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Regions of the abdomen
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The regions of the abdomen are theoretical divisions used by clinicians to help localize, identify and diagnose a patients symptoms. There are two main forms of categorization, the first which is simpler and is mapped out by dividing the abdomen into four quadrants, while the second method divides it into nine segments.
Either of these two ideas about the abdominal regions are internationally recognized and can be used on a daily basis during clinical practice. It is simply up to the physician on how they wish to present their findings.
This article will discuss both schemes and include a list of the internal organs and other important anatomical structures that can be found within each region.
| Four region scheme |
Principle: vertical line through linea alba (median plane) crosses horizontal line through the umbilicus (transumbilical plane) -> four quadrants: right upper quadrant (RUQ), right lower quadrant (RLQ), left upper quadrant (LUQ), left lower quadrant (LLQ) Quadrants: RUQ - LUQ | | RLQ - LLQ |
| Nine region scheme |
Principle: two vertical midclavicular lines (left and right) cross two horizontal: subcostal (through lower edge of 10th costal cartilage) and transtubercular (through tubercles of iliac crests) -> nine segments: right and left hypochondrium, epigastrium, right and left lumbar regions, umbilical region, right and left inguinal regions, hypogastrium Segments: right hipochondrium - epigastrium - left hipochondrium right lumbar - umbilical - left lumbar right inguinal - hypogastrium - left inguinal |
| Clinical relations | Grey-Turner's sign, Cullen's sign |
The four region scheme
Divisions and landmarks
The four anatomical regions of the abdomen are known as quadrants. They are separated by theoretical anatomical lines that can be traced on the abdomen using certain anatomical landmarks. The median plane is that which follows the linea alba and extends from the xiphoid process to the pubic symphysis and splits the abdomen vertically in half. The transumbilical plane is a horizontal line that runs at the level of the umbilicus. These two planes transect at the umbilicus in a cross-like form and divide the abdomen into four quarters.
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Before learning everything about the regions of the abdomen, test your knowledge with our quiz:
Right upper quadrant
The right upper quadrant (RUQ), in a craniocaudal order, contains the:
- right lobe of the liver
- gallbladder
- pylorus of the stomach
- first 3 parts of duodenum
- head of the pancreas
- right kidney and the right suprarenal gland
- distal ascending colon
- hepatic flexure of the colon
- right half of the transverse colon
Right lower quadrant
The right lower quadrant (RLQ) contains the:
- majority of the ileum
- cecum and vermiform appendix
- proximal ascending colon
- proximal right ureter
Left upper quadrant
The left upper quadrant (LUQ), in a craniocaudal order, contains the:
- left lobe of the liver
- spleen
- stomach
- jejunum
- proximal ileum
- body and the tail of the pancreas
- left kidney and the left suprarenal gland
- left half of the transverse colon
- splenic flexure of the colon
- superior part of the descending colon
Left lower quadrant
The left lower quadrant (LLQ) contains:
- distal descending colon
- sigmoid colon
- left ureter
Depending on the sex of the individual, both the left and right lower quadrants contain parts of the urinary bladder and uterus (female), as well as:
- ovary/uterine tube (female)
- ductus deferens (male)
Has this article on the regions of the abdomen made you realise that you need to review your knowledge of medical terminology? Check out our guide to basic medical terminology 101.
The nine region scheme
Divisions and landmarks
Compared to the four region scheme, the nine region scheme of the abdomen may seem more complicated. However, it can help to further localize clinical symptoms and arrive at an accurate diagnosis more quickly. There are two vertical planes and two horizontal planes that are used to separate the nine segments. The vertical planes are known as the left and right midclavicular lines. They run from the midpoint in the clavicle caudally towards the midpoint of the inguinal ligament.
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The horizontal planes include the subcostal plane and the transtubercular plane. The subcostal plane runs horizontally through the lower border of the tenth costal cartilage on either side. Finally, the transtubercular plane passes through the tubercles of the iliac crest and the body of the fifth lumbar vertebra.
The right and left hypochondriac regions are found superiorly on either side of the abdomen, while the epigastric region sits between them in a central, superior position. The right and left lumbar regions surround the umbilical region, which is central and has the umbilicus as its center point. Lastly, the right and left inguinal regions are found inferiorly on either side of the hypogastric region, which is the most inferior of the central line of segments.
Each of the nine regions shall now be listed individually, running craniocaudally from left to right:
Left hypochondriac region
The left hypochondriac region contains the:
- stomach
- top of the left lobe of the liver
- left kidney
- spleen
- tail of the pancreas
- parts of the small intestine
- transverse colon
- descending colon
Learn everything about the abdominal regions with our videos, quizzes, labeled diagrams, and articles:
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Right hypochondriac region
The right hypochondriac region contains the:
- liver
- gallbladder
- small intestine
- ascending colon
- transverse colon
- right kidney
Epigastric region
The epigastric region contains the:
- esophagus
- stomach
- liver
- spleen
- pancreas
- right and left kidneys
- right and left ureters
- right and left suprarenal glands
- small intestine
- transverse colon
The position of the transverse colon can differ slightly from person to person due its mobile suspension within the transverse mesocolon. It is, however, usually located between the epigastric and umbilical regions of the abdomen.
