Abdominal pain: Difference between revisions

(9 intermediate revisions by 4 users not shown)
Line 4: Line 4:
*Fever is not a reliable marker for surgical disease
*Fever is not a reliable marker for surgical disease
*Abdominal pain may be particularly misleading in elderly or diabetics
*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


==Clinical Features==
==Clinical Features==
Line 43: Line 44:
==Disposition==
==Disposition==
*Depends on etiology
*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==
==See Also==
Line 52: Line 54:


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

Revision as of 02:21, 17 May 2019

For pediatric patients see Abdominal pain (peds)

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

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/