Abdominal pain

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

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. Acute Pancreatitis
3. Sickle Cell Crisis
4. Early Appendicitis
5. Mesenteric thrombosis
6. Gastroenteritis
7. Dissecting/rupturing aneurysm
8. Intestinal obstruction
9. Diabetes

RUQ

1. Acute Cholecystitis/Biliary colic
2. Acute hepatitis
3. Hepatic abscess
4. Hepatomegaly due to CHF
5. Perforated duodenal ulcer
6. Acute Pancreatitis (can be bilateral)
7. Retrocecal appendicitis
8. Herpes zoster
9. Myocardial ischemia
10. Right lower lobe Pneumonia
11. Bowel obstruction

Epigastric

1. Gallbladder Disease
2. GERD
3. PUD
4. Gastritis
5. Acute Pancreatitis
6. Splenic enlargement/rupture/infarction/aneurysm
7. Myocardial ischemia
8. Pericarditis/Myocarditis
9. Aortic Dissection

LUQ

1. Gastritis
2. Acute Pancreatitis
3. Splenic enlargement/rupture/infarction/aneurysm
4. Myocardial Ischemia
5. Left lower lobe Pneumonia

RLQ

1. Appendicitis
2. Regional enteritis
3. Meckel's diverticulitis
4. Cecal diverticulitis
5. Leaking aneurysm
6. Abdominal wall hematoma
7. Ruptured Ectopic
8. Twisted ovarian cyst (torsion)

LLQ

1. Sigmoid diverticulitis
2. Leaking aneurysm
3. Ruptured ectopic
4. Mittleshmerz
5. Twisted ovarian cyst (torsion)

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

3/20/06 DONALDSON (adapted from Rosen)