[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Clinical exam](https://durgical.com/en/clinical-exam/) › [Abdomen](https://durgical.com/en/clinical-exam/#a-abdomen) › Abdominal regions and quadrants: what lies under each [Clinical exam](https://durgical.com/en/clinical-exam/) · [Abdomen](https://durgical.com/en/clinical-exam/#a-abdomen) # Abdominal regions and quadrants: what lies under each - Topic Imaginary lines divide the abdomen into four quadrants or nine regions, so you can say where it hurts and which organ may be involved. Updated 2026-11-01 **See it in 3D:** [Liver](https://durgical.com/en/anatomy/liver/) · [Stomach](https://durgical.com/en/anatomy/stomach/) · [Appendix](https://durgical.com/en/anatomy/vermiform-appendix/) · [Sigmoid colon](https://durgical.com/en/anatomy/sigmoid-colon/) · [Gallbladder](https://durgical.com/en/anatomy/gallbladder/) · [Spleen](https://durgical.com/en/anatomy/spleen/) · [Pancreas](https://durgical.com/en/anatomy/pancreas/) · [Kidneys](https://durgical.com/en/anatomy/kidney/) · [Cecum](https://durgical.com/en/anatomy/cecum/) · [Ascending colon](https://durgical.com/en/anatomy/ascending-colon/) · [Transverse colon](https://durgical.com/en/anatomy/transverse-colon/) · [Descending colon](https://durgical.com/en/anatomy/descending-colon/) · [Duodenum](https://durgical.com/en/anatomy/duodenum/) · [Urinary bladder](https://durgical.com/en/anatomy/urinary-bladder/) ## Key points - Four quadrants: a vertical midline and a horizontal line that cross at the umbilicus (upper and lower, right and left). - Nine regions: two vertical lines dropping from the midpoint of each clavicle (midclavicular lines) and two horizontal lines, one below the costal margin and one at the level of the iliac crests. - Right iliac fossa: cecum and appendix; home of McBurney point. - Right hypochondrium: liver and gallbladder; where Murphy sign is sought. - Left iliac fossa: sigmoid colon; pain here in an older adult suggests diverticulitis. - Early visceral pain is usually felt in the midline (epigastric, umbilical, hypogastric) even when the organ lies to one side. ## What it is To describe a pain, a mass or a finding precisely, the abdominal wall is divided by imaginary lines. The four-quadrant system, with two lines crossing at the umbilicus, is the one most used in practice; the nine-region system is more detailed. Knowing which organs project onto each zone shapes the differential diagnosis from the first touch. ## Key facts - Right upper quadrant: liver, gallbladder, duodenum, head of pancreas, hepatic flexure, right kidney. - Left upper quadrant: stomach, spleen, tail of pancreas, splenic flexure, left kidney. - Right lower quadrant: cecum, appendix, terminal ileum, right ureter; in women, the right ovary and tube. - Left lower quadrant: sigmoid and descending colon, left ureter; in women, the left ovary and tube. - Lower midline: bladder and, in women, the uterus. ## Structure - Vertical lines: the midclavicular lines, continued down to about the midpoint of the inguinal ligament. - Upper horizontal line: the subcostal line joining the lowest points of the costal margin; the lower one joins the tubercles of the iliac crests. - Top row: right hypochondrium, epigastrium, left hypochondrium. Middle row: right flank (lumbar), umbilical region, left flank. Bottom row: right iliac fossa, hypogastrium, left iliac fossa. - The kidneys and pancreas are retroperitoneal: they project onto the front wall, but their pain is often felt in the flank or back. ## The nine regions and the organs that project onto each (adult, lying supine). | Region | Main organs | Examples of pain here | | --- | --- | --- | | Right hypochondrium | Right lobe of liver, gallbladder, hepatic flexure, upper pole of right kidney | Cholecystitis, biliary colic, hepatitis | | Epigastrium | Stomach, left lobe of liver, duodenum, pancreas, abdominal aorta | Peptic ulcer, pancreatitis, early appendicitis | | Left hypochondrium | Spleen, gastric fundus, tail of pancreas, splenic flexure, upper pole of left kidney | Splenomegaly, splenic infarct or rupture | | Right flank (lumbar) | Ascending colon, right kidney, small bowel loops | Renal colic, pyelonephritis | | Umbilical | Jejunum and ileum, transverse colon, horizontal duodenum, aorta | Bowel obstruction, early appendicitis, aortic aneurysm | | Left flank (lumbar) | Descending colon, left kidney, small bowel loops | Renal colic, diverticulitis | | Right