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]].'' | ''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== <!--T:2--> | ||
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*Patients with immunosuppression often have delayed or atypical presentations | *Patients with immunosuppression often have delayed or atypical presentations | ||
*[[Special:MyLanguage/Fever|Fever]] is not a reliable marker for surgical disease | *[[Special:MyLanguage/Fever|Fever]] is not a reliable marker for surgical disease | ||
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==Clinical Features== | ==Clinical Features== <!--T:4--> | ||
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*Abdominal pain (see workup by location) | *Abdominal pain (see workup by location) | ||
*May be associated with [[Special:MyLanguage/nausea|nausea]], [[Special:MyLanguage/vomiting|vomiting]] or [[Special:MyLanguage/diarrhea|diarrhea]] | *May be associated with [[Special:MyLanguage/nausea|nausea]], [[Special:MyLanguage/vomiting|vomiting]] or [[Special:MyLanguage/diarrhea|diarrhea]] | ||
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==Differential Diagnosis== | ==Differential Diagnosis== <!--T:6--> | ||
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==Evaluation== | ==Evaluation== <!--T:7--> | ||
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*Workup is by location: | *Workup is by location: | ||
**[[Special:MyLanguage/RUQ pain|RUQ pain]] | **[[Special:MyLanguage/RUQ pain|RUQ pain]] | ||
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==Management== | ==Management== <!--T:9--> | ||
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*Treat underlying cause | *Treat underlying cause | ||
*Multiple studies show [[Special:MyLanguage/pain medicine|pain medicine]] should not be withheld for fear of masking symptoms | *Multiple studies show [[Special:MyLanguage/pain medicine|pain medicine]] should not be withheld for fear of masking symptoms | ||
==Disposition== | ==Disposition== <!--T:11--> | ||
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*Depends on etiology | *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. | *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== | ==See Also== <!--T:13--> | ||
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*[[Special:MyLanguage/Abdominal Pain (Geriatrics)|Abdominal Pain (Geriatrics)]] | *[[Special:MyLanguage/Abdominal Pain (Geriatrics)|Abdominal Pain (Geriatrics)]] | ||
*[[Special:MyLanguage/Abdominal Pain (Peds)|Abdominal Pain (Peds)]] | *[[Special:MyLanguage/Abdominal Pain (Peds)|Abdominal Pain (Peds)]] | ||
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==References== | ==References== <!--T:15--> | ||
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<references/> | <references/> | ||
[[Category:GI]] | [[Category:GI]] | ||
Revision as of 14:23, 5 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
| 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
- Abdominal aortic aneurysm
- Acute gastroenteritis
- Aortoenteric fisulta
- Appendicitis (early)
- Bowel obstruction
- Bowel perforation
- Diabetic ketoacidosis
- Gastroparesis
- Hernia
- Hypercalcemia
- Inflammatory bowel disease
- Mesenteric ischemia
- Pancreatitis
- Peritonitis
- Sickle cell crisis
- Spontaneous bacterial peritonitis
- Volvulus
Epigastric Pain
- Gastroesophageal reflux disease (GERD)
- Peptic ulcer disease with or without perforation
- Gastritis
- Pancreatitis
- Gallbladder disease
- Myocardial Ischemia
- Splenic Infarctionenlargement/rupture/aneurysm
- Pericarditis/Myocarditis
- Aortic dissection
- Hepatitis
- Pyelonephritis
- Pneumonia
