Right lower quadrant pain

Introduction Abdominal pain is one of the most common clinical symptoms. But because abdominal pain is mostly sporadic, it is often easy for patients to take it lightly. The approximate division of the location of the abdominal organs. Upper right: liver, gallbladder, biliary tract, pancreas, duodenum, right kidney, right segment of the large intestine. Top left: stomach, spleen, pancreas, left kidney, left colon. Bottom right: cecum, appendix, right ovary and fallopian tube, right ureter. Bottom left: sigmoid colon, left ovary and fallopian tube, left ureter. Right lower abdominal pain is a disease of the cecum, appendix, right ovary and fallopian tube, right ureter.

Cause

Chronic right lower abdominal pain - common in chronic appendicitis, intestinal tuberculosis and right fallopian tube oophoritis.

There are many reasons for pain in the right lower quadrant. The more common ones are as follows:

The main symptom of chronic appendicitis is pain in the lower right abdomen accompanied by gastrointestinal dysfunction. Pain in the right lower quadrant is intermittent or mild pain or persistent pain, often caused by severe activity or improper diet. Can be associated with a variety of gastrointestinal dysfunction, such as indigestion, bloating, heating, nausea, acid reflux, upper abdominal discomfort, increased frequency of bowel movements or constipation.

Intestinal tuberculosis can be manifested as abdominal distension, diarrhea, abdominal pain, and systemic symptoms. Abdominal pain is mostly located in the right lower abdomen or around the umbilicus. It is often paroxysmal abdominal pain accompanied by bowel sounds. It can also be persistent pain in the lower right abdomen and abdominal pain. It can be irregular or induced by eating.

an examination

Related inspection

Abdominal plain film abdominal MRI examination abdominal percussion

1, routine examination of blood, urine, feces: the total number of white blood cells and neutrophil increased suggesting inflammatory lesions, almost every patient with abdominal pain need to be examined. A large number of red blood cells in the urine suggest urinary stones, tumors or trauma. Proteinuria and white blood cells suggest a urinary system infection. Pus and blood will prompt intestinal infection, bloody stools suggest strangulated intestinal obstruction, mesenteric thromboembolism, hemorrhagic enteritis and so on.

2, blood biochemical examination: serum amylase increased suggestive of pancreatitis, is the most commonly used blood biochemical examination in the differential diagnosis of abdominal pain. Determination of blood sugar and blood ketone can be used to line up abdominal pain caused by diabetic ketosis. Increased serum bilirubin suggests biliary fatigue. Examination of liver and kidney function and electrolytes is also helpful in judging the condition.

3. Routine and biochemical examination of abdominal puncture fluid: When the diagnosis of abdominal pain is unknown and abdominal fluid is found, abdominal puncture must be performed. The liquid obtained by puncture should be sent for routine and biochemical examination, and if necessary, bacterial culture is required. However, the visual observation of the puncture fluid has been helpful in the diagnosis of intra-abdominal hemorrhage and infection.

4, X-ray examination: abdominal X-ray film examination is the most widely used in the diagnosis of abdominal pain. The gastrointestinal perforation of free gas found in the armpit can be determined. Intestinal gas expansion, most fluid in the intestine can diagnose intestinal obstruction. Calcification of the sputum can prompt ureteral stones. Lumbar muscle shadows are blurred or disappeared, suggesting peritoneal inflammation or bleeding. X-ray barium meal imaging, or barium enema examination can find gastroduodenal ulcers, tumors and so on. Only in case of suspected intestinal obstruction, taboo meal should be contraindicated. Gallbladder, cholangiography, endoscopic retrograde cholangiopancreatography and percutaneous cholangiography are helpful for the differential diagnosis of biliary and pancreatic diseases.

5, real-time ultrasound and CT examination: the differential diagnosis of liver, gallbladder, pancreatic disease has an important role, if necessary, according to ultrasound examination and positioning for liver puncture and other liver abscess, liver cancer, etc. can be confirmed.

6, endoscopy: can be used for the differential diagnosis of gastrointestinal diseases, often in patients with chronic abdominal pain.

