Chart — Gastrointestinal
Acute Abdominal Pain by Location Chart
Where it hurts narrows what it is. This quadrant map links each region to its usual suspects and the signs that confirm them — the fast first pass on any acute abdomen.
Educational use only. Location narrows but never confirms — pain can refer or be atypical (especially in older adults, diabetics, and pregnancy). Always correlate with the full picture and imaging. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Region by Region
| Region | Likely conditions | Hallmark signs |
|---|---|---|
| Right upper quadrant (RUQ) | Cholecystitis/gallstones, hepatitis, liver abscess | Murphy's sign, pain after fatty meals radiating to right shoulder, jaundice |
| Epigastric | Pancreatitis, peptic ulcer/gastritis, MI (can refer here) | Pain boring to the back relieved leaning forward (pancreatitis); ↑lipase; rule out cardiac |
| Left upper quadrant (LUQ) | Splenic issues, gastritis, pancreatitis (tail) | Splenomegaly/trauma history; pain with the pancreatic picture |
| Periumbilical → RLQ | Appendicitis (early periumbilical, then localizes) | McBurney's point, Rovsing's, psoas, obturator, rebound |
| Right lower quadrant (RLQ) | Appendicitis, ovarian/ectopic, Crohn's | Localized rebound; check pregnancy in females |
| Left lower quadrant (LLQ) | Diverticulitis, ovarian/ectopic, constipation | LLQ pain + fever ('left-sided appendicitis') |
| Diffuse / generalized | Peritonitis, bowel obstruction, ischemia, DKA | Rigid silent abdomen + rebound (peritonitis); distension + obstipation (obstruction) |
Exam Traps
- ✦RUQ + fatty-meal pain + Murphy's = cholecystitis; epigastric boring to the back = pancreatitis.
- ✦Periumbilical pain that migrates to the RLQ (McBurney's) = appendicitis.
- ✦LLQ pain + fever = diverticulitis ('left-sided appendicitis').
- ✦Always rule out ectopic pregnancy in a female with lower abdominal pain — check hCG.
- ✦Epigastric pain can be a silent MI — don't anchor on the GI tract; consider cardiac.
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with American College of Gastroenterology (ACG) / AGA · ASPEN (nutrition support). It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →