Abdominal Pain Location Guide
Common Abdominal Pain Patterns in OSCEs
The location of abdominal pain can point towards different diagnoses.
It does not give you the diagnosis by itself, but it helps you decide what to ask next.
Pain Location and Possible Causes
Epigastric Pain
- Reflux, gastritis, peptic ulcer disease, pancreatitis, atypical MI, AAA
Left Upper Quadrant Pain
- Splenic pathology, gastritis, pancreatitis
Left Iliac Fossa Pain
- Diverticulitis, ulcerative colitis, gynaecological pathology
Suprapubic Pain
- UTI, urinary retention, pelvic inflammatory disease, pregnancy-related causes, testicular torsion
Right Upper Quadrant Pain
- Gallstones, cholecystitis, cholangitis, hepatitis
Right Iliac Fossa Pain
- Appendicitis, Crohn’s disease, gynaecological pathology
Flank Pain
-
renal colic, pyelonephritis, AAA
Appendicitis
Classically presents with central abdominal pain that migrates to the right iliac fossa.
Associated symptoms may include:
Norexia
Nausea
Vomiting
Fever
Biliary Colic, Cholecystitis & Cholangitis
Usually causes right upper quadrant or epigastric pain
Features may include:
Pain after fatty foods
Radiation to the right shoulder tip
Nausea or vomiting
Fever if cholecystitis or cholangitis is present
Jaundice with cholangitis
Peptic Ulcer Disease
Usually causes epigastric burning pain.
Features may include:
Relation to meals
NSAID use
Smoking and alcohol
Haematemesis
Melaena
Pancreatitis
Usually causes right upper quadrant or epigastric pain
Features may include:
Pain after fatty foods
Radiation to the right shoulder tip
Nausea or vomiting
Fever if cholecystitis or cholangitis is present
Jaundice with cholangitis
Gastroenteritis
Often causes crampy abdominal pain with vomiting and diarrhoea.
Ask about:
Sick contacts
Recent food exposure
Recent travel
Fever
Blood in stool
Hydration/volume status
Inflammatory Bowel Disease
This encompasses Crohns and Ulcerative Colitis. These may cause pain throughout the abdomen.
Ask about:
Passing mucous or blood rectally
Abnormal bowel habit, frequency passing stools
Anaemia symptoms (tiredness)
Poor appetitie, weight loss
Renal Colic
Often causes flank pain radiating to the groin.
Ask about:
Waves of severe pain
Haematuria
Nausea or vomiting
Urinary symptoms
Pyelonephritis
Can present similar to UTI/Colic with flank pain or suprapubic pain.
Ask about:
Urinary tract symptoms: dysuria/haematuria
Fever
Loin to groin pain
OSCE Talk Tip
Abdominal Aortic Aneurysm and Aortic Dissection can present with generalised abdominal pain and an unwell patient. This is one to always consider, especially in older patients with risk factors (hypertension, smoking, male, connective tissue disorders, >65)
Urinary Tract Infection
Suprapubic pain. Consider this in elderly patients off baseline/with delirium.
Ask about:
Urinary tract symptoms: dysuria/haematuria/foul smelling urine/frequency
Sexual history and safe sex
Multiple recent UTIs (consider diabetes or structural renal pathology)
Are they passing urine? If not consider retention and urgent catheterisation
Testicular Torsion
Suprapubic pain can be present, alongside severe groin/testicular pain.
Needs urological and surgical input urgently.
Ask about:
Swelling/erythema of the scrotum
Nausea/vomiting
Pain worse with moving/walking
Gynaecological Pathology
This includes torsion, cysts, PID, endometriosis, and ectopic pregnancy
This may cause pain anywhere in the abdomen and can be under investigated.
Ask about:
Menstrual cycle, irregularity, pain, heavy periods
Pregnancy
Sexually transmitted infections
Nausea/vomiting
Temperatures