Health Matters 7/12: Abdominal Pain: What Could It Be?


By Tomer Davidov, M.D.

Whether from eating a big meal or catching a stomach bug, almost everyone experiences some sort of abdominal pain every now and then. 

In fact, abdominal pain is one of the most common reasons people visit the emergency room, according to the Centers for Disease Control and Prevention. 

But how do you know if abdominal pain is indigestion from last night’s dinner or something more serious? 


In diagnosing abdominal pain, its location often offers one of the first clues to its cause. 

Lower Right Quadrant 

Sudden pain that occurs in the lower right side of your abdomen and gets progressively worse over a period of 12 to 48 hours is highly suspicious of appendicitis. 

The appendix is a small, tube-like organ attached to the large intestine that has no known function. 

Appendicitis is characterized by inflammation of the appendix caused by a blockage inside the organ and can occur in men and women of any age, though it tends to affect boys and men in their teens and 20s more. 

An estimated 5% of the U.S. population will develop appendicitis at some point, according to the National Institutes of Health (NIH). 

In addition to pain in the lower right abdominal quadrant, other symptoms of appendicitis may include: 

  • Nausea 
  • Vomiting
  • Loss of appetite 
  • Fever 
  • Chills

If left untreated, appendicitis can cause the appendix to burst and spread infection into the abdomen, which is why appendicitis is a medical emergency.  

Diagnosing appendicitis usually involves blood tests and a CT scan of the abdomen.  Treatment almost always requires surgical removal of the appendix. 

Upper Right Quadrant 

If you have pain in the upper right abdominal quadrant that often occurs at night and worsens after eating, it could be a sign of gallstones. 

Gallstones are hard, pebble-like pieces of material, usually made of cholesterol or bilirubin, that form in your gallbladder, a small pear-shaped organ that stores bile until it’s needed for digestion. 

Gallstones can range in size from a grain of sand to a golf ball, and when they block your bile ducts, can cause sudden pain in your upper right abdomen. 

As the NIH reports, gallstones are common affecting 10 to 15 percent of the U.S. population, which is almost 25 million people. About a quarter of the nearly 1 million people diagnosed with gallstones each year will need to be treated, usually with surgery.

Women, especially women in their 30s and 40s, are more likely to develop gallstones than men. Gallstones also tend to run in families. 

Other signs of gallstones may include nausea, gassiness, and on occasion, fever. 

To diagnose gallstones, doctors will typically perform an ultrasound of the abdomen. In cases of repeat gallbladder attacks, treatment normally involves removing the gallbladder through laparoscopic surgery. 

Lower Left Quadrant 

Pain in the lower left quadrant of your abdomen, particularly if you’re an older adult, may be associated with diverticulitis, the inflammation of the diverticula or small pouches that often develop in the colon.  

These pouches are common in older people and typically don’t cause any symptoms. However, when they become inflamed, this can cause sudden pain as well as: 

  • Fever 
  • Vomiting 
  • Nausea
  • Chills 
  • Cramping
  • Constipation and/or diarrhea 
  • Decreased appetite
  • Fatigue 

Typically, mild diverticulitis will resolve on its own, but if it is more severe, antibiotics may be necessary. Patients who suffer recurrent bouts of diverticulitis may require surgery to remove the troublesome pouches. 

Diverticulitis is usually diagnosed through imaging tests such as a CT scan and colonoscopy. 

Left Upper Quadrant 

When pain occurs in the left upper abdomen or below the breastbone it is often a sign of heartburn or indigestion. 

And while an occasional episode of heartburn, also known as acid reflux, is normal, if it occurs regularly, it could signal gastroesophageal reflux disorder (GERD). 

In simplest terms, GERD occurs when acid from the stomach backs up into the esophagus causing a burning feeling. 

GERD affects about 20 percent of the U.S. population, according to the NIH, and can lead to more serious health problems over time.  

While anyone can develop GERD, you are more likely to have it if you are: 

  • Overweight or obese
  • Pregnant 
  • Taking certain medications 
  • A smoker 

Doctors use a variety of tests to diagnose GERD, including upper endoscopy, esophageal manometry to measure the function of the esophagus, and pH monitoring to measure the pH in your esophagus. 

GERD is typically treated with medication, but in cases where medication fails or no longer works, surgery may be necessary. 

If you experience sudden, unexplained abdominal pain or abdominal pain that is constant, seek medical attention. Pain should not be ignored – no matter where it’s located.   

Learn More 

Penn Medicine Princeton Health, through its Community Wellness program, will host a discussion titled “Abdominal Pain: What Could It Be?” from 1 p.m. to 2 p.m. on Friday, July 19 at the Princeton Fitness & Wellness Center, 1225 State Road, Princeton. 

To register for the free session or for more information visit or call 888.897.8979. 

To find a physician affiliated with Penn Medicine Princeton Health, call 888.742.7496 or visit 

Tomer Davidov, M.D., F.A.C.S., specializes in general surgery and is a member of the Penn Medicine Princeton Health medical staff.