Abdominal Pain in the Hypogastrium, Central and Lower Abdomen

CLINICAL DIAGNOSTIC MANUAL

Abdominal pain in the hypogastrium, also known as pain in the central and lower abdomen, can be associated with various pathologies affecting the organs located in this area, such as the bladder, uterus, intestines, and other pelvic structures.

This pain can vary in intensity, from mild to severe, and can be constant or intermittent. A detailed clinical evaluation and appropriate complementary tests are essential to determine the underlying cause and provide the appropriate treatment.

Pathology	Symptoms and Clinical Signs	Suspicion Diagnosis	Confirmatory Diagnosis
Cystitis	Dysuria, urinary frequency, suprapubic pain, haematuria, fever	Clinical history, physical examination, urinalysis	Urine culture, urinary tract ultrasound
Pyelonephritis	Fever, flank pain, dysuria, nausea, vomiting	Clinical history, physical examination, urinalysis, complete blood count	Urine culture, abdominal CT scan
Endometriosis	Chronic pelvic pain, dysmenorrhoea, dyspareunia, infertility	Clinical history, gynaecological examination	Laparoscopy, pelvic ultrasound
Pelvic Inflammatory Disease	Pelvic pain, fever, abnormal vaginal discharge, dyspareunia, dysuria	Clinical history, physical examination, complete blood count, urinalysis	Vaginal secretion culture, pelvic ultrasound
Appendicitis	Hypogastric pain shifting to the right lower quadrant, nausea, vomiting, fever	Clinical history, physical examination, complete blood count	Abdominal CT scan
Diverticulitis	Left flank pain, fever, changes in bowel habits, nausea	Clinical history, physical examination, complete blood count	Abdominal CT scan, colonoscopy
Irritable Bowel Syndrome	Chronic abdominal pain, changes in bowel habits, abdominal distension, relief with defecation	Clinical history, physical examination	Clinical diagnosis, tests to exclude other pathologies
Inguinal Hernia	Groin pain, visible or palpable lump in the inguinal area, increased pain with exertion	Clinical history, physical examination	Abdominal ultrasound, abdominal CT scan
Ovarian Cysts	Pelvic pain, abdominal distension, menstrual irregularities	Clinical history, gynaecological examination	Pelvic ultrasound, magnetic resonance imaging (MRI)
Ectopic Pregnancy	Acute pelvic pain, vaginal bleeding, dizziness, hypotension	Clinical history, gynaecological examination, pregnancy test	Transvaginal ultrasound, serum hCG levels