iliac fossa | Cecum, appendix, terminal ileum, right ureter, right ovary and tube | Appendicitis, ectopic pregnancy, ovarian torsion | | Hypogastrium (suprapubic) | Bladder, uterus, sigmoid colon, rectum | Urinary retention, cystitis, pelvic inflammatory disease | | Left iliac fossa | Sigmoid colon, left ureter, left ovary and tube | Diverticulitis, ectopic pregnancy | ## Memory aid Treat the umbilicus as a compass: upper right is bile, upper left is blood (spleen), lower right is the appendix and lower left is the sigmoid. ## Test yourself Think of the answer, then tap the question to see it. ## Which lines define the nine abdominal regions? Two vertical midclavicular lines and two horizontal lines: the subcostal line below the costal margin and the line joining the tubercles of the iliac crests. ## In which region do the cecum and appendix project? The right iliac fossa (right lower quadrant), where McBurney point lies. ## Why is early appendicitis pain felt around the umbilicus? At first it is visceral pain, poorly localized to the midline according to the gut's embryonic segment; it settles in the right iliac fossa only once the parietal peritoneum is irritated. ## Which retroperitoneal organs project onto the flanks? The kidneys, together with the ascending colon on the right and the descending colon on the left; their pain often spreads to the back. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/clinical-exam/abdominal-regions-and-quadrants-what-lies-under-each/) ## See it in 3D The structures of Durgical's 3D anatomy where it is found. - [Liver](https://durgical.com/en/anatomy/liver/) - [Stomach](https://durgical.com/en/anatomy/stomach/) - [Appendix](https://durgical.com/en/anatomy/vermiform-appendix/) - [Sigmoid colon](https://durgical.com/en/anatomy/sigmoid-colon/) - [Gallbladder](https://durgical.com/en/anatomy/gallbladder/) - [Spleen](https://durgical.com/en/anatomy/spleen/) - [Pancreas](https://durgical.com/en/anatomy/pancreas/) - [Kidneys](https://durgical.com/en/anatomy/kidney/) - [Cecum](https://durgical.com/en/anatomy/cecum/) - [Ascending colon](https://durgical.com/en/anatomy/ascending-colon/) - [Transverse colon](https://durgical.com/en/anatomy/transverse-colon/) - [Descending colon](https://durgical.com/en/anatomy/descending-colon/) - [Duodenum](https://durgical.com/en/anatomy/duodenum/) - [Urinary bladder](https://durgical.com/en/anatomy/urinary-bladder/) ## Related - [Abdominal inspection](https://durgical.com/en/clinical-exam/abdominal-inspection/) - [Abdominal palpation: light and deep, guarding and masses](https://durgical.com/en/clinical-exam/abdominal-palpation-light-and-deep-guarding-and-masses/) - [McBurney point](https://durgical.com/en/clinical-exam/mcburney-point/) - [Murphy sign](https://durgical.com/en/clinical-exam/murphy-sign/) - [Acute abdomen and peritoneal irritation](https://durgical.com/en/clinical-exam/acute-abdomen-and-peritoneal-irritation/) ## Related conditions - [Acute appendicitis](https://durgical.com/en/conditions/acute-appendicitis/) - [Acute cholecystitis](https://durgical.com/en/conditions/acute-cholecystitis/) - [Acute pancreatitis](https://durgical.com/en/conditions/acute-pancreatitis/) - [Diverticular disease and diverticulitis](https://durgical.com/en/conditions/diverticular-disease-and-diverticulitis/) - [Kidney stones (urolithiasis)](https://durgical.com/en/conditions/kidney-stones/) [← All of the clinical exam](https://durgical.com/en/clinical-exam/) Educational content on the clinical exam; it is learned and practised under supervision. It does not replace assessment by a health professional and is not for self-diagnosis. Sources: [1.6 Anatomical Terminology - Anatomy and Physiology 2e | OpenStax](https://openstax.org/books/anatomy-and-physiology-2e/pages/1-6-anatomical-terminology) (OpenStax, Rice University, 2022); [Abdominal examination](https://en.wikipedia.org/wiki/Abdominal_examination) (Wikipedia, 2026); [Evaluation of the Gastrointestinal Patient - Gastroenterology - Merck Manual Professional Edition](https://www.merckmanuals.com/professional/gastrointestinal-disorders/approach-to-the-gastrointestinal-patient/evaluation-of-the-gastrointestinal-patient) (Merck & Co., Inc., 2025). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/clinical-exam/abdominal-regions-and-quadrants-what-lies-under-each/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/clinical-exam/abdominal-regions-and-quadrants-what-lies-under-each/