There’s a special place in medicine reserved for the mysterious and often misleading Right Lower Quadrant (RLQ) pain. It’s the abdominal equivalent of “It’s complicated.” 👀
From my time in the emergency bay at Sheikh Khalifa Hospital, one thing is clear — RLQ pain doesn’t read textbooks, and neither do the patients. Just last week, a lady from Tump walked in insisting it was her appendix, but turned out to have an ovarian torsion, caught just in time by our sharp-eyed Dr. Bilal Chaudhary.
So how do we not get blindsided?
Enter: the APPENDICITIS mnemonic — a comprehensive, memorable, and annoyingly accurate list of RLQ differentials that’ll keep you from calling surgery on every case with rebound tenderness. 🥼
RLQ Pain DDx Mnemonic
| Letter | Condition | Clinical Clues / Pearls |
|---|---|---|
| A | Appendicitis / Abscess | Classic: periumbilical to RLQ migration, fever, McBurney’s point tenderness 🔥 |
| P | Pelvic Inflammatory Disease / Period | Cervical motion tenderness, vaginal discharge, missed period? Time to call Gyn 👩⚕️ |
| P | Pancreatitis (radiating pain) | Not classic, but tail inflammation can confuse you — check lipase, and don’t trust the location 🥴 |
| E | Ectopic Pregnancy / Endometriosis | hCG test before you order anything — always. Endometriosis pain may be cyclical 🩸 |
| N | Neoplasia | Ovarian or colonic — consider if chronic, cachexia, or constitutional symptoms 🤔 |
| D | Diverticulitis (usually LLQ but…) | Think right-sided diverticulitis in Asian populations or in odd presentations |
| I | Intussusception | Sausage-shaped mass, red currant jelly stool — pediatrics gold. Dr. Bilal loves these 👶 |
| C | Crohn’s Disease / Cyst (ovarian) | Terminal ileitis or a ruptured ovarian cyst — both can mimic appendicitis 🎭 |
| I | Inflammatory Bowel Disease | Chronic diarrhea, weight loss, family history — and yes, it can flare suddenly 📉 |
| T | Torsion (ovarian/testicular) | Sudden, severe, nauseating — do not delay ultrasound. Surgical emergency 🚨 |
| I | Irritable Bowel Syndrome (IBS) | The great pretender. Crampy, relieved by defecation, and no red flags 🧘 |
| S | Stones (ureteric) | Flank to groin pain, hematuria, can mimic appendicitis. CT KUB is your friend 🪨 |
🏥 Real-World Confusion: The Mashkhel Mix-Up
A 22-year-old woman from Mashkhel, Balochistan came in crying, curled up on the bed, guarding her RLQ. Surgical resident says “appendicitis,” and the OT is booked.
But something felt off — she wasn’t febrile, leukocytes were low, and pain started mid-cycle. A quick pelvic ultrasound (thanks to Dr. Danish Ramzan) revealed a ruptured hemorrhagic ovarian cyst. Appendix was innocent. Again.
That moment reminded me why mnemonics like this exist — not just to impress the FCPS/PLAB examiners, but to protect real patients from unnecessary scalpels.
💬 Clinical Tips
- Don’t forget the pregnancy test. Even in the “I’m sure I’m not pregnant” cases. Trust me.
- Always examine the groin — hernias love to be dramatic in unexpected places.
- Ask about previous episodes — Crohn’s, IBS, and even kidney stones often have a pattern.
- Beware of anchoring — just because the last 5 RLQ patients had appendicitis doesn’t mean the 6th one does. Medicine isn’t cricket. 🏏
Happy learning, folks! 🙂
Author: Dr. Aurangzaib Qambrani
Qualifications: MBBS, PLAB, MRCP-UK
Hospital: Sheikh Khalifa Bin Zayed Hospital, Quetta
