>\n
        • Smoking<\/span><\/li>\n
        • Physically inactive<\/span><\/li>\n
        • Family history of<\/span><\/li>\n
        • colorectal cancer [27, 28<\/strong>]<\/sup><\/span><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
        Celiac disease<\/strong><\/span><\/td>\n\n
          \n
        • Chronic diarrhoea<\/span><\/li>\n
        • Abdominal distension<\/span><\/li>\n
        • Malabsorption<\/span><\/li>\n
        • Anorexia<\/span><\/li>\n<\/ul>\n<\/td>\n
        		\n
          \n
        • Auto immune disorder-<\/strong> Due to over reaction of our immunity towards our own organs.<\/span><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
        Ketoacidosis<\/strong><\/span><\/td>\n\n
          \n
        • Nausea<\/span><\/li>\n
        • Vomiting<\/span><\/li>\n
        • Abdominal pain<\/span><\/li>\n<\/ul>\n<\/td>\n
        		\n
          \n
        • Diabetes<\/span><\/li>\n
        • Starvation<\/span><\/li>\n
        • Alcohol [29<\/strong>]<\/sup><\/span><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
        Adrenal insufficiency<\/strong><\/span><\/td>\n\n
          \n
        • Hypoglycemia<\/span><\/li>\n
        • Dehydration<\/span><\/li>\n
        • Weight loss<\/span><\/li>\n
        • Disorientation<\/span><\/li>\n
        • Low blood pressure<\/span><\/li>\n
        • Muscle aches<\/span><\/li>\n
        • Nausea, vomiting<\/span><\/li>\n
        • Diarrhoea [30, 31<\/strong>]<\/sup><\/span><\/li>\n<\/ul>\n<\/td>\n
        		\n
          \n
        • Withdrawal of long term corticosteroid therapy<\/span><\/li>\n
        • Addison\u2019s disease<\/span><\/li>\n
        • AIDS<\/span><\/li>\n
        • Amyloidosis<\/span><\/li>\n
        • Sarcoidosis [30, 31<\/strong>]<\/sup><\/span><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
        Irritable bowel syndrome<\/strong><\/span><\/td>\n\n
          \n
        • Diarrhoea<\/span><\/li>\n
        • Constipation<\/span><\/li>\n
        • Bloating of abdomen<\/span><\/li>\n
        • Abdominal Cramps [32<\/strong>]<\/sup><\/span><\/li>\n<\/ul>\n<\/td>\n
        		\n
          \n
        • Cause unknown [32<\/strong>]<\/sup><\/span><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
        Diverticulosis<\/strong><\/span><\/td>\n\n
          \n
        • \u00a0Diarrhoea<\/span><\/li>\n
        • Abdominal cramps<\/span><\/li>\n<\/ul>\n<\/td>\n
        		\n
          \n
        • Low fiber intake<\/span><\/li>\n
        • Genetic predisposition [33<\/strong>]<\/sup><\/span><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