Left lateral/lumbar region
The left lateral region contains a:
- portion of the small intestine
- part of the descending colon
- part of the left kidney
Right lateral/umbar region
The right lateral region contains the:
- inferiormost part of the right lobe liver
- gallbladder
- small intestine
- ascending colon
- part of the right kidney
Umbilical region
The umbilical region contains the:
- stomach
- pancreas
- small intestine
- transverse colon
- medial extremities of inferior poles of the right and left kidneys
- right and left ureters
- cisterna chyli
Left inguinal region
The left inguinal region contains the:
- descending colon
- sigmoid colon
- part of the small intestine
- left ovary and the left uterine tube (female)
Right inguinal region
The right inguinal region contains the:
- small intestine
- vermiform appendix
- cecum
- ascending colon
- right ovary and right uterine tube in females.
Hypogastric region
The hypogastric region contains the:
- small intestine
- sigmoid colon
- rectum
- urinary bladder
- right and left ureters
- uterus, right and left ovaries and uterine (female)
- ductus deferens, seminal vesicles and prostate (male)
Frequent questions
How many abdominal regions are there?
The standard anatomical division of the abdomen accepted by most authors is based on four imaginary lines crossing the surface of the abdomen. Two of these lines are vertical, crossing over the middle point of each clavicle (midclavicular line). The other two are horizontal, one crossing below the level of the rib cage (subcostal line) and the other drawn through the iliac tubercles. These four lines divide the abdomen into nine regions, helping describe the location of organs and clinical findings more precisely. Some authors use a simplified classification of the regions of the abdomen that divides the area into four quadrants, separated by a vertical and a horizontal line, both crossing the umbilicus.
What are the 9 abdominal regions?
The standard anatomical division of the abdomen accepted by most authors subdivides the area into nine regions. These nine regions of the abdomen are, from left to right and from top to bottom:
- Right hypochondriac region
- Epigastric region
- Left hypochondriac region
- Right lumbar region (right flank)
- Umbilical region
- Left lumbar region (left flank)
- Right iliac region (right inguinal region)
- Hypogastric region (pubic region)
- Left iliac region (left inguinal region)
What is the primary advantage of using abdominal regions over abdominopelvic quadrants?
While dividing the abdomen into four quadrants is simple, quick, and easy to learn, using nine regions instead allows for more precise communication regarding the location of organs and pathologies. This precision helps narrow down the possible structures involved in a particular pathology, making it more valuable in clinical practice, surgery, and radiology.
What is housed in each of the 9 precise regions of the abdominal cavity?
The nine abdominal regions and their contents are:
- Right hypochondriac region: Right lobe of liver, gallbladder, parts of the small intestine, part of ascending colon, part of transverse colon, upper pole of right kidney
- Epigastric region: Esophagus, most of the stomach, left lobe of liver, most of the pancreas, duodenum, adrenal glands
- Left hypochondriac region: Spleen, fundus of stomach, upper pole of left kidney, tail of pancreas
- Right lumbar region (right flank): Ascending colon, mid portion of right kidney, small intestine
- Umbilical region: Transverse colon, small intestine (jejunum, ileum), parts of the aorta, inferior vena cava and their branches/tributaries, part of the ureters, cisterna chyli
- Left lumbar region (left flank): Descending colon, mid portion of left kidney, small intestine
- Right iliac region (right inguinal region): Cecum, appendix, terminal ileum, right ovary and uterine tube (in females)
- Hypogastric region: Urinary bladder, sigmoid colon, rectum, distal part of ureters, uterus (in femeles), ductus deferens, seminal vesicles and prostate (in males)
- Left iliac region (left inguinal region): Part of sigmoid colon, descending colon, left ovary and uterine tube (in females)
What is the abdominal region that lies inferior to all other abdominal regions?
In the nine-region abdominal system, the standard anatomical division of the abdomen used by most anatomists, there are three rows, each consisting of three regions. The lowest row includes the right iliac (right inguinal), hypogastric, and left iliac (left inguinal) regions, making them the most inferior regions of the abdomen.
What abdominal quadrants (and regions) is the pancreas located in?
In the four-quadrant abdominal system, the pancreas is located in the two upper quadrants. The head of the pancreas is found in the right upper quadrant, while its body and tail are found in the left upper quadrant. In the nine-regions abdominal system, the majority of the pancreas is located in the epigastric region, and the tail is located in the left hypochondriac region. The head and uncionate process of the organ may extend to the right hypochondriac and/or umbilical regions in some individuals.
Clinical aspects
Grey-Turner’s sign is a redness or bruising that can be seen on the right lumbar region after a period of 24 to 48 hours, indicating a retroperitoneal hemorrhage. Its presence is significant because it can be predictive of severe hemorrhagic pancreatitis, abdominal injury or even metastatic cancer. Cullen’s sign is a discoloration of the skin around the umbilicus and points to a peritoneal hemorrhage.
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