Abdominal Pain: Differential Diagnosis of Pain Based on Location

How Can Abdominal Pain Location Guide the Differential Diagnosis?

Abdominal pain can occur anywhere in the abdominal region. Our abdomen can be divided into nine anatomical regions or quadrants. These regions or quadrants help in correlating anatomical structures (organs) in those particular areas.

Abdominal pain occurring in a particular location corresponds to organs present in those regions or quadrants. This helps doctors arrive at a differential diagnosis.

What Are the Differential Diagnoses for Pain Involving Multiple Regions of the Abdomen?

The differential diagnoses for abdominal pain may vary depending on its location. Some of them are discussed below:

Differential diagnosis for right hypochondriac (right upper quadrant) pain:

The right upper quadrant of the abdomen involves the gall bladder, liver, and kidneys. The common causes of abdominal pain in this region include:

1. Gallbladder diseases:

It is a pear-shaped organ. It helps to store and concentrate bile juice. Upper abdominal pain in the right quadrant may occur due to gallbladder diseases. These include:

• Cholecystitis (redness and swelling of the gallbladder).

• Cholelithiasis (when gallstones form from the digestive fluids in the gallbladder).

2. Duodenal ulcers:

A duodenal ulcer is a small wound or sore in the first part of the small intestine (called the duodenum). These ulcers may cause pain in the right upper quadrant of the abdomen. With time, this pain is reduced with the intake of food or with the help of antacids.

3. Hepatitis and other hepatobiliary diseases:

These diseases, such as cirrhosis (severe scarring of the liver), hepatoma (cancer of the liver cells), or cholangitis (infection of the bile duct system), can cause pain and tenderness in this region. These conditions lead to increased bilirubin levels, resulting in yellowing of the skin and eyes (jaundice), as well as yellowing of the white part of the eye (scleral icterus).

Differential diagnosis for left hypochondriac (upper left abdomen) pain:

The left hypochondriac area consists of components of the stomach, the upper portion of the left side of the liver, the kidney, the spleen, and the tail of the pancreas.

Pain in the left hypochondriac region can be due to gastroesophageal reflux disorder (GERD), gastritis, or gastric ulcers. A splenic rupture (breakage in the surface of the spleen) and cyst can also be the cause, or other diseases of the spleen can cause pain in this region, which frequently radiates to the back.

Some of these conditions may cause anemia and an enlarged spleen, which can be detected during a physical examination by a doctor.

Differential diagnosis for umbilical pain:

The umbilical area is the part of the abdomen that generally surrounds the navel (belly button). The pain in this area may be due to the following conditions:

• Pancreatitis:

Inflammation of the pancreas.

• Peptic ulcer disease:

In this condition, sores are formed in the stomach lining, duodenum (first part of the small intestine), and esophagus (food pipe) due to stomach acid.

• Mesenteric ischemia:

In this condition, there is a blockage of blood flow to the small intestine.

• Small bowel obstruction:

The small intestine is blocked.

Apart from these, your doctor may also check for an umbilical hernia. In this condition, a part of the intestine protrudes through the abdominal muscles. If the hernia cannot be controlled, surgery may be necessary for this type of hernia.

Another possible cause of pain in this region is enteritis. This condition is characterized by inflammation of the small intestine. It occurs due to either infections (bacterial or viral) or autoimmune issues. The symptoms related include:

• Nausea.

• Vomiting.

• Diarrhea.

Doctors usually enquire about the food intake. This is because this infection is caused mainly due to contaminated food intake, or through close contact with an affected person (like a family member or a friend).

Differential diagnosis for right lumbar pain:

This region is from the middle part of the abdomen to the belly button.

1. Sudden pain in the left or right lumbar region, accompanied by fever or painful urination, can be caused by kidney stones or a kidney infection.

2. Early appendicitis is an inflammation of the appendix. This can also result in pain around the belly button, which may later shift to the lower right side of the abdomen.

Differential diagnosis for bilateral iliac pain:

• Pain in the left and right iliac regions or lower abdominal pain in females can be due to ovarian torsion (when the ovary twists and loses blood supply) or ovarian cysts.

• Pain in both these areas can also be due to testicular torsion (when the testicle twists) in males.

Differential diagnosis for epigastric pain:

The epigastric region is in the upper central area of the abdomen.

• Pain present in the epigastrium (upper middle part of the abdomen) will be related to GERD and gastritis. These conditions can cause heartburn, regurgitation (food coming back up), chest pain, and coughing.

• A gastric ulcer also causes pain in the epigastric region. In this condition, the pain becomes worse after eating, and the pain will not be relieved with the help of antacids.

Differential diagnosis for right iliac pain:

• In this region, the patient may experience a sudden pain that moves to the lower right side of the abdomen.

• These may experience anorexia (an eating disorder characterized by calorie restriction), nausea, and vomiting.

• Inguinal hernias (bulge in the groin area) present on the right side can be responsible for pain in the right lower abdomen.

Differential diagnosis for left side iliac pain:

• Conditions such as diverticulitis, ischemic colitis (reduced blood flow to the colon), and inguinal hernias can cause pain in the left lower abdomen region.

Conclusion

Abdominal pain may be due to various reasons, like infections, food poisoning, or menstruation. It is felt anywhere between the ribs and the pelvic region. The exact region of the pain is important for the doctor to identify the cause of the abdominal pain. Different areas of pain may indicate different conditions like GERD, gastritis, cholecystitis, hernia, and appendicitis. Hence, it becomes essential for a doctor to determine the exact location of the pain to conclude what is causing the pain. Along with this, the healthcare provider may conduct a physical examination, take a medical history, and various tests may be performed. For more information, you can consult a gastro health specialist online.

Key Takeaways

• Abdominal pain may be due to either a simple cause or a serious issue.

• The exact location of the abdominal pain may provide a clue as to what is causing it.

• Doctors can often diagnose the condition based on the location of the abdominal pain.