Abdominal pain: Difference between revisions
 
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==Workup==
''For pediatric patients see [[Abdominal pain (peds)]]. See also [[abdominal pain (geriatrics)]] and [[Abdominal pain in pregnancy]].''
# B-hCG
==Background==
# CBC
*Patients with immunosuppression often have delayed or atypical presentations
# Chem 7
*[[Fever]] is not a reliable marker for surgical disease
# LFTs
*Abdominal pain may be particularly misleading in elderly or diabetics
# Lipase
*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
# UA/Gm stain/UCx
# Guaiac
# IVF
# ECG (>50 yo)
# ?CXR
# ?Coags
# ?contrast --> CT
# ?US


==DDX ==
{{Abdominal pain location}}
===Killers===
# [[AAA]]
# Mesenteric Ischemia
# Bowel Perforation
# Small Bowel Obstruction
# Sigmoid Volvulus
# [[Ectopic Pregnancy]]
# Placental Abruption
# [[ACS]]


===Diffuse===
==Clinical Features==
# Peritonitis
*Abdominal pain (see workup by location)
# Acute [[Pancreatitis]]
*May be associated with [[nausea]], [[vomiting]] or [[diarrhea]]
# [[Sickle Cell Crisis]]
*[[Fever]] may be present in pain from infectious etiology
# Early Appendicitis
# Mesenteric thrombosis
# Gastroenteritis
# Dissecting/rupturing aneurysm
# Intestinal obstruction
# [[Diabetes]]


===RUQ===
==Differential Diagnosis==
# [[Acute Cholecystitis]]/[[Biliary colic]]
{{Abdominal Pain DDX Diffuse}}
# [[Acute hepatitis]]
{{Abdominal Pain DDX Epigastric}}
# Hepatic abscess
{{DDX RUQ}}
# Hepatomegaly due to [[CHF]]
{{DDX LUQ}}
# Perforated duodenal ulcer
{{Abd DDX RLQ}}
# Acute [[Pancreatitis]] (can be bilateral)
{{LLQ DDX}}
# Retrocecal appendicitis
{{Pelvic pain DDX}}
# Herpes zoster
{{Extra-abdominal sources of abdominal pain DDX}}
# Myocardial ischemia
# Right lower lobe [[Pneumonia]]
# Bowel obstruction
===Epigastric===
# [[Gallbladder Disease]]
# GERD
# PUD
# Gastritis
# Acute [[Pancreatitis]]
# Splenic enlargement/rupture/infarction/aneurysm
# Myocardial ischemia
# [[Pericarditis]]/Myocarditis
# [[Aortic Dissection]]
===LUQ===
# Gastritis
# Acute [[Pancreatitis]]
# Splenic enlargement/rupture/infarction/aneurysm
# [[Myocardial Ischemia]]
# Left lower lobe [[Pneumonia]]
===RLQ===
# [[Appendicitis]]
# Regional enteritis
# Meckel's diverticulitis
# Cecal diverticulitis
# Leaking aneurysm
# Abdominal wall hematoma
# Ruptured [[Ectopic]]
# Twisted ovarian cyst (torsion)
===LLQ===
# Sigmoid diverticulitis
# Leaking aneurysm
# Ruptured ectopic
# Mittleshmerz
# Twisted ovarian cyst (torsion)
===Pelvic===
# Mittelschmerz
# Endometriosis
# Ureteral calculi ([[Kidney Stone]])
# Seminal vesiculitis
# Psoas abscess
# Mesenteric adenitis
# Incarcerated hernia
# Endometriosis


===Extra-Abdominal===
==Evaluation==
# [[MI]]
*Workup is by location:
# [[Aortic Dissection]]
**[[RUQ pain]]
# [[AAA]]  
**[[RLQ pain]]
# [[PNA]]
**[[Epigastric pain]]
# [[PE]]
**[[LUQ pain]]
# [[Testicular Torsion]]
**[[LLQ pain]]
# Herpes zoster
**[[Diffuse abdominal pain]]
# Muscle spasm
**[[Flank pain]]
# [[Strep Pharyngitis]] (children)
# Mononucleosis
# [[DKA]]
# ETOH ketoacidosis
# Uremia
# Sickle cell disease
# Porphyria
# SLE
# Vasculitis
# Glaucoma
# Hyperthyroidsim
# Methanol poisoning
# Heavy metal toxicity
# Addison's Disease
# Acute Porphyria


==Source ==
==Management==
3/20/06 DONALDSON (adapted from Rosen)
*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]].<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==
*[[Abdominal Pain (Geriatrics)]]
*[[Abdominal Pain (Peds)]]
*[[Abdominal Trauma]]
*[[Abdominal pain in pregnancy]]
*[[Pelvic Pain]]
==References==
<references/>
[[Category:GI]]
[[Category:GI]]
[[Category:Misc/General]]
[[Category:Symptoms]]

Latest revision as of 22:35, 31 January 2024

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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