Abdominal pain: Difference between revisions
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''For pediatric patients see [[Special:MyLanguage/Abdominal pain (peds)|Abdominal pain (peds)]]. See also [[Special:MyLanguage/abdominal pain (geriatrics)|abdominal pain (geriatrics)]] and [[Special:MyLanguage/Abdominal pain in pregnancy|Abdominal pain in pregnancy]].''
==Background==
==Background==
*Elderly pts
**Surgical emergencies are more common in elderly than in any other pt population
**Viral gastroenteritis is uncommon
**Conservative admission strategy is strongly advocated
*Pts with immunosuppression often have delayed or atypical presentations
*Fever is not a reliable marker for surgical disease
==Workup==
*Urine pregnancy
*CBC
**Note: WBC cannot exclude surgical disease
*Chem
*LFT
*Lipase
**May be normal early in course of pancreatitis
*UA/UCx
*Guaiac
*ECG (>40 yo)
*?CXR
*?Coags
**GI bleeding, end-stage liver disease, coagulopathy
*?Lactate
*?Abd x-ray
**Consider for r/o obstruction, perforation, or severe constipation
*?US
*?CT


==DDX ==
*Patients with immunosuppression often have delayed or atypical presentations
===Killers===
*[[Special:MyLanguage/Fever|Fever]] is not a reliable marker for surgical disease
#[[AAA]]
*Abdominal pain may be particularly misleading in elderly or diabetics
#[[Mesenteric Ischemia]]
*Consider pain in any abdominal or pelvic region in a female of child-bearing age, including pre-teens, is an [[Special:MyLanguage/ectopic pregnancy|ectopic pregnancy]] until proven otherwise
#Bowel Perforation
 
#[[Small Bowel Obstruction]]
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#[[Sigmoid Volvulus]]
{{Abdominal pain location}}
#[[Ectopic Pregnancy]]
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#[[Placental Abruption]]
 
#[[ACS]]
 
 
==Clinical Features==
 
*Abdominal pain (see workup by location)
*May be associated with [[Special:MyLanguage/nausea|nausea]], [[Special:MyLanguage/vomiting|vomiting]] or [[Special:MyLanguage/diarrhea|diarrhea]]
*[[Special:MyLanguage/Fever|Fever]] may be present in pain from infectious etiology
 
 
 
==Differential Diagnosis==
 
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{{Abdominal Pain DDX Diffuse}}
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{{Abdominal Pain DDX Epigastric}}
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{{DDX RUQ}}
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{{DDX LUQ}}
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{{Abd DDX RLQ}}
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{{LLQ DDX}}
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{{Pelvic pain DDX}}
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{{Extra-abdominal sources of abdominal pain DDX}}
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==Evaluation==
 
*Workup is by location:
**[[Special:MyLanguage/RUQ pain|RUQ pain]]
**[[Special:MyLanguage/RLQ pain|RLQ pain]]
**[[Special:MyLanguage/Epigastric pain|Epigastric pain]]
**[[Special:MyLanguage/LUQ pain|LUQ pain]]
**[[Special:MyLanguage/LLQ pain|LLQ pain]]
**[[Special:MyLanguage/Diffuse abdominal pain|Diffuse abdominal pain]]
**[[Special:MyLanguage/Flank pain|Flank pain]]
 


===Diffuse===
#Peritonitis
#[[Pancreatitis]]
#[[Appendicitis]] (early)
#[[AAA]] (leaking, ruptured)
#[[Aortic Dissection]]
#[[Small Bowel Obstruction]]
#Diabetic gastric paresis
#[[Mesenteric Ischemia]]
#[[Diabetic Ketoacidosis]]
#Bowel perforation
#Volvulus
#[[Sickle Cell Crisis]]
#[[Mesenteric Ischemia]]
#[[Gastroenteritis]]


===Epigastric===
==Management==
#[[Gallbladder Disease (Main)]]
#GERD
#PUD
#Gastritis
#[[Pancreatitis]]
#Splenic enlargement/rupture/infarction/aneurysm
#[[Myocardial Ischemia]]
#[[Pericarditis]]/Myocarditis
#[[Aortic Dissection]]


===RUQ===
*Treat underlying cause
#[[Gallbladder Disease (Main)]]
*Multiple studies show [[Special:MyLanguage/pain medicine|pain medicine]] should not be withheld for fear of masking symptoms
#[[Appendicitis]] (retrocecal)
#Hepatitis
#[[Pyogenic liver abscess]]
#Fitz-Hugh-Curtis Syndrome
#Hepatomegaly due to [[CHF]]
#Perforated duodenal ulcer
#[[Pancreatitis]]
#Herpes zoster
#[[Myocardial Ischemia]]
#[[Pneumonia]]
#Bowel obstruction
#[[Pulmonary Embolism]]


===LUQ===
#Gastritis/gastric ulcer
#Herpes Zoster
#[[Pancreatitis]]
#Splenic rupture/distension
#[[Myocardial Ischemia]]
#[[Pneumonia]]
#[[Pulmonary Embolism]]
#[[Splenic Infarction]]


