Abdominal pain: Difference between revisions

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==Background==
*3 Questions:
**1. Is this pt critically ill?
**2. Does the pt have a constellation of sx that fit a known disease pattern?
**3. Are there risk factors that would make it diff
==Workup==
==Workup==
#Urine pregnancy
#Urine pregnancy
Line 15: Line 21:
==DDX ==
==DDX ==
===Killers===
===Killers===
# [[AAA]]
#[[AAA]]
# [[Mesenteric Ischemia]]
#[[Mesenteric Ischemia]]
# Bowel Perforation
#Bowel Perforation
# [[Small Bowel Obstruction]]
#[[Small Bowel Obstruction]]
# Sigmoid Volvulus
#Sigmoid Volvulus
# [[Ectopic Pregnancy]]
#[[Ectopic Pregnancy]]
# [[Placental Abruption]]
#[[Placental Abruption]]
# [[ACS]]
#[[ACS]]


===Diffuse===
===Diffuse===
# Peritonitis
#Peritonitis
# Acute [[Pancreatitis]]
#[[Pancreatitis]]
# [[Sickle Cell Crisis]]
#Appendicitis (early)
# Early Appendicitis
#Aortic aneurysm (leaking, ruptured)
# [[Mesenteric Ischemia]]
#Aortic dissection
# [[Gastroenteritis]]
#[[Small Bowel Obstruction]]
# Dissecting/rupturing aneurysm
#Diabetic gastric paresis
# Intestinal obstruction
#[[Mesenteric Ischemia]]
# [[Diabetes]]
#[[Diabetic Ketoacidosis]]
#Bowel perforation
#Volvulus
#[[Sickle Cell Crisis]]
#[[Mesenteric Ischemia]]
#[[Gastroenteritis]]


===RUQ===
===RUQ===
# [[Acute Cholecystitis]]/[[Biliary colic]]
#[[Gallbladder Disease (Main)]]
# Acute hepatitis
#Appendicitis (retrocecal)
# Hepatic abscess
#Hepatitis
# Hepatomegaly due to [[CHF]]
#Hepatic abscess
# Perforated duodenal ulcer
#Fitz-Hugh-Curtis Syndrome
# Acute [[Pancreatitis]] (can be bilateral)
#Hepatomegaly due to [[CHF]]
# Retrocecal appendicitis
#Perforated duodenal ulcer
# Herpes zoster
#[[Pancreatitis]]
# Myocardial ischemia
#Herpes zoster
# Right lower lobe [[Pneumonia]]
#Myocardial ischemia
# Bowel obstruction
#[[Pneumonia]]
#Bowel obstruction
#Pulmonary embolism


===Epigastric===
===Epigastric===
# [[Gallbladder Disease]]
#[[Gallbladder Disease (Main)]]
# GERD
#GERD
# PUD
#PUD
# Gastritis
#Gastritis
# Acute [[Pancreatitis]]
#[[Pancreatitis]]
# Splenic enlargement/rupture/infarction/aneurysm
#Splenic enlargement/rupture/infarction/aneurysm
# Myocardial ischemia
#Myocardial ischemia
# [[Pericarditis]]/Myocarditis  
#[[Pericarditis]]/Myocarditis  
# [[Aortic Dissection]]  
#[[Aortic Dissection]]  
   
   
===LUQ===
===LUQ===
# Gastritis
#Gastritis/gastric ulcer
# Acute [[Pancreatitis]]
#Herpes Zoster
# Splenic enlargement/rupture/infarction/aneurysm
#[[Pancreatitis]]
# [[Myocardial Ischemia]]
#Splenic rupture/distension
# Left lower lobe [[Pneumonia]]
#[[Myocardial Ischemia]]
#[[Pneumonia]]
#Pulmonary Embolism
   
   
===RLQ===
===RLQ===
# Appendicitis
#Appendicitis
# Regional enteritis
#Aortic aneurysm (leaking, ruptured)
# Meckel's diverticulitis
#Crohn disease (terminal ileitis)
# Cecal diverticulitis
#Diverticulitis (cecal)
# Leaking aneurysm
#Ectopic
# Abdominal wall hematoma
#Endometriosis
# Ruptured [[Ectopic]]
#Epiploic appendagitis
# Twisted ovarian cyst (torsion)
#Herpes zoster
#Inguinal hernia
#Ischemic colitis
#Meckel diverticulum
#Mittelschmerz
#Ovarian cyst (ruptured)
#Ovarian torsion
#PID
#Psoas abscess
#Testicular torsion
#Kidney stone
   
   
===LLQ===
===LLQ===
# Sigmoid diverticulitis
 
# Leaking aneurysm
#Aortic aneurysm (leaking, ruptured)
# Ruptured ectopic
#Diverticulitis (sigmoid)
# Mittleshmerz
#Ectopic
# Twisted ovarian cyst (torsion)
#Endometriosis
#Epiploic appendagitis
#Herpes Zoster
#Inguinal hernia
#Ischemic colitis
#Mittelschmerz
#Ovarian cyst (ruptured)
#Ovarian torsion
#PID
#Psoas abscess
#Testicular torsion
#Kidney stone
 
===Pelvic===
===Pelvic===
# Mittelschmerz
#Mittelschmerz
# Endometriosis
#Endometriosis
# Ureteral calculi ([[Kidney Stone]])
#Ureteral calculi ([[Kidney Stone]])
# Seminal vesiculitis
#Seminal vesiculitis
# Psoas abscess
#Psoas abscess
# Mesenteric adenitis
#Mesenteric adenitis
# Incarcerated hernia
#Incarcerated hernia
# Endometriosis
#Endometriosis