          <\/h2>\n

          Right Upper Quadrant Pain (RUQ)<\/h2>\n\n\n\n\n\n\n\n\n\n
          Abdomen<\/strong><\/caption>\n
          Organ<\/strong><\/span><\/td>\nCause<\/strong><\/span><\/td>\nComments<\/strong><\/span><\/td>\n<\/tr>\n
          Vessels & Lymphatics<\/span><\/strong><\/td>\n\n
            \n
          • Mesenteric ischemia<\/span><\/li>\n
          • Mesenteric adenitis<\/span><\/li>\n<\/ul>\n<\/td>\n
          		\n
            \n
          • Sudden onset, sever, diffuse pain in the abdomen<\/span><\/li>\n
          • Nausea, vomiting, anorexia<\/span><\/li>\n
          • Diarrhoea<\/span><\/li>\n
          • Abdominal distension<\/span><\/li>\n
          • Gastrointestinal bleeding[34, 35, 36, 37<\/strong>]<\/sup><\/span><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
          Liver<\/a><\/span><\/strong><\/td>\n\n
            \n
          • Acute viral hepatitis<\/span><\/li>\n
          • Acute alcoholic hepatitis<\/span><\/li>\n
          • Mass or swelling in liver<\/span><\/li>\n
          • Enlarged Liver (hepatomegaly)<\/span><\/li>\n
          • Budd-Chiari Syndrome<\/span><\/li>\n
          • Fitz-Hugh-Curtis Syndrome<\/span><\/li>\n<\/ul>\n<\/td>\n
          		Depending on the condition symptoms appear<\/span><\/p>\n
            \n
          • Jaundice<\/span><\/li>\n
          • Right Hypochondriac pain<\/span><\/li>\n
          • Pale stools<\/span><\/li>\n
          • Dark urine<\/span><\/li>\n
          • Swelling in the ankles, feet and abdomen<\/span><\/li>\n
          • Excessive tiredness<\/span><\/li>\n
          • Bruising and bleeding<\/span><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
          Gall Bladder<\/span><\/strong><\/td>\n\n
            \n
          • Acute Cholecystitis<\/span><\/li>\n
          • Cholelithiasis<\/span><\/li>\n<\/ul>\n<\/td>\n
          		\n
            \n
          • Gall bladder inflammation<\/span><\/li>\n
          • Gall bladder stones<\/span><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
          Biliary Tract<\/span><\/strong><\/td>\n\n
            \n
          • Acute Cholangitis<\/span><\/li>\n
          • Choledocholithiasis<\/span><\/li>\n<\/ul>\n<\/td>\n
          		\n
            \n
          • Biliary tract inflammation<\/span><\/li>\n
          • Biliary tract stones<\/span><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
          Others<\/span><\/strong><\/td>\n\n
            \n
          • Duodenal ulcers<\/span><\/li>\n
          • Pancreatitis<\/span><\/li>\n
          • Colon obstruction<\/span><\/li>\n
          • Colitis<\/span><\/li>\n
          • Colonic mass<\/span><\/li>\n
          • Pyelonephritis<\/span><\/li>\n
          • Perinephric abscess<\/span><\/li>\n
          • Nephrolithiasis<\/span><\/li>\n
          • Sub-diaphragmatic abscess<\/span><\/li>\n<\/ul>\n<\/td>\n
          		\n
            \n
          • Infrequent causes of RUQ pain<\/span><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
          Abdominal Wall<\/span><\/strong><\/td>\n\n
            \n
          • Cellulitis<\/span><\/li>\n
          • Herpes Zoster<\/span><\/li>\n
          • Hematoma or strain of the abdominal muscles<\/span><\/li>\n<\/ul>\n<\/td>\n
          		Skin or muscular lesions can cause abdominal pain. The pain in skin lesions can range from moderate to severe.<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

           <\/p>\n\n\n\n\n\n
          Peritoneum<\/strong><\/caption>\n
          \u00a0<\/span><\/td>\n\n
            \n
          • Intra-peritoneal abscess<\/span><\/li>\n<\/ul>\n<\/td>\n
          		\n
            \n
          • Sub-diaphragmatic abscess<\/span><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
          \u00a0<\/span><\/td>\n\n
            \n
          • Peritonitis<\/span><\/li>\n<\/ul>\n<\/td>\n
          		\n
            \n
          • Gall bladder perforation<\/span><\/li>\n
          • Duodenal ulcer perforation<\/span><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
          <\/td>\n\n
            \n
          • Intra- peritoneal haemorrhage<\/span><\/li>\n<\/ul>\n<\/td>\n
          		\n
            \n
          • Ruptured Abdominal Aortic Aneurysm.<\/span><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

             <\/p>\n\n\n\n\n\n
            Extra Abdomen<\/strong><\/caption>\n
            Bones<\/span><\/strong><\/td>\n\n
              \n
            • Right sided lower rib fractures<\/span><\/li>\n
            • Thoracic Spine fracture<\/span><\/li>\n<\/ul>\n<\/td>\n
            		It is interesting to note that few structures situated outside the abdomen may also lead to pain in the abdomen. This \u2018Referred pain\u2019 can happen when the nerves entering the spinal cord at same level are arising from different locations.<\/span><\/td>\n<\/tr>\n
            Heart<\/span><\/strong><\/td>\n\n
              \n
            • Inferior wall myocardial infarction.<\/span><\/li>\n<\/ul>\n<\/td>\n
            		It is interesting to note that few structures situated outside the abdomen may also lead to pain in the abdomen. This \u2018Referred pain\u2019 can happen when the nerves entering the spinal cord at same level are arising from different locations.<\/span><\/td>\n<\/tr>\n
            Lungs<\/span><\/strong><\/td>\n\n
              \n
            • Lower lobe pneumonia<\/span><\/li>\n
            • Pulmonary Embolism<\/span><\/li>\n
            • Pleurisy<\/span><\/li>\n
            • Pneumothorax<\/span><\/li>\n<\/ul>\n<\/td>\n
            		\u00a0<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