- Pyogenic liver abscess
- Fitz-Hugh-Curtis Syndrome
- Hepatomegaly due to CHF
- Bowel obstruction
- SMA syndrome
- Pulmonary embolism
- Bezoar
- Ingested foreign body
RUQ Pain
- Gallbladder disease
- Pancreatitis
- Acute hepatitis
- Pancreatitis
- GERD
- Appendicitis (retrocecal)
- Pyogenic liver abscess
- Bowel obstruction
- Cirrhosis
- Budd-Chiari syndrome
- GU
- Other
- Hepatomegaly due to CHF
- Peptic ulcer disease with or without perforation
- Pneumonia
- Herpes zoster
- Myocardial ischemia
- Pulmonary embolism
- Abdominal aortic aneurysm
Left upper quadrant abdominal pain
- GERD
- Peptic ulcer disease with or without perforation
- Pancreatitis
- Splenic infarction/Splenic artery aneurysm rupture
- Pyelonephritis
- Bowel obstruction
- Myocardial Ischemia
- Pneumonia
- Pulmonary embolism
- Herpes zoster
- Pericarditis/Myocarditis
- Aortic Dissection
RLQ Pain
- GI
- Appendicitis
- Perforated appendicitis
- Peritonitis
- Crohn's disease (terminal ileitis)
- Diverticulitis (cecal, Asian patients)
- Inguinal hernia
- Mesenteric ischemia
- Ischemic colitis
- Meckel's diverticulum
- Neutropenic enterocolitis (typhlitis)
- Appendicitis
- GU
- Other
LLQ Pain
- Diverticulitis
- Kidney stone
- UTI
- Pyelonephritis
- Ectopic pregnancy
- Infectious colitis
- Inflammatory bowel disease (Crohn's Disease, Ulcerative Colitis)
- Inguinal hernia
- Mesenteric ischemia
- Epiploic appendagitis
- Mittelschmerz
- Ovarian cyst
- Ovarian torsion
- PID
- Psoas abscess
- Testicular torsion
- Appendicitis
- Abdominal aortic aneurysm
- Herpes zoster
- Endometriosis
- Colon cancer
- Irritable bowel syndrome
- Small bowel obstruction
Acute Pelvic Pain
Gynecologic/Obstetric
- Normal variants may be noted on exam but generally do not cause pain or other symptoms
- Nabothian cysts: Epithelial cells within mucous glans that appear as yellow inclusions on the cervix
- Cervical Ectropion: Edothelial cells on the exterior of the cervix
- Parous cervix: The is no longer round but may have multiple shapes after birth
- Pregnancy-related
- Ectopic pregnancy
- Spontaneous abortion, threatened or incomplete
- Septic abortion
- Pelvic organ prolapse
- Acute Infections
- Vulvovaginitis
- Adnexal Disorders
- Hemorrhage/rupture of ovarian cyst
- Ovarian torsion
- Twisted paraovarian cyst
- Other
- Myoma (degenerating)
- Genitourinary trauma
- Ovarian hyperstimulation syndrome
- Sexual assault
- Recurrent
- Mittelschmerz
- Primary/Secondary Dysmenorrhea
- Pelvic Congestion Syndrome
- Endometriosis
Genitourinary
Gastrointestinal
- Gastroenteritis
- Appendicitis
- Bowel obstruction
- Perirectal abscess
- Diverticulitis
- Inflammatory bowel disease
- Irritable bowel syndrome
- Mesenteric adenitis
Musculoskeletal
- Abdominal wall hematoma
- Psoas hematoma, psoas abscess
- Hernia
Vascular
- Pelvic thrombophlebitis
- Abdominal aortic aneurysm
- Ischemic bowel (Mesenteric Ischemia)
Extra-abdominal Sources of Abdominal pain
- MI
- Aortic Dissection
- PNA
- PE
- Testicular Torsion
- Herpes Zoster
- Muscle spasm
- Spinal pathology
- Strep Pharyngitis (peds)
- Mononucleosis
- DKA
- ETOH Ketoacidosis
- Uremia
- Sickle Cell Crisis
- SLE
- Vasculitis
- Glaucoma
- Hyperthyroidism
- Methanol Poisoning
- Heavy Metal toxicity
- Addison's disease
- Porphyria
- Paroxysmal nocturnal hemoglobinuria
- Black widow spider bite
Evaluation
- Workup is by location:
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
- Abdominal Pain (Geriatrics)
- Abdominal Pain (Peds)
- Abdominal Trauma
- Abdominal pain in pregnancy
- Pelvic Pain
References
- ↑ Norris DL, Young JD. UTI. EM Clin N Am. 2008; 26:413-30.
- ↑ 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/