Abdominal pain: Difference between revisions
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==Background==
<languages/>
*Elderly pts
<translate>
**Surgical emergencies are more common in elderly than in any other pt population
<!--T:1-->
**Viral gastroenteritis is uncommon
''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]].''
**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 ==
==Background== <!--T:2-->
===Killers===
#[[AAA]]
#[[Mesenteric Ischemia]]
#Bowel Perforation
#[[Small Bowel Obstruction]]
#[[Sigmoid Volvulus]]
#[[Ectopic Pregnancy]]
#[[Placental Abruption]]
#[[ACS]]


===Diffuse===
<!--T:3-->
{{Templated:Abdominal Pain DDX Diffuse}}
*Patients with immunosuppression often have delayed or atypical presentations
*[[Special:MyLanguage/Fever|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 [[Special:MyLanguage/ectopic pregnancy|ectopic pregnancy]] until proven otherwise


===Epigastric===
</translate>
{{Template:Abdominal Pain DDX Epigastric}}
{{Abdominal pain location}}
<translate>


===RUQ===
#[[Gallbladder Disease (Main)]]
#[[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===
==Clinical Features== <!--T:4-->
#Gastritis/gastric ulcer
#Herpes Zoster
#[[Pancreatitis]]
#Splenic rupture/distension
#[[Myocardial Ischemia]]
#[[Pneumonia]]
#[[Pulmonary Embolism]]
#[[Splenic Infarction]]


===RLQ===
<!--T:5-->
#[[Appendicitis]]
*Abdominal pain (see workup by location)
#[[Abdominal Aortic Aneurysm]] (leaking, ruptured)
*May be associated with [[Special:MyLanguage/nausea|nausea]], [[Special:MyLanguage/vomiting|vomiting]] or [[Special:MyLanguage/diarrhea|diarrhea]]
#Crohn disease (terminal ileitis)
*[[Special:MyLanguage/Fever|Fever]] may be present in pain from infectious etiology
#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===
{{Template:LLQ DDX}}


===Pelvic===
==Differential Diagnosis== <!--T:6-->
 
</translate>
{{Abdominal Pain DDX Diffuse}}
<translate>
</translate>
{{Abdominal Pain DDX Epigastric}}
<translate>
</translate>
{{DDX RUQ}}
<translate>
</translate>
{{DDX LUQ}}
<translate>
</translate>
{{Abd DDX RLQ}}
<translate>
</translate>
{{LLQ DDX}}
<translate>
</translate>
{{Pelvic pain DDX}}
{{Pelvic pain DDX}}
<translate>
</translate>
{{Extra-abdominal sources of abdominal pain DDX}}
<translate>
==Evaluation== <!--T:7-->
<!--T:8-->
*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]]
==Management== <!--T:9-->
<!--T:10-->
*Treat underlying cause
*Multiple studies show [[Special:MyLanguage/pain medicine|pain medicine]] should not be withheld for fear of masking symptoms
==Disposition== <!--T:11-->
<!--T:12-->
*Depends on etiology
*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.
==See Also== <!--T:13-->


===Extra-Abdominal===
<!--T:14-->
#[[MI]]
*[[Special:MyLanguage/Abdominal Pain (Geriatrics)|Abdominal Pain (Geriatrics)]]
#[[Aortic Dissection]]
*[[Special:MyLanguage/Abdominal Pain (Peds)|Abdominal Pain (Peds)]]
#[[PNA]]
*[[Special:MyLanguage/Abdominal Trauma|Abdominal Trauma]]
#[[PE]]
*[[Special:MyLanguage/Abdominal pain in pregnancy|Abdominal pain in pregnancy]]
#[[Testicular Torsion]]
*[[Special:MyLanguage/Pelvic Pain|Pelvic Pain]]
#[[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==
*[[Abdominal Pain (Geriatrics)]]
*[[Abdominal Pain (Peds)]]
*[[Abdominal Trauma]]
*[[Abdominal pain in pregnancy]]
*[[Pelvic Pain]]


==Source ==
==References== <!--T:15-->
*Tintinalli


*ACEP Geriatric lecture series
<!--T:16-->
*[[Category:GI]]
<references/>
[[Category:GI]]
[[Category:Misc/General]]
[[Category:Symptoms]]
</translate>

Latest revision as of 14:23, 5 January 2026

Other languages:

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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