             <\/p>\n

            Left Upper Quadrant Pain (LUQ)<\/h2>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
            Condition<\/strong><\/span><\/td>\nClinical features<\/strong><\/span><\/td>\nDiagnostics<\/strong><\/span><\/td>\n<\/tr>\n
            Splenic trauma\/Infarct<\/span><\/strong><\/td>\n\n
              \n
            • Left upper quadrant pain in the abdomen<\/span><\/li>\n
            • Fever, chills<\/span><\/li>\n
            • Nausea, vomiting<\/span><\/li>\n
            • Left shoulder pain<\/span><\/li>\n<\/ul>\n<\/td>\n
            		\n
              \n
            • Complete blood count<\/span><\/li>\n
            • Ultrasonography of abdomen<\/span><\/li>\n
            • CT scan abdomen[38, 39, 40, 41<\/strong>]<\/sup><\/span><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
            Splenomegaly (Enlarged spleen)<\/strong><\/span><\/a><\/td>\n\n
              \n
            • Left upper quadrant pain in the abdomen<\/span><\/li>\n
            • Fever, chills<\/span><\/li>\n
            • Nausea, vomiting<\/span><\/li>\n
            • Left shoulder pain occasionally<\/span><\/li>\n<\/ul>\n<\/td>\n
            		\n
              \n
            • Complete blood count<\/span><\/li>\n
            • Ultrasonography of abdomen<\/span><\/li>\n
            • CT scan abdomen<\/span><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
            Mesenteric Ischemia<\/span><\/strong><\/td>\n\n
              \n
            • Constant pain\/Colicky pain<\/span><\/li>\n
            • Abdominal distension<\/span><\/li>\n
            • Gastro intestinal bleeding<\/span><\/li>\n
            • Fever<\/span><\/li>\n
            • Nausea, vomiting<\/span><\/li>\n<\/ul>\n<\/td>\n
            		\n
              \n
            • Complete blood count<\/span><\/li>\n
            • Serum amylase<\/span><\/li>\n
            • X-ray abdomen- Flat & erect positions<\/span><\/li>\n
            • Angiography<\/span><\/li>\n
            • CT angiography<\/span><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
            Small Bowel Obstruction<\/span><\/strong><\/td>\n\n
              \n
            • Left upper quadrant pain in the abdomen<\/span><\/li>\n
            • Abdominal distension<\/span><\/li>\n
            • Nausea<\/span><\/li>\n
            • Vomiting<\/span><\/li>\n<\/ul>\n<\/td>\n
            		\n
              \n
            • X- ray abdomen<\/span><\/li>\n
            • CT abdomen<\/span><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
            Crohn\u2019s disease<\/span><\/strong><\/td>\n\n
              \n
            • Abdominal pain, nausea, vomiting, fatigue<\/span><\/li>\n
            • Arthritis, erythema nodosum, uveitis, oral ulcers<\/span><\/li>\n<\/ul>\n<\/td>\n
            		\n
              \n
            • Complete blood count<\/span><\/li>\n
            • Colonoscopy with tissue biopsy<\/span><\/li>\n
            • Barium enema<\/span><\/li>\n
            • Ultrasonography of abdomen<\/span><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
