Diagnosis of Abdominal Pain: The Four Quadrants

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  • 0:26 How Best To Diagnose…
  • 1:02 Right Upper Quadrant
  • 1:57 Left Upper Quadrant
  • 2:29 Left Lower Quadrant
  • 3:04 Right Lower Quadrant
  • 3:38 All Over or Midline Pain
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Lesson Transcript
Instructor: Artem Cheprasov

Artem has a doctor of veterinary medicine degree.

This lesson will discuss the major points of the four-quadrant approach to diagnosing abdominal pain. While every possible permutation of pain in the abdomen won't be covered, you will come out with a good understanding as to what a problem may be.

Pain in the Abdomen

My stomach hurts! Who hasn't exclaimed that a bunch of times in their life? The problem is that it may not really be your stomach that hurts. Knowing the relative location of stomach pain is nonetheless important for doctors to have an idea as to what the problem may be.

That's what this lesson will discuss: the approach to diagnosing abdominal pain via the four-quadrant approach - and then some.

How to Best Diagnose Abdominal Pain

Before jumping in here, do realize that some of the things I'm going to discuss may overlap into other areas or be more nuanced than what I mention, but I'm going to boil this down to its simplest form so you don't get confused and so that you can, instead, focus on the basic but important points.

In order for the diagnosis of abdominal pain to make sense to you, you need to know your anatomy really well. Looking at lots of pictures helps - pictures like the ones that show all of the abdominal contents and pictures that divide the abdomen into four quadrants.

Right Upper Quadrant

Once you've nailed down the location of all of the contents of the abdomen, either by studying pictures like the ones shown on the screen or by watching more Study.com videos specific to each organ system, then you'll be ready to start playing doctor at home with your family.

First, your brother runs into your room complaining that the right side of his abdomen hurts for some reason. You notice he's clasping at an area above the belly button on the right. This is the location of our right upper quadrant. Pain in this area could be attributed to several organs and many different diseases, including:

  • The liver, where it may indicate hepatitis, the inflammation of the liver
  • The gallbladder, where pain could be a sign of cholecystitis, the inflammation of the gallbladder
  • An intestinal obstruction

Left Upper Quadrant

After making your brother feel much worse by telling him what could be wrong, your dad comes in screaming, clutching the left side of his body. Thankfully, it's not likely a heart attack since he's not clutching his chest (more on that later). Instead, he's clutching the left upper quadrant of the abdomen. Reasons for this may include problems with the:

  • Stomach, due to something like an ulcer, gastritis (the inflammation of the stomach), or an obstruction
  • Spleen, due to a rupture
  • An intestinal obstruction

Left Lower Quadrant

After all this, your sister comes into the room yelling for help, too! Your family must have had some very strange Kool-Aid for dinner for everyone to get so sick right away. Anyways, you try to figure out what could be wrong with your sister based on the fact that she's crying about the lower left part of her abdomen hurting her. The reasons for this can be things that affect the:

  • Descending colon, like diverticulitis, the inflammation of pouches, diverticula, formed in the wall of the colon
  • The left ovary or fallopian tube
  • An intestinal obstruction

Right Lower Quadrant

And just as you thought it couldn't get any worse, your mom comes in yelling for help as well, clasping at her right lower abdomen. You explain to her that this can be due to conditions that affect the:

  • Appendix - pain related to appendicitis might begin as periumbilical, around the navel, or epigastric, but it migrates to the right lower quadrant with time
  • The right ovary or fallopian tube
  • An intestinal obstruction

Midline Pain

All of this mayhem and stress has caused you some abdominal pain as well. You can't tell if it's coming from the middle of your body or is on both sides at once. You try to logically figure which it could be. If it's hurting on both sides at the same time, it could be due to:

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