Right lower quadrant abdominal pain

(Redirected from RLQ pain)


  • This page describes the general approach to RLQ pain in adults

Classification by Abdominal pain location

Side-by-side comparison of quadrants and regions.
Chart of commonly reported referred pain sites.
RUQ pain Epigastric pain LUQ pain
Flank pain Diffuse abdominal pain Flank pain
RLQ pain Pelvic pain LLQ pain

Clinical Features

  • Right lower quadrant abdominal pain

Differential Diagnosis

RLQ Pain


Appendicitis Risk Scores

Alvarado Clinical Scoring System

Right Lower Quadrant Tenderness +2
Elevated Temperature (37.3°C or 99.1°F) +1
Rebound Tenderness +1
Migration of Pain to the Right Lower Quadrant +1
Anorexia +1
Nausea or Vomiting +1
Leukocytosis > 10,000 +2
Leukocyte Left Shift +1

Clinical scoring system, where a score (Total=10) is composed on presence/absence of 3 signs, 3 symptoms and 2 lab values to help guide in case management.

  • ≤3 = Appendicitis unlikely
  • ≥7 = Surgical consultation
  • 4-6 = Consider CT

MANTRELS Mnemonic: Migration to the right iliac fossa, Anorexia, Nausea/Vomiting, Tenderness in the right iliac fossa, Rebound pain, Elevated temperature (fever), Leukocytosis, and Shift of leukocytes to the left (factors listed in the same order as presented above).


  • Include genital exam (pelvic exam or testicular), if appropriate


  • Abdominal panel
    • CBC
    • Chemistry
    • Consider LFTs + lipase
    • Consider coagulation studies (PT, PTT, INR), as a marker of liver function
  • Urinalysis
    • Leukocytes will be present in 40% of patients[1]
    • Urine pregnancy test (if age and sex appropriate)



  • Typically start with CT abdomen/pelvis (to rule out appy)


  • Frequently utilize bimanual pelvic exam to determine first study:

^If pregnant, consider substituting MRI for CT


  • Definitive diagnosis may be determined via a combination of history, labs, and/or imaging
  • About one-third of patients do not have a definitive diagnosis by end of ED workup[2]


  • Treat underlying disease process
    • If imaging studies are negative, but bimanual was positive, consider empiric treatment for PID


  • Per underlying disease process

See Also

External Links


  1. Baird DLH, Simillis C, Kontovounisios C, Rasheed S, Tekkis PP. Acute appendicitis. BMJ. 2017;357:j1703. Published 2017 Apr 19. doi:10.1136/bmj.j1703
  2. Hosiniejad SM, et al. Arch Acad Emerg Med. 2019; 7(1): e44. Published online 2019 Aug 17. One Month Follow-Up of Patients with Unspecified Abdominal Pain Referring to the Emergency Department; a Cohort Study.