Abdominal pain: Difference between revisions
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==Background==
==Background==
*3 Questions:
*Pts with immunosuppression often have delayed or atypical presentations
**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==

Revision as of 05:38, 25 July 2011

Background

  • Pts with immunosuppression often have delayed or atypical presentations

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

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