Abdominal pain: Difference between revisions

(Created page with "==Workup== 1) B-hCG 2) CBC 3) Chem 7 4) LFTs 5) Lipase 6) UA/Gm stain/UCx 7) Guaiac 8) IVF 9) ECG (>50 yo) 10) ?CXR 11) ?Coags 12) ?contrast --> CT 13) ?US ==DD...")
 
 
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==Workup==
''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


{{Abdominal pain location}}


1) B-hCG
==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


2) CBC
==Differential Diagnosis==
{{Abdominal Pain DDX Diffuse}}
{{Abdominal Pain DDX Epigastric}}
{{DDX RUQ}}
{{DDX LUQ}}
{{Abd DDX RLQ}}
{{LLQ DDX}}
{{Pelvic pain DDX}}
{{Extra-abdominal sources of abdominal pain DDX}}


3) Chem 7
==Evaluation==
 
*Workup is by location:
4) LFTs
**[[RUQ pain]]
 
**[[RLQ pain]]
5) Lipase
**[[Epigastric pain]]
 
**[[LUQ pain]]
6) UA/Gm stain/UCx
**[[LLQ pain]]
 
**[[Diffuse abdominal pain]]
7) Guaiac
**[[Flank pain]]
 
8) IVF
 
9) ECG (>50 yo)
 
10) ?CXR
 
11) ?Coags
 
12) ?contrast --> CT
 
13) ?US
 
 
==DDX ==
 
 
=== ===
 
 
Killers
 
* AAA
* Mesenteric Ischemia
* Bowel Perforation
* Small Bowel Obstruction
* Sigmoid Volvulus
* Ectopic Pregnancy
* Placental Abruption
* MI
 
===Diffuse===
 
 
* Peritonitis
* Acute pancreatitis
* Sickle cell crisis
* Early appendicitis
* Mesenteric thrombosis
* Gastroenteritis
* Dissecting/rupturing aneurysm
* Intestinal obstruction
* Diabetes
 
===RUQ===
 
 
* Acute cholecystitis/biliary colic
* Acute hepatitis
* Hepatic abscess
* Hepatomegaly due to CHF
* Perforated duodenal ulcer
* Acute pancreatitis (can be bilateral)
* Retrocecal appendicitis
* Herpes zoster
* Myocardial ischemia
* Right lower lobe pneumonia
* Bowel obstruction
 
===Epigastric===
 
 
* Gallbladder disease
* GERD
* PUD
* Gastritis
* Acute pancreatitis
* Splenic enlargement/rupture/infarction/aneurysm
* Myocardial ischemia
* Pericarditis/Myocarditis
* Aortic dissection
 
===LUQ===
 
 
* Gastritis
* Acute pancreatitis
* Splenic enlargement/rupture/infarction/aneurysm
* Myocardial ischemia
* Left lower lobe pneumonia
 
===RLQ===
 
 
* Appendicitis
* Regional enteritis
* Meckel's diverticulitis
* Cecal diverticulitis
* Leaking aneurysm
* Abdominal wall hematoma
* Ruptured ectopic
* Twisted ovarian cyst
 
===LLQ===
 
 
* Sigmoid diverticulitis
* Leaking aneurysm
* Ruptured ectopic
* Mittleshmerz
* Twisted ovarian cyst
 
===Pelvic===
 
 
* Mittelschmerz
* Endometriosis
* Ureteral calculi
* Seminal vesiculitis
* Psoas abscess
* Mesenteric adenitis
* Incarcerated hernia
* Endometriosis
 
===Extra-Abdominal===
 
 
* MI
* Aortic Dissection
* AAA
* PNA
* PE
* Testicular Torsion
* Herpes zoster
* Muscle spasm
* Strep pharyngitis (children)
* Mononucleosis
* DKA
* ETOH ketoacidosis
* Uremia
* Sickle cell disease
* Porphyria
* SLE
* Vasculitis
* Glaucoma
* Hyperthyroidsim
* Methanol poisoning
* Heavy metal toxicity
* Addison's Disease
* Acute Porphyria
 
==Source ==
 
 
3/20/06 DONALDSON (adapted from Rosen)


==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]].<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==
*[[Abdominal Pain (Geriatrics)]]
*[[Abdominal Pain (Peds)]]
*[[Abdominal Trauma]]
*[[Abdominal pain in pregnancy]]
*[[Pelvic Pain]]


==References==
<references/>
[[Category:GI]]
[[Category:GI]]
[[Category:Misc/General]]
[[Category:Symptoms]]

Latest revision as of 22:35, 31 January 2024

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

Side-by-side comparison of quadrants and regions.
Chart of commonly reported referred pain sites.
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

Epigastric Pain

RUQ Pain

Left upper quadrant abdominal pain

RLQ Pain

LLQ Pain

Acute Pelvic Pain

Differential diagnosis of acute pelvic pain

Gynecologic/Obstetric

Genitourinary

Gastrointestinal

Musculoskeletal

Vascular

Extra-abdominal Sources of Abdominal pain

Evaluation

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

References

  1. ↑ Norris DL, Young JD. UTI. EM Clin N Am. 2008; 26:413-30.
  2. ↑ 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/
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