Abdominal pain: Difference between revisions
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==Workup==
<languages/>
# B-hCG
<translate>
# CBC
''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]].''
# Chem 7
# LFTs
# Lipase
# UA/Gm stain/UCx
# Guaiac
# IVF
# ECG (>50 yo)
# ?CXR
# ?Coags
# ?contrast --> CT
# ?US


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


===Diffuse===
==Background==
# Peritonitis
# Acute [[Pancreatitis]]
# [[Sickle Cell Crisis]]
# Early Appendicitis
# Mesenteric thrombosis
# Gastroenteritis
# Dissecting/rupturing aneurysm
# Intestinal obstruction
# [[Diabetes]]


===RUQ===
*Patients with immunosuppression often have delayed or atypical presentations
# [[Acute Cholecystitis]]/[[Biliary colic]]
*[[Special:MyLanguage/Fever|Fever]] is not a reliable marker for surgical disease
# Acute hepatitis
*Abdominal pain may be particularly misleading in elderly or diabetics
# Hepatic abscess
*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
# Hepatomegaly due to [[CHF]]
# Perforated duodenal ulcer
# Acute [[Pancreatitis]] (can be bilateral)
# Retrocecal appendicitis
# Herpes zoster
# Myocardial ischemia
# Right lower lobe [[Pneumonia]]
# Bowel obstruction


===Epigastric===
</translate>
# [[Gallbladder Disease]]
{{Abdominal pain location}}
# GERD
<translate>
# 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===
# [[MI]]
# [[Aortic Dissection]]
# [[AAA]]
# [[PNA]]
# [[PE]]
# [[Testicular Torsion]]
# Herpes zoster
# Muscle spasm
# [[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 ==
3/20/06 DONALDSON (adapted from Rosen)


==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==
</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}}
<translate>
</translate>
{{Extra-abdominal sources of abdominal pain DDX}}
<translate>
==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]]
==Management==
*Treat underlying cause
*Multiple studies show [[Special:MyLanguage/pain medicine|pain medicine]] should not be withheld for fear of masking symptoms
==Disposition==
*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==
*[[Special:MyLanguage/Abdominal Pain (Geriatrics)|Abdominal Pain (Geriatrics)]]
*[[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==
<references/>
[[Category:GI]]
[[Category:GI]]
[[Category:Misc/General]]
[[Category:Symptoms]]
</translate>

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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