            Mesenteric adenitis<\/span><\/strong><\/td>\n\n
              \n
            • Usually right lower quadrant abdominal pain<\/span><\/li>\n
            • Fever<\/span><\/li>\n
            • Diarrhoea<\/span><\/li>\n
            • Anorexia<\/span><\/li>\n<\/ul>\n<\/td>\n
            		\n
              \n
            • Complete blood count<\/span><\/li>\n
            • Ultrasonography of abdomen<\/span><\/li>\n
            • CT scan abdomen<\/span><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
            Acute pancreatitis<\/span><\/strong><\/td>\n\n
              \n
            • Abdominal pain with radiation to back<\/span><\/li>\n
            • Nausea<\/span><\/li>\n
            • Vomiting<\/span><\/li>\n
            • Fever<\/span><\/li>\n<\/ul>\n<\/td>\n
            		\n
              \n
            • Serum amylase, lipase<\/span><\/li>\n
            • CBC<\/span><\/li>\n
            • Ultrasonography of abdomen<\/span><\/li>\n
            • CT scan abdomen<\/span><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
            Pancreatic cyst\/ malignancy<\/span><\/strong><\/td>\n\n
              \n
            • Abdominal pain<\/span><\/li>\n
            • Jaundice<\/span><\/li>\n
            • Weight loss<\/span><\/li>\n<\/ul>\n<\/td>\n
            		\n
              \n
            • Ultrasonography of abdomen<\/span><\/li>\n
            • CT scan abdomen<\/span><\/li>\n
            • CBC<\/span><\/li>\n
            • Serum amylase, lipase<\/span><\/li>\n
            • CEA and CA 19-9<\/span><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
            Pyelonephritis<\/span><\/strong><\/td>\n\n
              \n
            • Dysuria<\/span><\/li>\n
            • Haematuria<\/span><\/li>\n
            • Flank pain<\/span><\/li>\n
            • Urgency<\/span><\/li>\n
            • Frequency<\/span><\/li>\n<\/ul>\n<\/td>\n
            		\n
              \n
            • CBC<\/span><\/li>\n
            • Urine culture<\/span><\/li>\n
            • Ultrasonography of abdomen<\/span><\/li>\n
            • CT scan abdomen<\/span><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
            Perinephric abscess<\/span><\/strong><\/td>\n\n
              \n
            • Dysuria<\/span><\/li>\n
            • Flank Pain<\/span><\/li>\n
            • Fever<\/span><\/li>\n<\/ul>\n<\/td>\n
            		\n
              \n
            • CBC<\/span><\/li>\n
            • Urine culture<\/span><\/li>\n
            • Ultrasonography of abdomen<\/span><\/li>\n
            • CT scan abdomen<\/span><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
            Nephrolithiasis<\/span><\/strong><\/td>\n\n
              \n
            • Flank pain<\/span><\/li>\n
            • Nausea<\/span><\/li>\n
            • Vomiting<\/span><\/li>\n<\/ul>\n<\/td>\n
            		\n
              \n
            • Urinalysis<\/span><\/li>\n
            • Ultrasonography of abdomen<\/span><\/li>\n
            • X- ray abdomen<\/span><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

