Next Unit: Abdominal Trauma for the EMR
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The Abdominal Quadrants
The abdominal exam is organized based on abdominal quadrants. These quadrants are focused around the umbilicus and are known as the Right Upper Quadrant (RUQ), Left Upper Quadrant (LUQ), Right Lower Quadrant (RLQ), and Left Lower Quadrant (LLQ).
Each of these divisions is named after the patient's right or left side. (That is, referencing from the patient's point of view.)
The upper quadrants extend cephalad (upwards from the umbilicus) to the base of the ribs and the lower quadrants extend caudally (downwards from the umbilicus) to the pelvic girdle.
These divisions are important as they categorize the position of organs within the body. What follows is a listing of said organ positions:
- Right Upper Quadrant (RUQ): liver - gallbladder - duodenum of the intestines - a small portion of the pancreas
- Left Upper Quadrant (LUQ): Stomach - Spleen
- Left Lower Quadrant (LLQ): The descending colon - The left half of the transverse colon - Sigmoid colon - Rectum
- Right Lower Quadrant (RLQ): large intestine - small intestine - appendix
Right Upper Quadrant
The RUQ is known for liver and gallbladder (biliary) pathology. While there are many unique diseases of the biliary system and liver, almost all of them will present with pain in this quadrant, and perhaps some referred pain to the right shoulder blade. Little or no external manifestations will be evident. Liver lacerations and resultant hematomas (with hypotension) are the most classic traumatic RUQ injury.
Left Upper Quadrant
The LUQ is known for stomach ulcers and splenic pathology.
- Stomach ulcers are extremely common and can present with pain in both the LUQ and RUQ. They may be associated with significant hematemesis.
- Trauma to the LUQ can also present with hematemesis.
- Similar to the RUQ for liver lacerations, a splenic laceration is the most common traumatic LUQ injury and can present with hematoma and hypotension. (Referred pain to the left shoulder blade.)
Left Lower Quadrant
The LLQ is commonly involved in diseases such as diverticulitis, impacted stool, and ovarian pathology. Each of these will present with tenderness and variable other findings. Trauma is less common in this quadrant: most complaints will involve acute presentations of the above illnesses, but be prepared to recognize ovarian torsion and intestinal perforation. Perforations of the rectum and sigmoid colon can occur with foreign bodies or trauma.
Right Lower Quadrant
The RLQ is very similar to the LLQ. An exception is the presence of the appendix.
Appendicitis is one of the most common acute abdominal complaints. Located in the RLQ, the appendix can become inflamed and lead to central abdominal pain that migrates to the LLQ after several hours. Few other findings are present until the appendix ruptures but, after this, extreme tenderness, a tense abdomen, fever, and signs of shock may be present.