Abdominal pain

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
   1. A single WBC cannot exclude surgical disease
3. Chemistry
4. LFTs
5. Lipase
   1. May be normal early in course of pancreatitis
6. UA/UCx
7. Guaiac
8. ECG (>40 yo)
9. ?CXR
10. ?Coags
    1. GI bleeding, end-stage liver disease, coagulopathy
11. ?Lactate
12. ?Abd X-ray
    1. Consider for r/o obstruction, perforation, or severe constipation
13. ?US
14. ?CT

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