              <\/h2>\n

              Right Lower Quadrant Pain (RLQ)<\/h2>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
              Abdomen<\/strong><\/caption>\n
              Organ<\/strong><\/span><\/td>\nCause<\/strong><\/span><\/td>\nComments<\/strong><\/span><\/td>\n<\/tr>\n
              Abdominal wall<\/span><\/strong><\/td>\n\n
                \n
              • Cellulitis<\/span><\/li>\n
              • Herpes Zoster<\/span><\/li>\n
              • Hematoma or strain of the abdominal muscles<\/span><\/li>\n
              • Inguinal hernias<\/span><\/li>\n<\/ul>\n<\/td>\n
              		Skin or muscular lesions can cause abdominal pain. The pain in skin lesions can range from moderate to severe. [42<\/strong>]<\/sup><\/span><\/td>\n<\/tr>\n
              Peritoneum and peritoneal cavity<\/span><\/strong><\/td>\n\n
                \n
              • Peritonitis<\/span><\/li>\n
              • Intraperitoneal abscess\/haemorrhage<\/span><\/li>\n<\/ul>\n<\/td>\n
              		\n
                \n
              • Acute appendicitis\/ caecal perforation<\/span><\/li>\n
              • Diverticular abscess<\/span><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
              Appendix<\/strong><\/span><\/a><\/td>\n\n
                \n
              • Acute Appendicitis<\/span><\/li>\n<\/ul>\n<\/td>\n
              		Appendicits is the infection of appendix. Right lower quadrant pain with rebound tenderness, nausea and vomiting can be seen. Occasionally an infected appendix may burst, leading to peritonitis.<\/span><\/td>\n<\/tr>\n
              Ileocaecal junction<\/span><\/strong><\/td>\n\n
                \n
              • Irritable bowel syndrome<\/span><\/li>\n
              • Crohn\u2019s disease<\/span><\/li>\n<\/ul>\n<\/td>\n
              		\n
                \n
              • Diarrhoea<\/span><\/li>\n
              • Constipation<\/span><\/li>\n
              • Bloating of abdomen<\/span><\/li>\n
              • Abdominal Cramps [32<\/strong>]<\/sup><\/span><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
              Caecum<\/span><\/strong><\/td>\n\n
                \n
              • Caecal volvulus<\/span><\/li>\n
              • Intestinal Obstruction<\/span><\/li>\n
              • Caecal perforation<\/span><\/li>\n<\/ul>\n<\/td>\n
              		In intestinal obstruction, the following may occur along with inability to pass stool.<\/span><\/p>\n
                \n
              • Nausea<\/span><\/li>\n
              • Vomiting<\/span><\/li>\n
              • Constipation<\/span><\/li>\n<\/ul>\n

                Whereas in perforation, it can lead to a localized pain which may aggravate into peritonitis.<\/span><\/td>\n<\/tr>\n

              Proximal ascending colon<\/span><\/strong><\/td>\n\n
                \n
              • Colitis<\/span><\/li>\n
              • Colonic perforation<\/span><\/li>\n
              • Colonic mass<\/span><\/li>\n<\/ul>\n<\/td>\n
              		Abdominal pain, diarrhoea, blood in stool can occur in colitis. Perforation in the intestine can lead to peritonitis.<\/span><\/td>\n<\/tr>\n
              Right Kidney and ureter<\/strong><\/a><\/span><\/td>\n\n
                \n
              • Nephrolithiasis (Ureteric colic due to stone in the ureter)<\/span><\/li>\n<\/ul>\n<\/td>\n
              		Pain maybe in the flanks, lower abdomen or back<\/span><\/td>\n<\/tr>\n
              Right ovary<\/span><\/strong><\/td>\n\n
                \n
              • Endometriosis<\/span><\/li>\n
              • Ovarian cyst rupture<\/span><\/li>\n
              • Ovarian torsion<\/span><\/li>\n<\/ul>\n<\/td>\n
              		Severe abdominal pain with nausea vomiting.<\/span>
              \n Right fallopian tube<\/span><\/td>\n<\/tr>\n
              Right fallopian tube<\/span><\/strong><\/td>\n\n
                \n
              • Pelvic inflammatory disease<\/span><\/li>\n
              • Ruptured ectopic pregnancy<\/span><\/li>\n<\/ul>\n<\/td>\n
              		Rupture can lead to internal bleeding and peritonitis.<\/span><\/td>\n<\/tr>\n
              Retroperitoneal<\/span><\/strong><\/td>\n\n
                \n
              • Iliopsoas abscess<\/span><\/li>\n
              • Iliopsoas haematoma<\/span><\/li>\n<\/ul>\n<\/td>\n
              		Fever, abdominal pain with or without radiation to the thigh, nausea, vomiting, anorexia.<\/span><\/td>\n<\/tr>\n
              Blood vessels and lymphatics<\/span><\/strong><\/td>\n\n
                \n
              • Mesenteric ischemia<\/span><\/li>\n
              • Mesenteric adenitis<\/span><\/li>\n
              • Vasculitis<\/span><\/li>\n<\/ul>\n<\/td>\n
              		\n
                \n
              • Sudden onset, sever, diffuse pain in the abdomen<\/span><\/li>\n
              • Nausea, vomiting, anorexia<\/span><\/li>\n
              • Diarrhoea<\/span><\/li>\n
              • Abdominal distension<\/span><\/li>\n
              • Gastrointestinal bleeding<\/span><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