===Extra-Abdominal===
===Extra-Abdominal===
# [[MI]]
#[[MI]]
# [[Aortic Dissection]]
#[[Aortic Dissection]]
# [[AAA]]  
#[[AAA]]  
# [[PNA]]
#[[PNA]]
# [[PE]]
#[[PE]]
# [[Testicular Torsion]]
#[[Testicular Torsion]]
# Herpes zoster
#Herpes zoster
# Muscle spasm
#Muscle spasm
# [[Strep Pharyngitis]] (children)
#[[Strep Pharyngitis]] (children)
# Mononucleosis
#Mononucleosis
# [[DKA]]
#[[DKA]]
# ETOH ketoacidosis
#ETOH ketoacidosis
# Uremia
#Uremia
# Sickle cell disease
#Sickle cell disease
# Porphyria
#Porphyria
# SLE
#SLE
# Vasculitis
#Vasculitis
# Glaucoma
#Glaucoma
# Hyperthyroidsim
#Hyperthyroidsim
# Methanol poisoning
#Methanol poisoning
# Heavy metal toxicity
#Heavy metal toxicity
# Addison's Disease  
#Addison's Disease  
# Acute Porphyria
#Acute Porphyria


==Source ==
==Source ==
3/20/06 DONALDSON (adapted from Rosen)
Tintinalli


[[Category:GI]]
[[Category:GI]]

Revision as of 05:21, 25 July 2011

Background

  • 3 Questions:
    • 1. Is this pt critically ill?
    • 2. Does the pt have a constellation of sx that fit a known disease pattern?
    • 3. Are there risk factors that would make it diff

Workup

  1. Urine pregnancy
  2. CBC
  3. Chem 7
  4. LFTs
  5. Lipase
  6. UA/Gram stain/UCx
  7. Guaiac
  8. ECG (>50 yo)
  9. ?CXR
  10. ?Coags
  11. ?CT
  12. ?US

DDX

Killers

  1. AAA
  2. Mesenteric Ischemia
  3. Bowel Perforation
  4. Small Bowel Obstruction
  5. Sigmoid Volvulus
  6. Ectopic Pregnancy
  7. Placental Abruption
  8. ACS

Diffuse

  1. Peritonitis
  2. Pancreatitis
  3. Appendicitis (early)
  4. Aortic aneurysm (leaking, ruptured)
  5. Aortic dissection
  6. Small Bowel Obstruction
  7. Diabetic gastric paresis
  8. Mesenteric Ischemia
  9. Diabetic Ketoacidosis
  10. Bowel perforation
  11. Volvulus
  12. Sickle Cell Crisis
  13. Mesenteric Ischemia
  14. Gastroenteritis

RUQ

  1. Gallbladder Disease (Main)
  2. Appendicitis (retrocecal)
  3. Hepatitis
  4. Hepatic abscess
  5. Fitz-Hugh-Curtis Syndrome
  6. Hepatomegaly due to CHF
  7. Perforated duodenal ulcer
  8. Pancreatitis
  9. Herpes zoster
  10. Myocardial ischemia
  11. Pneumonia
  12. Bowel obstruction
  13. Pulmonary embolism

Epigastric

  1. Gallbladder Disease (Main)
  2. GERD
  3. PUD
  4. Gastritis
  5. Pancreatitis
  6. Splenic enlargement/rupture/infarction/aneurysm
  7. Myocardial ischemia
  8. Pericarditis/Myocarditis
  9. Aortic Dissection

LUQ

  1. Gastritis/gastric ulcer
  2. Herpes Zoster
  3. Pancreatitis
  4. Splenic rupture/distension
  5. Myocardial Ischemia
  6. Pneumonia
  7. Pulmonary Embolism

RLQ

  1. Appendicitis
  2. Aortic aneurysm (leaking, ruptured)
  3. Crohn disease (terminal ileitis)
  4. Diverticulitis (cecal)
  5. Ectopic
  6. Endometriosis
  7. Epiploic appendagitis
  8. Herpes zoster
  9. Inguinal hernia
  10. Ischemic colitis
  11. Meckel diverticulum
  12. Mittelschmerz
  13. Ovarian cyst (ruptured)
  14. Ovarian torsion
  15. PID
  16. Psoas abscess
  17. Testicular torsion
  18. Kidney stone

LLQ

  1. Aortic aneurysm (leaking, ruptured)
  2. Diverticulitis (sigmoid)
  3. Ectopic
  4. Endometriosis
  5. Epiploic appendagitis
  6. Herpes Zoster
  7. Inguinal hernia
  8. Ischemic colitis
  9. Mittelschmerz
  10. Ovarian cyst (ruptured)
  11. Ovarian torsion
  12. PID
  13. Psoas abscess
  14. Testicular torsion
  15. Kidney stone

Pelvic

  1. Mittelschmerz
  2. Endometriosis
  3. Ureteral calculi (Kidney Stone)
  4. Seminal vesiculitis
  5. Psoas abscess
  6. Mesenteric adenitis
  7. Incarcerated hernia
  8. Endometriosis

Extra-Abdominal

  1. MI
  2. Aortic Dissection
  3. AAA
  4. PNA
  5. PE
  6. Testicular Torsion
  7. Herpes zoster
  8. Muscle spasm
  9. Strep Pharyngitis (children)
  10. Mononucleosis
  11. DKA
  12. ETOH ketoacidosis
  13. Uremia
  14. Sickle cell disease
  15. Porphyria
  16. SLE
  17. Vasculitis
  18. Glaucoma
  19. Hyperthyroidsim
  20. Methanol poisoning
  21. Heavy metal toxicity
  22. Addison's Disease
  23. Acute Porphyria

Source

Tintinalli

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