Source / episode info

• **Episode:**629
• **Title:**DIP Ep 629: The Clutch Right Lower Quadrant Podcast
• **Published:**2026-01-20
• Source:Episode page

One-liner

This episode provides a comprehensive review of acute abdominal pain differentials, covering the classic presentation and workup of appendicitis, Crohn's disease, kidney stones, ovarian torsion, ectopic pregnancy, and other surgical emergencies.

High-yield summary

• Appendicitis: Pain typically starts periumbilical and migrates to the right lower quadrant (RLQ) due to irritation of the parietal peritoneum at McBurney's point.
• Ectopic Pregnancy Workup: In a stable patient, initial steps are Urine Pregnancy Test (UPT) followed by Transvaginal Ultrasound (TVUS). A -hCG level >2000 { mIU/mL} is needed to visualize a gestational sac on ultrasound.
• Crohn's Disease: Most commonly affects the terminal ileum, leading to B12 deficiency and potential hypersegmented neutrophils due to malabsorption of Vitamin B12.
• Ovarian Torsion: Presents as sudden, severe, unilateral pelvic/RLQ pain, often associated with a history of ovarian cysts or bulky ovaries; diagnosis requires TVUS with Doppler flow assessment.
• Nephrolithiasis: The gold standard diagnostic imaging is a non-contrast abdominal CT scan (unless the patient is pregnant, then ultrasound is preferred). Pain radiates from the flank/RLQ toward the groin.
• Acute Abdomen Management: Always consider perforation (e.g., perforated appendix) if signs of generalized peritonitis are present; this requires immediate surgical consultation.

Learning objectives

• Differentiate the clinical presentation and diagnostic workup of acute RLQ pain sources (appendicitis, diverticulitis, ovarian torsion, etc.).
• Apply appropriate initial steps for suspected ectopic pregnancy based on patient hemodynamic stability.
• Recognize the classic features and complications associated with Crohn's disease, particularly malabsorption syndromes.
• Interpret imaging findings (e.g., coffee bean sign, non-contrast CT) in acute abdominal pathology.
• Understand the management principles of surgical emergencies like ovarian torsion and incarcerated hernia.