7, B-ultrasound is mainly used to check biliary and urinary calculi, bile duct dilatation, pancreas and hepatosplenomegaly. It also has a good diagnostic value for a small amount of effusion, intra-abdominal cysts and inflammatory masses in the abdominal cavity.

8, ECG examination for older patients, should be an electrocardiogram to understand myocardial blood supply, exclude myocardial infarction and angina

Differential diagnosis

Identification of symptoms that are easily confused in the right lower quadrant :

Differential diagnosis of right lower abdominal pain:

1, right lower abdomen pain is one of the important symptoms of appendicitis, if the patient's right lower abdomen has obvious pain, especially the right anterior superior iliac spine and umbilical cord 1/3 outside the line of severe pain, it should be suspected of appendicitis. Coupled with high fever, high blood pressure, there is often the risk of appendicitis pus and perforation, not surgery. However, the patient's right lower quadrant pain is not all appendicitis and should be identified.

2. If the pain in the right upper abdomen is high and radiated to the right shoulder and back, abdominal pain is related to greasy food. When the medical examination is extended to the enlarged gallbladder, acute cholecystitis should be considered; if the umbilical cord and the umbilicus are in pain at the lower right Accompanied by upper respiratory tract infection, especially children with abdominal pain after fever, abdominal pain is not completely confined to the right lower abdomen, mesenteric lymphadenitis should be thought of; if there is severe knife-like abdominal pain before the right lower quadrant pain, in the past Have a history of stomach, check the abdomen like a wooden board, do not forget the perforation of the stomach or duodenal ulcer; if the right lower abdomen pain presents an unbearable colic, and radiate to the scrotum and the inner thigh, check the urine If a large number of red blood cells are found in the fluid, there is a possibility of urinary tract stones; if the right lower abdomen occurs in women of childbearing age and there is menopause, it is suspected that the ectopic pregnancy ruptures, and if the woman has a lower right abdominal pain, the local can touch a round and smooth cystic A lump, it is necessary to think of ovarian cyst torsion; if the right lower abdomen pain accompanied by chills, fever, low back pain and urgency, frequent urination, urinary disease, there may be acute pyelonephritis.

3, chronic appendicitis: the main symptoms are right lower quadrant pain accompanied by gastrointestinal dysfunction. Pain in the right lower quadrant is intermittent or mild pain or persistent pain, often caused by severe activity or improper diet. Can be associated with a variety of gastrointestinal dysfunction, such as indigestion, bloating, heating, nausea, acid reflux, upper abdominal discomfort, increased frequency of bowel movements or constipation.

4, intestinal tuberculosis: can show abdominal distension, diarrhea, abdominal pain, accompanied by systemic symptoms, abdominal pain is mostly located in the right lower abdomen or around the umbilicus, often with paroxysmal abdominal pain, accompanied by bowel sounds, can also be sustained in the lower right abdomen Hidden pain, abdominal pain can be irregular, but can also be induced by eating.

diagnosis:

1. Acute gastroenteritis: Most food poisoning caused by eating unclean food, usually accompanied by severe vomiting, diarrhea, fever and other symptoms.

2. Acute appendicitis: commonly known as appendicitis, may occur in any age group, but it occurs between 20 and 40 years old. Most patients are transferred from upper abdominal pain to lower right abdomen pain, and their pain reaches a peak in about 4 to 6 hours. At this time, the pain is even worsened by coughing or moving the body.

3. Ulcer perforation: Sudden upper abdominal pain is a typical symptom, and other symptoms include abdominal distension, nausea, vomiting, fever, and severe severe peritonitis.

4. Acute cholecystitis: Pain usually occurs after a meal or in the middle of the night, in the right upper abdomen or upper abdomen, sometimes the pain will spread to the right shoulder or shoulder, and combined with fever, vomiting, jaundice and so on.

5. Acute pancreatitis: Common symptoms are severe and persistent upper or upper abdomen pain (sometimes the pain extends to the back), nausea, vomiting, and fever. When the body bends forward, the pain is slightly relieved.

6. Intestinal obstruction: Sudden upper abdominal pain is a typical symptom, and there are other symptoms such as bloating, nausea, severe vomiting, etc. Common causes include stool obstruction, intestinal cancer obstruction, intestinal torsion, etc., and even severe sepsis Complications such as perforation.

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