Abdominal pain: Difference between revisions

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#Appendicitis (early)
#Appendicitis (early)
#Aortic aneurysm (leaking, ruptured)
#Aortic aneurysm (leaking, ruptured)
#Aortic dissection
#[[Aortic dissection]]
#[[Small Bowel Obstruction]]
#[[Small Bowel Obstruction]]
#Diabetic gastric paresis
#Diabetic gastric paresis
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#[[Pancreatitis]]
#[[Pancreatitis]]
#Splenic enlargement/rupture/infarction/aneurysm
#Splenic enlargement/rupture/infarction/aneurysm
#Myocardial ischemia
#[[Myocardial ischemia]]
#[[Pericarditis]]/Myocarditis  
#[[Pericarditis]]/Myocarditis  
#[[Aortic Dissection]]
#[[Aortic Dissection]]
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#[[Pancreatitis]]
#[[Pancreatitis]]
#Herpes zoster
#Herpes zoster
#Myocardial ischemia
#[[Myocardial ischemia]]
#[[Pneumonia]]
#[[Pneumonia]]
#Bowel obstruction
#Bowel obstruction
#Pulmonary embolism
#[[Pulmonary embolism]]


===LUQ===
===LUQ===
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#[[Myocardial Ischemia]]
#[[Myocardial Ischemia]]
#[[Pneumonia]]
#[[Pneumonia]]
#Pulmonary Embolism
#[[Pulmonary Embolism]]
   
   
===RLQ===
===RLQ===
#Appendicitis
#Appendicitis
#Aortic aneurysm (leaking, ruptured)
#[[Aortic Aneurysm]] (leaking, ruptured)
#Crohn disease (terminal ileitis)
#Crohn disease (terminal ileitis)
#Diverticulitis (cecal)
#Diverticulitis (cecal)
#Ectopic
#[[Ectopic]]
#Endometriosis
#Endometriosis
#Epiploic appendagitis
#Epiploic appendagitis
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#Mittelschmerz
#Mittelschmerz
#Ovarian cyst (ruptured)
#Ovarian cyst (ruptured)
#Ovarian torsion
#[[Ovarian Torsion]]
#PID
#[[PID]]
#Psoas abscess
#Psoas abscess
#Testicular torsion
#[[Testicular torsion]]
#Kidney stone
#[[Kidney stone]]
   
   
===LLQ===
===LLQ===
#Aortic aneurysm (leaking, ruptured)
#[[Aortic aneurysm]] (leaking, ruptured)
#Diverticulitis (sigmoid)
#Diverticulitis (sigmoid)
#Ectopic
#[[Ectopic]]
#Endometriosis
#Endometriosis
#Epiploic appendagitis
#Epiploic appendagitis
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#Mittelschmerz
#Mittelschmerz
#Ovarian cyst (ruptured)  
#Ovarian cyst (ruptured)  
#Ovarian torsion
#[[Ovarian torsion]]
#PID
#[[PID]]
#Psoas abscess
#Psoas abscess
#Testicular torsion
#[[Testicular torsion]]
#Kidney stone
#[[Kidney stone]]


===Pelvic===
===Pelvic===
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#Incarcerated hernia
#Incarcerated hernia
====Pelvic origin====
====Pelvic origin====
#Ectopic
#[[Ectopic]]
#Adnexal torsion
#Adnexal torsion
#Endometriosis
#Endometriosis
#PID
#[[PID]]
#Myoma (degenerating)
#Myoma (degenerating)
#Ovarian cyst (rupture)
#Ovarian cyst (rupture)

Revision as of 18:40, 26 July 2011

Background

  • Elderly pts
    • Surgical emergencies are more common in elderly than in any other pt population
    • Viral gastroenteritis is uncommon
    • Conservative admission strategy is strongly advocated
  • Pts with immunosuppression often have delayed or atypical presentations
  • Fever is not a reliable marker for surgical disease

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

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

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

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

Abdominal origin

  1. Ureteral calculi (Kidney Stone)
  2. Psoas abscess
  3. Mesenteric adenitis
  4. Incarcerated hernia

Pelvic origin

  1. Ectopic
  2. Adnexal torsion
  3. Endometriosis
  4. PID
  5. Myoma (degenerating)
  6. Ovarian cyst (rupture)
  7. Tubo-ovarian abscess
  8. Mittelschmerz
  9. Endometriosis
  10. Seminal vesiculitis

Extra-Abdominal

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

Source

Tintinalli

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