For women, right-sided abdominal pain that comes on suddenly is nearly always serious and quite often ends up in A&E. Surgery is on the cards.
This is because causes of right-sided pain could be appendicitis, ectopic pregnancy and Crohn’s disease – all requiring immediate intervention.
It can be complicated because appendicitis needs a surgeon, ectopic pregnancy needs a gynaecologist and Crohn’s disease a physician to do a medical review of symptoms such as classically watery diarrhoea, weight loss and colicky abdominal pain.
On top of this it could also be a urinary tract infection or a sexually transmitted infection.
To reach a precise diagnosis all possible causes need investigation and an array of tests.
The diagnosis of appendicitis can usually be made from the symptoms. The clue is migrating pain from the centre of the abdomen to the lower right side which is worse on pressure. There’s loss of appetite and later fever.
There are several other tell-tale signs which become obvious when a doctor examines a patient with appendicitis and once confirmed the treatment is prompt surgical removal.
Recognising a ruptured ectopic pregnancy is time critical, because the potential for rapid blood loss and surgical shock is ever present.
Signs are pale skin, clammy hands, feeling faint and dizzy, possibly with vaginal bleeding. A patient with a suspected ectopic pregnancy needs an urgent laparoscopy, after a test is done to confirm a pregnancy.
Pelvic inflammatory disease is always in the frame when a woman is complaining of sudden pain in the lower right side of the abdomen. In addition to the pain there’s fever, abnormal vaginal discharge, and possibly a previous sexually transmitted infection.
The picture may be difficult to distinguish from an abscess of the fallopian tubes with which there’s always the danger of peritonitis – and even more serious, sepsis (blood poisoning). Unless treated promptly there’s always the possibility of infertility.
While ectopic pregnancy and appendicitis are common causes of acute right-sided abdominal pain Crohn’s disease shouldn’t be missed. The classical triad of Crohn’s is longstanding watery diarrhoea, weight loss and chronic, intermittent, colicky, abdominal pain, often related to eating.
Crohn’s can affect the entire gastrointestinal tract right up to the mouth with aphthous ulcers. The skin can get a characteristic rash, erythema nodosum, which exhibits round, red patches often on the shins.
Patients who are suffering from inflammatory bowel disease may be anaemic or malnourished and need immediate treatment.