                 <\/p>\n\n\n\n\n\n
                Extra abdomen<\/strong><\/caption>\n
                Hernia<\/span><\/strong><\/td>\n\n
                  \n
                • Femoral hernia (hernia occurring through the femoral canal in thigh)<\/span><\/li>\n<\/ul>\n<\/td>\n
                		\n
                  \n
                • It causes referred pain<\/span><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
                Right hip pathology<\/span><\/strong><\/td>\n\n
                  \n
                • Osteoarthritis<\/span><\/li>\n
                • Intertrochanteric fracture (Fracture of the trochanteric region of the thigh bone)<\/span><\/li>\n
                • Acetabular fracture (Fracture of acetabulum of the hip bone)<\/span><\/li>\n<\/ul>\n<\/td>\n
                		\n
                  \n
                • Causes referred pain<\/span><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
                Fracture of hip bone<\/span><\/strong><\/td>\n\n
                  \n
                • Pubis ramus fracture<\/span><\/li>\n<\/ul>\n<\/td>\n
                		<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

                <\/h2>\n

                Left Lower Quadrant Pain (LLQ)<\/h2>\n\n\n\n\n\n\n\n\n\n
                Abdomen<\/strong><\/caption>\n
                Organ<\/strong><\/span><\/td>\nCause<\/strong><\/span><\/td>\nComments<\/strong><\/span><\/td>\n<\/tr>\n
                Abdominal wall<\/span><\/strong><\/td>\n\n
                  \n
                • Cellulitis<\/span><\/li>\n
                • Herpes Zoster<\/span><\/li>\n
                • Hematoma or strain of the abdominal muscles<\/span><\/li>\n
                • Inguinal hernias<\/span><\/li>\n<\/ul>\n<\/td>\n
                		Skin or muscular lesions can cause abdominal pain. The pain in skin lesions can range from moderate to severe[43<\/strong>]<\/sup><\/span><\/td>\n<\/tr>\n
                Peritoneum and peritoneal cavity<\/span><\/strong><\/td>\n\n
                  \n
                • Peritonitis<\/span><\/li>\n
                • Intraperitoneal abscess\/haemorrhage<\/span><\/li>\n<\/ul>\n<\/td>\n
                		Intestinal perforation or haemorrhage may lead to peritonitis. This is characterized by a rigid abdomen which is tender.<\/span><\/td>\n<\/tr>\n
                Left Kidney and ureter<\/span><\/strong><\/td>\n\n
                  \n
                • Nephrolithiasis (Ureteric colic due to stone in the ureter)<\/span><\/li>\n<\/ul>\n<\/td>\n
                		Pain maybe in the flanks, lower abdomen or back<\/span><\/td>\n<\/tr>\n
                Left ovary<\/span><\/strong><\/td>\n\n
                  \n
                • Endometriosis<\/span><\/li>\n
                • Ovarian cyst rupture<\/span><\/li>\n
                • Ovarian torsion<\/span><\/li>\n<\/ul>\n<\/td>\n
                		Severe abdominal pain with nausea vomiting.<\/span><\/td>\n<\/tr>\n
                Left fallopian tube<\/span><\/strong><\/td>\n\n
                  \n
                • Pelvic inflammatory disease<\/span><\/li>\n
                • Ruptured ectopic pregnancy<\/span><\/li>\n<\/ul>\n<\/td>\n
                		Rupture can lead to internal bleeding and peritonitis.<\/span><\/td>\n<\/tr>\n
                Blood vessels and lymphatics<\/span><\/strong><\/td>\n\n
                  \n
                • Mesenteric ischemia<\/span><\/li>\n
                • Mesenteric adenitis<\/span><\/li>\n
                • Vasculitis<\/span><\/li>\n<\/ul>\n<\/td>\n
                		\n
                  \n
                • Sudden onset, sever, diffuse pain in the abdomen<\/span><\/li>\n
                • Nausea, vomiting, anorexia<\/span><\/li>\n
                • Diarrhoea<\/span><\/li>\n
                • Abdominal distension<\/span><\/li>\n
                • Gastrointestinal bleeding<\/span><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

