Abdominal Pain: Common Causes
and When to Get Scanned
Abdominal pain is one of the most common reasons patients seek medical attention. The location, character, and associated symptoms are the key to identifying the cause.
In brief: The location of abdominal pain is the most important diagnostic clue. Right upper quadrant pain suggests gallbladder or liver disease; right lower quadrant pain in a young adult suggests appendicitis. An abdominal ultrasound is the first-line investigation for most structural causes of abdominal pain and can be arranged the same day at Victoria Medical.
Upper Abdominal Pain — Possible Causes
Pain in the upper right abdomen (right upper quadrant, or RUQ) is most commonly caused by gallbladder disease. Gallstones affect approximately 10–15% of the UK adult population, and biliary colic — the cramping pain caused by a stone obstructing the bile duct — is a classic presentation: severe, colicky pain in the RUQ, often radiating to the right shoulder tip, triggered by fatty meals. A 2023 study confirmed that point-of-care ultrasound has a sensitivity of 94% for acute cholecystitis.[2]
Upper central (epigastric) pain is commonly caused by peptic ulcer disease, gastro-oesophageal reflux disease (GORD), or pancreatitis. Pancreatitis typically presents as severe epigastric pain radiating to the back, often associated with nausea and vomiting, and requires urgent hospital assessment.
Lower Abdominal Pain — Possible Causes
Lower right quadrant pain in a young adult is appendicitis until proven otherwise — it is a surgical emergency. However, in women of reproductive age, the differential diagnosis also includes ovarian cyst, ovarian torsion, and ectopic pregnancy. Lower left quadrant pain in adults over 40 is commonly caused by diverticular disease.
Generalised or diffuse abdominal pain — pain that is difficult to localise — is most commonly caused by irritable bowel syndrome (IBS), which affects approximately 10–15% of the global population.[5] However, diffuse pain can also indicate more serious conditions including inflammatory bowel disease, mesenteric ischaemia, or early bowel obstruction.
Abdominal Pain by Region
| Region | Common Causes |
|---|---|
| Upper right (RUQ) | Gallstones, cholecystitis, hepatitis, liver disease, right lower lobe pneumonia |
| Upper left (LUQ) | Gastritis, peptic ulcer, pancreatitis, splenomegaly, left lower lobe pneumonia |
| Central (epigastric) | Peptic ulcer disease, GORD, pancreatitis, aortic aneurysm (AAA), early appendicitis |
| Lower right (RLQ) | Appendicitis, ovarian cyst/torsion (women), inguinal hernia, Crohn's disease, kidney stone |
| Lower left (LLQ) | Diverticulitis, constipation, ovarian cyst (women), inguinal hernia, kidney stone |
| Diffuse / generalised | IBS, IBD, peritonitis, mesenteric ischaemia, early bowel obstruction, functional pain |
Call 999 or go to A&E immediately if you have:
- • Sudden, severe abdominal pain — especially if it came on in seconds
- • Abdominal pain with fever, vomiting blood, or blood in stool
- • Rigid, board-like abdomen (peritonism)
- • Severe pain with dizziness or collapse (possible AAA or ectopic pregnancy)
- • Pain in pregnancy with bleeding or shoulder tip pain
When Abdominal Pain Needs Investigation
Abdominal pain that persists for more than 2–4 weeks, recurs regularly, is associated with weight loss or change in bowel habit, or is accompanied by jaundice, fever, or blood in the stool should always be investigated. NICE NG12 recommends urgent investigation for abdominal pain with associated weight loss or rectal bleeding in adults over 40.[1]
An abdominal ultrasound is the first-line investigation for most structural causes of abdominal pain. It can identify gallstones, kidney stones, liver disease, and aortic aneurysm quickly and without radiation. For suspected bowel pathology, additional investigations such as blood tests, stool tests, or colonoscopy may be needed. A private GP assessment at Victoria Medical will guide which investigations are most appropriate for your presentation.
From Our Practice — Dr George Xynopoulos
"Abdominal pain is one of the most diagnostically challenging presentations in general medicine. The location gives you the first clue, but the character of the pain — colicky versus constant, sharp versus dull — and the associated features are equally important. I always ask patients whether the pain wakes them at night: pain that disturbs sleep is more likely to have an organic cause and should always be investigated. An ultrasound is usually my first investigation of choice for abdominal pain — it is fast, safe, and often gives a clear answer."
Frequently Asked Questions
When should abdominal pain prompt an urgent GP visit?
Seek urgent assessment if your pain is severe, sudden in onset, associated with fever, vomiting, or jaundice, or if you notice blood in your stool or urine. Pain that wakes you from sleep or is progressively worsening over hours also warrants same-day assessment.
What will an abdominal ultrasound show?
An abdominal ultrasound can identify gallstones, kidney stones, liver disease (including fatty liver and cysts), splenomegaly, and aortic aneurysm. It is the first-line investigation for right upper quadrant pain and suspected gallbladder disease.
Can IBS be diagnosed by ultrasound?
No. IBS is a clinical diagnosis based on symptom criteria (Rome IV criteria) — ultrasound will typically be normal in IBS. However, ultrasound is often performed to exclude structural causes of abdominal pain before an IBS diagnosis is made.
Do I need a GP referral for a private abdominal ultrasound?
No. At Victoria Medical you can self-refer for a private abdominal ultrasound without a GP referral. If your scan identifies a significant finding, our team can arrange a same-day GP consultation to discuss the results and next steps.
How quickly can I get a private abdominal ultrasound?
At Victoria Medical, same-day and next-day appointments are usually available. Results are provided within 24 hours.
References
- [1]Demb J, Kolb JM, Dounel J, et al. Red Flag Signs and Symptoms for Patients With Early-Onset Colorectal Cancer. JAMA Netw Open. 2024;7(3):e240570. https://doi.org/10.1001/jamanetworkopen.2024.0570
- [2]Dumbrava B, Puia A, Dumbrava M, et al. The Accuracy of Point-of-Care Ultrasound (POCUS) in Acute Gallbladder Disease. Diagnostics. 2023;13(3):412. https://doi.org/10.3390/diagnostics13030412
- [3]Abbas SK, Kadhim A, Al-Asadi JN. Ultrasound accuracy in evaluating renal calculi. J Med Life. 2024;17(3). https://doi.org/10.25122/jml-2024-0041
- [4]Bellini MI, Tortorici F, Amabile MI, et al. Abdominal Ultrasound in Organ Assessment. J Clin Med. 2022;11(3):700. https://doi.org/10.3390/jcm11030700
- [5]Sperber AD, Dumitrascu D, Fukudo S, et al. The global prevalence of IBS in adults remains elusive due to the heterogeneity of studies. Gut. 2017;66(6):1075–1082. https://doi.org/10.1136/gutjnl-2015-311240
- [6]NICE. Gallstone disease: diagnosis and initial management. NICE guideline NG188. 2014 (updated 2023). https://www.nice.org.uk/guidance/ng188
Dr George Xynopoulos
Consultant Physician & Cardiologist | GMC Registered | MRCP (UK)
Dr Xynopoulos is a Consultant Physician and Cardiologist at Victoria Medical, 170 Vauxhall Bridge Road, London.
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