===RLQ===
#[[Appendicitis]]
#[[Abdominal Aortic Aneurysm]] (leaking, ruptured)
#Crohn disease (terminal ileitis)
#Diverticulitis (cecal)
#[[Ectopic]]
#Endometriosis
#[[Epiploic Appendagitis]]
#Herpes zoster
#Inguinal hernia
#Ischemic colitis
#Meckel diverticulum
#Mittelschmerz
#Ovarian cyst (ruptured)
#Ovarian Torsion
#[[PID]]
#[[Psoas Abscess]]
#[[Testicular Torsion]]
#[[Kidney Stone]]


===LLQ===
==Disposition==
#[[Abdominal Aortic Aneurysm]] (leaking, ruptured)
 
#Diverticulitis (sigmoid)
*Depends on etiology
#[[Ectopic]]
*The two most notoriously missed conditions are [[Special:MyLanguage/appendicitis|appendicitis]] and [[Special:MyLanguage/small bowel obstruction|small bowel obstruction]].<ref>Macaluso CR and McNamara RM. Evaluation and management of acute abdominal pain in the emergency department. Int J Gen Med. 2012; 5: 789–797. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3468117/</ref>. When discharging patients with abdominal pain, clear instructions should be given for return if there are red flags.
#Endometriosis
#[[Epiploic Appendagitis]]
#Herpes Zoster
#Inguinal hernia
#Ischemic colitis
#Mittelschmerz
#Ovarian cyst (ruptured)
#Ovarian torsion
#[[PID]]
#[[Psoas Abscess]]
#[[Testicular Torsion]]
#[[Kidney Stone]]


===Pelvic===
====Abdominal origin====
#Ureteral calculi ([[Kidney Stone]])
#Psoas abscess
#Mesenteric adenitis
#Incarcerated hernia
====Pelvic origin====
#[[Ectopic]]
#Adnexal torsion
#Endometriosis
#[[PID]]
#Myoma (degenerating)
#Ovarian cyst (rupture)
#Tubo-ovarian abscess
#Mittelschmerz
#Endometriosis
#Seminal vesiculitis


===Extra-Abdominal===
#[[MI]]
#[[Aortic Dissection]]
#[[PNA]]
#[[PE]]
#[[Testicular Torsion]]
#[[Herpes Zoster]]
#Muscle spasm
#[[Pharyngitis|Strep Pharyngitis]] (peds)
#[[Mononucleosis]]
#[[DKA]]
#[[ETOH Ketoacidosis]]
#[[Uremia]]
#[[Sickle Cell Crisis]]
#SLE
#Vasculitis
#Glaucoma
#[[Hyperthyroidism]]
#[[Methanol Poisoning]]
#[[Heavy Metal]] toxicity
#Addison's Disease
#Porphyria


==See Also==
==See Also==
*[[Abdominal Pain (Geriatrics)]]
*[[Abdominal Trauma]]
*[[Pelvic Pain]]


==Source ==
*[[Special:MyLanguage/Abdominal Pain (Geriatrics)|Abdominal Pain (Geriatrics)]]
*Tintinalli
*[[Special:MyLanguage/Abdominal Pain (Peds)|Abdominal Pain (Peds)]]
*[[Special:MyLanguage/Abdominal Trauma|Abdominal Trauma]]
*[[Special:MyLanguage/Abdominal pain in pregnancy|Abdominal pain in pregnancy]]
*[[Special:MyLanguage/Pelvic Pain|Pelvic Pain]]
 
 
 
==References==


*ACEP Geriatric lecture series
<references/>
*[[Category:GI]]
[[Category:GI]]
[[Category:Misc/General]]
[[Category:Symptoms]]
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Latest revision as of 21:04, 17 January 2026

For pediatric patients see Abdominal pain (peds). See also abdominal pain (geriatrics) and Abdominal pain in pregnancy.


Background

  • Patients with immunosuppression often have delayed or atypical presentations
  • Fever is not a reliable marker for surgical disease
  • Abdominal pain may be particularly misleading in elderly or diabetics
  • Consider pain in any abdominal or pelvic region in a female of child-bearing age, including pre-teens, is an ectopic pregnancy until proven otherwise


Classification by Abdominal pain location

Side-by-side comparison of quadrants and regions.
Chart of commonly reported referred pain sites.
RUQ pain Epigastric pain LUQ pain
Flank pain Diffuse abdominal pain Flank pain
RLQ pain Pelvic pain LLQ pain


Clinical Features

  • Abdominal pain (see workup by location)
  • May be associated with nausea, vomiting or diarrhea
  • Fever may be present in pain from infectious etiology


Differential Diagnosis

Diffuse Abdominal pain


Epigastric Pain

RUQ Pain

Left upper quadrant abdominal pain


RLQ Pain

LLQ Pain

Acute Pelvic Pain

Differential diagnosis of acute pelvic pain

Gynecologic/Obstetric

Genitourinary

Gastrointestinal

Musculoskeletal

Vascular

Extra-abdominal Sources of Abdominal pain


Evaluation


Management

  • Treat underlying cause
  • Multiple studies show pain medicine should not be withheld for fear of masking symptoms


Disposition

  • Depends on etiology
  • The two most notoriously missed conditions are appendicitis and small bowel obstruction.[2]. When discharging patients with abdominal pain, clear instructions should be given for return if there are red flags.


See Also


References

  1. ↑ Norris DL, Young JD. UTI. EM Clin N Am. 2008; 26:413-30.
  2. ↑ Macaluso CR and McNamara RM. Evaluation and management of acute abdominal pain in the emergency department. Int J Gen Med. 2012; 5: 789–797. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3468117/
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