Localized Tenderness in the Lower Right or Left Quadrants

CLINICAL DIAGNOSTIC MANUAL

Localized tenderness in the lower quadrants of the abdomen, either right or left, is a common symptom in various pathologies affecting the organs and anatomical structures in these areas.

The lower abdominal quadrants house important structures such as the intestines, appendix, ovaries, and fallopian tubes in women, as well as parts of the urinary system.

Pain in these quadrants can be acute or chronic and may be accompanied by other symptoms such as fever, changes in bowel habits, or urinary symptoms. A detailed diagnostic approach is essential to identify the underlying cause and provide appropriate treatment.

Pathology	Symptoms and Clinical Signs	Suspicion Diagnosis	Confirmatory Diagnosis
Appendicitis	Pain that begins in the epigastrium and migrates to the right lower quadrant, fever, nausea	Clinical history, physical examination, complete blood count	Abdominal CT scan
Diverticulitis	Pain in the left lower quadrant, fever, changes in bowel habits, nausea	Clinical history, physical examination, complete blood count	Abdominal CT scan
Ectopic Pregnancy	Acute pelvic pain, vaginal bleeding, dizziness, hypotension	Clinical history, gynaecological examination, pregnancy test	Transvaginal ultrasound, serum hCG levels
Ovarian Cysts	Pelvic pain, abdominal distension, menstrual irregularities	Clinical history, gynaecological examination	Pelvic ultrasound, magnetic resonance imaging (MRI)
Pelvic Inflammatory Disease	Pelvic pain, fever, abnormal vaginal discharge, dyspareunia, dysuria	Clinical history, physical examination, complete blood count, urinalysis	Vaginal secretion culture, pelvic ultrasound
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
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
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