From the Guidelines
The relevant review of systems for a 50-year-old female presenting with abdominal pain in the bilateral lower quadrants should include a thorough evaluation of the gastrointestinal, gynecologic, urologic, and musculoskeletal systems.
Key Components of the Review of Systems
- Gastrointestinal system: questions about nausea, vomiting, changes in bowel habits, or blood in the stool to evaluate for conditions such as diverticulitis, bowel obstruction, or inflammatory bowel disease 1
- Gynecologic system: questions about menstrual history, last menstrual period, or symptoms of pelvic inflammatory disease to evaluate for conditions such as ovarian torsion, ectopic pregnancy, or adnexal masses, although less likely in a 50-year-old female 1
- Urologic system: questions about dysuria, frequency, or flank pain to evaluate for conditions such as urinary tract infection or urolithiasis 1
- Musculoskeletal system: questions about trauma, heavy lifting, or strenuous activity to evaluate for conditions such as muscle strain or hernia 1
Additional Considerations
- Fever: associated fever with abdominal pain constitutes an even more challenging clinical situation, raising clinical suspicion of an intra-abdominal infection, abscess, or other condition that may need immediate surgical or medical attention 1
- Imaging: the American College of Radiology has developed clinical guidelines, the Appropriateness Criteria, based on the location of abdominal pain to help physicians choose the most appropriate imaging study, with computed tomography (CT) recommended for evaluating right or left lower quadrant pain 1
From the Research
Relevant Review of Systems
The relevant review of systems for a 50-year-old female presenting with abdominal pain in the bilateral lower quadrants includes:
- Abdominal pain characteristics, such as location, severity, and duration
- Gynecological history, including menstrual history, previous surgeries, and sexually transmitted infections
- Urinary symptoms, such as dysuria, frequency, or retention
- Bowel habits, including changes in bowel movements or blood in stool
- Neurological symptoms, such as back pain, sciatica, or numbness in the lower extremities
Potential Causes
Potential causes of abdominal pain in the bilateral lower quadrants in a 50-year-old female include:
- Pelvic inflammatory disease (PID) 2, 3
- Diverticulitis 2, 4, 5
- Sciatic hernias 4
- Gynecological disorders, such as ovarian cysts or endometriosis
- Urinary tract infections or kidney stones
- Bowel disorders, such as inflammatory bowel disease or colon cancer
Diagnostic Evaluation
A thorough diagnostic evaluation is necessary to determine the cause of abdominal pain in the bilateral lower quadrants, including:
- Physical examination, including abdominal and pelvic examination
- Laboratory tests, such as complete blood count, blood chemistry, and urinalysis
- Imaging studies, such as computed tomography (CT) scan or magnetic resonance imaging (MRI) 6, 4, 5
- Gynecological evaluation, including transvaginal ultrasound and cervical sampling 3