                   <\/p>\n\n\n\n\n\n
                  Extra abdomen<\/strong><\/caption>\n
                  Hernia<\/span><\/strong><\/td>\n\n
                    \n
                  • Femoral hernia (hernia occurring through the femoral canal in thigh)<\/span><\/li>\n<\/ul>\n<\/td>\n
                  		\n
                    \n
                  • It causes referred pain<\/span><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
                  Left hip pathology<\/span><\/strong><\/td>\n\n
                    \n
                  • Osteoarthritis<\/span><\/li>\n
                  • Intertrochanteric fracture (Fracture of the trochanteric region of the thigh bone)<\/span><\/li>\n
                  • Acetabular fracture (Fracture of acetabulum of the hip bone)<\/span><\/li>\n<\/ul>\n<\/td>\n
                  		\n
                    \n
                  • Causes referred pain<\/span><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
                  Fracture of hip bone<\/strong><\/span><\/td>\n\n
                    \n
                  • Pubis ramus fracture<\/span><\/li>\n<\/ul>\n<\/td>\n
                  		\n
                    \n
                  • Pain in the abdomen or lower back<\/span><\/li>\n
                  • Pain increases on walking<\/span><\/li>\n
                  • Numbness in the groin or legs.<\/span><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

                    Reference:<\/strong><\/p>\n

                      \n
                    1. Moore KL, Agur AM, Dalley AF. Essential Clinical Anatomy. 4th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2011. 116-35.<\/em><\/li>\n
                    2. http:\/\/www.newhealthguide.org\/9-Regions-Of-Abdomen.html<\/em><\/li>\n
                    3. https:\/\/en.wikipedia.org\/wiki\/Abdomen<\/em><\/li>\n
                    4. Neil S. Norton, Ph.D. and Frank H. Netter, MD, Netter\u2019s Head and Neck Anatomy for Dentistry, Elsevier Saunders, Chapter 22 Page 556.<\/em><\/li>\n
                    5. Frank H. Netter, MD, Atlas of Human Anatomy, Fifth Edition, Saunders – Elsevier, Chapter Abdomen, Subchapter 24 Topographic Anatomy, Guide: Abdominal Regions, Page 126 to 127.<\/em><\/li>\n
                    6. http:\/\/humananatomychart.us\/page\/136\/<\/em><\/li>\n
                    7. https:\/\/www.onhealth.com\/content\/1\/pelvic_pain_causes<\/em><\/li>\n
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                    41. http:\/\/www.clinicaladvisor.com\/hospital-medicine\/left-upper-quadrant-abdominal-pain\/article\/600936\/<\/em><\/li>\n
                    42. http:\/\/www.clinicaladvisor.com\/hospital-medicine\/right-lower-quadrant-abdominal-pain\/article\/601145\/<\/em><\/li>\n
                    43. http:\/\/www.clinicaladvisor.com\/hospital-medicine\/left-lower-quadrant-abdominal-pain\/article\/601024\/<\/em><\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

                      Abdominal Pain Anatomy – Introduction & Divisions The abdomen, justly called as a \u2018Magic Box\u2019, has a lot of organs stuffed inside in particular positions and well-designed manner. It is in fact very difficult to identify the cause of an abdominal pain because of the multiple organs within. As you can see in the below […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[6,3],"tags":[],"class_list":["post-810","post","type-post","status-publish","format-standard","hentry","category-anatomy-and-body","category-pain-management"],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/emedicalupdates.com\/wp-json\/wp\/v2\/posts\/810","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/emedicalupdates.com\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/emedicalupdates.com\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/emedicalupdates.com\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/emedicalupdates.com\/wp-json\/wp\/v2\/comments?post=810"}],"version-history":[{"count":10,"href":"https:\/\/emedicalupdates.com\/wp-json\/wp\/v2\/posts\/810\/revisions"}],"predecessor-version":[{"id":1056,"href":"https:\/\/emedicalupdates.com\/wp-json\/wp\/v2\/posts\/810\/revisions\/1056"}],"wp:attachment":[{"href":"https:\/\/emedicalupdates.com\/wp-json\/wp\/v2\/media?parent=810"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/emedicalupdates.com\/wp-json\/wp\/v2\/categories?post=810"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/emedicalupdates.com\/wp-json\/wp\/v2\/tags?post=810"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}