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Lisa, MSN, FNP-BC, CCRN, Nurse Practitioner
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Experience:  Board Certified Family Nurse Practitioner
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What are other causes for lower right quadrent pain besides

Resolved Question:

What are other causes for lower right quadrent pain besides appendicitis?
Submitted: 7 years ago.
Category: Health
Expert:  Lisa, MSN, FNP-BC, CCRN replied 7 years ago.


Thank you for writing in today. There are many different potential problems that can manifest as abdominal pain. Since there are so many differential diagnosis to consider, health care providers tend to use mnemonics in order to remember all the different possible causes. "VINDICATE" is the mnemonic that providers use when ruling out abdominal pain complaints. The actually mnemonic and associated differential diagnosis associate with it is too cumbersome to re-type here, so I will provide you with a link to the information. (See chart) Also, differentiating between types of abdominal pain is really a specialized skill, and it can be difficult for a patient to really determine the exact cause of the pain. I want to provide you with a link that describes abdominal pain and the subtle differences in presentation of that pain. At any rate, given your age, if not appendicitis, I would suspect this is likely something more common, such as ovarian cyst, Irritable bowel syndrome or even possibly a self-limiting condition, more so than malignancy, etc. However, my best advice would be to see your provider and have a proper examination. I hope this helps. If you have any additional questions or concerns, please let me know. Lisa

Customer: replied 7 years ago.
well I have had pain since about 12 midnight. so it's been 14 hours. It hasn't gotten worse but hasn't gotten better either. I don't have a fever, i was nauseated around 3 AM but that passed (i have anxiety issues) The pain is localized to where Mcburneys point would be I guess, maybe a little lower. I had a normal bowel movement this morning, that about an hour later, I had another bowel movement. It wasn't watery diahrrea, but it was soft, yet still formed. I am terrifed of it being appendicitis as I am terrified of being put under and never waking up. It doesn't hurt when I press on it...Or when I release. I can cough and walk and jump without it hurting as well. I just don't know what else would cause pain there besides appendicitis as I have no pain anywhere else.

Also about 4-5 months ago I went into ER for suspectred appendiciitis. They did a CT with contrast on my abdomen and pelvis. My appendix was normal, but they did say I had an ovarian cyst. But it hasn't bothered me since now.
I will add bonus for your time and answers. Your help would be greatly appreciated.
Expert:  Lisa, MSN, FNP-BC, CCRN replied 7 years ago.


Thank you for responding. At this point, you should still be re-evaluated for possible appendicitis. Given the location, acute onset, and pain prior to nausea, appendicitis should still be ruled out. Although you do not present with classic symptoms, there are still enough symptoms to be concerned about possible appendicitis. This can actually have an atypical presentation. The reason it is so important to rule out appendicitis is the potential risk if the appendix were to rupture. Now, this could be and may actually be related to a different bowel issues, such as irritable bowel syndrome, colitis, etc. (Crohn's Disease and Ulcerative Colitis are concerning regarding RLQ pain; however, you don't really report the stools (mucous, blood, etc.) seen in these conditions.) However, I would be very suspicious of a GYN issue, especially since you have a recent history of ovarian cyst. This could be another ovarian cyst or even possibly some endometriosis. At this point, you really do need to have the evaluation. Appendicitis should be ruled out. If appendicitis is ruled out and you are no closer to a diagnosis, you may want to talk with your provider about a possible Gastrointestinal (GI) specialist consult. A GI specialist may be able to do a more comprehensive evaluation and help to determine the exact cause. Also, especially if they find another ovarian cyst, you should follow up with your OB Gyn provider. This could very well be related to ovarian cysts and/or endometriosis. Unfortunately, this is quite common in young women. It would be best to have your OB Gyn involved. Finally, I do want to take the time to discuss anesthesia. An appendectomy, although you don't necessarily need one now but for the future, is actually a relatively safe surgery. There is a very low mortality rate. As for anesthesia, death use to be more common; however, there has been so much improvement over the last few decades. Death due to anesthesia is actually very rare, particularly in young people. In over a decade of practice, I have cared for or known many patients to have had appendectomies. I have never seen a negative outcome. I know it is natural to still have some anxiety regarding surgery and possible complications, but it may actually help you to think about these positive points. I hope this helps. Lisa

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