Abdominal pain: Difference between revisions
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#[[Ectopic]] | #[[Ectopic]] | ||
#Endometriosis | #Endometriosis | ||
#Epiploic | #[[Epiploic Appendagitis]] | ||
#Herpes Zoster | #Herpes Zoster | ||
#Inguinal hernia | #Inguinal hernia |
Revision as of 12:06, 5 March 2012
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
- Urine pregnancy
- CBC
- A single WBC cannot exclude surgical disease
- Chemistry
- LFTs
- Lipase
- May be normal early in course of pancreatitis
- UA/UCx
- Guaiac
- ECG (>40 yo)
- ?CXR
- ?Coags
- GI bleeding, end-stage liver disease, coagulopathy
- ?Lactate
- ?Abd X-ray
- Consider for r/o obstruction, perforation, or severe constipation
- ?US
- ?CT
DDX
Killers
- AAA
- Mesenteric Ischemia
- Bowel Perforation
- Small Bowel Obstruction
- Sigmoid Volvulus
- Ectopic Pregnancy
- Placental Abruption
- ACS
Diffuse
- Peritonitis
- Pancreatitis
- Appendicitis (early)
- Abdominal Aortic Aneurysm (leaking, ruptured)
- Aortic Dissection
- Small Bowel Obstruction
- Diabetic gastric paresis
- Mesenteric Ischemia
- Diabetic Ketoacidosis
- Bowel perforation
- Volvulus
- Sickle Cell Crisis
- Mesenteric Ischemia
- Gastroenteritis
Epigastric
- Gallbladder Disease (Main)
- GERD
- PUD
- Gastritis
- Pancreatitis
- Splenic enlargement/rupture/infarction/aneurysm
- Myocardial Ischemia
- Pericarditis/Myocarditis
- Aortic Dissection
RUQ
- Gallbladder Disease (Main)
- Appendicitis (retrocecal)
- Hepatitis
- Hepatic abscess
- Fitz-Hugh-Curtis Syndrome
- Hepatomegaly due to CHF
- Perforated duodenal ulcer
- Pancreatitis
- Herpes zoster
- Myocardial Ischemia
- Pneumonia
- Bowel obstruction
- Pulmonary Embolism
LUQ
- Gastritis/gastric ulcer
- Herpes Zoster
- Pancreatitis
- Splenic rupture/distension
- Myocardial Ischemia
- Pneumonia
- Pulmonary Embolism
RLQ
- Appendicitis
- Abdominal Aortic Aneurysm (leaking, ruptured)
- Crohn disease (terminal ileitis)
- Diverticulitis (cecal)
- Ectopic
- Endometriosis
- Epiploic Appendagitis
- Herpes zoster
- Inguinal hernia
- Ischemic colitis
- Meckel diverticulum
- Mittelschmerz
- Ovarian cyst (ruptured)
- Ovarian Torsion
- PID
- Psoas Abscess
- Testicular Torsion
- Kidney Stone
LLQ
- Abdominal Aortic Aneurysm (leaking, ruptured)
- Diverticulitis (sigmoid)
- Ectopic
- Endometriosis
- Epiploic Appendagitis
- Herpes Zoster
- Inguinal hernia
- Ischemic colitis
- Mittelschmerz
- Ovarian cyst (ruptured)
- Ovarian torsion
- PID
- Psoas Abscess
- Testicular Torsion
- Kidney Stone
Pelvic
Abdominal origin
- Ureteral calculi (Kidney Stone)
- Psoas abscess
- Mesenteric adenitis
- Incarcerated hernia
Pelvic origin
- Ectopic
- Adnexal torsion
- Endometriosis
- PID
- Myoma (degenerating)
- Ovarian cyst (rupture)
- Tubo-ovarian abscess
- Mittelschmerz
- Endometriosis
- Seminal vesiculitis
Extra-Abdominal
- MI
- Aortic Dissection
- PNA
- PE
- Testicular Torsion
- Herpes zoster
- Muscle spasm
- Strep Pharyngitis (peds)
- Mononucleosis
- DKA
- ETOH ketoacidosis
- Uremia
- Sickle cell disease
- SLE
- Vasculitis
- Glaucoma
- Hyperthyroidsim
- Methanol poisoning
- Heavy metal toxicity
- Addison's Disease
- Porphyria
Source
Tintinalli