Abdominal pain
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
- Note: WBC cannot exclude surgical disease
- Chem
- LFT
- 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
Diffuse Abdominal pain
- Abdominal aortic aneurysm
- Acute gastroenteritis
- Aortoenteric fisulta
- Appendicitis (early)
- Bowel obstruction
- Bowel perforation
- Diabetic ketoacidosis
- Gastroparesis
- Hernia
- Hypercalcemia
- Inflammatory bowel disease
- Mesenteric ischemia
- Pancreatitis
- Peritonitis
- Sickle cell crisis
- Spontaneous bacterial peritonitis
- Volvulus
Epigastric
Epigastric Pain
- Gastroesophageal reflux disease (GERD)
- Peptic ulcer disease with or without perforation
- Gastritis
- Pancreatitis
- Gallbladder disease
- Myocardial Ischemia
- Splenic Infarctionenlargement/rupture/aneurysm
- Pericarditis/Myocarditis
- Aortic dissection
- Hepatitis
- Pyelonephritis
- Pneumonia
- Pyogenic liver abscess
- Fitz-Hugh-Curtis Syndrome
- Hepatomegaly due to CHF
- Bowel obstruction
- SMA syndrome
- Pulmonary embolism
- Bezoar
- Ingested foreign body
RUQ
- Gallbladder Disease (Main)
- Appendicitis (retrocecal)
- Hepatitis
- Pyogenic liver 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
- Splenic Infarction
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
LLQ Pain
- Diverticulitis
- Kidney stone
- UTI
- Pyelonephritis
- Ectopic pregnancy
- Infectious colitis
- Inflammatory bowel disease (Crohn's Disease, Ulcerative Colitis)
- Inguinal hernia
- Mesenteric ischemia
- Epiploic appendagitis
- Mittelschmerz
- Ovarian cyst
- Ovarian torsion
- PID
- Psoas abscess
- Testicular torsion
- Appendicitis
- Abdominal aortic aneurysm
- Herpes zoster
- Endometriosis
- Colon cancer
- Irritable bowel syndrome
- Small bowel obstruction
Pelvic
Acute Pelvic Pain
Gynecologic/Obstetric
- Pregnancy-related
- Ectopic Pregnancy
- Spontaneous abortion, threatened or incomplete
- Septic abortion
- Acute Infections
- Vulvovaginitis
- Adnexal Disorders
- Hemorrhage/rupture of ovarian cyst
- Ovarian torsion
- Twisted paraovarian cyst
- Other
- Myoma (degenerating)
- Genitourinary trauma
- Ovarian hyperstimulation syndrome
- Sexual assault
- Recurrent
- Mittelschmerz
- Primary/Secondary Dysmenorrhea
- Pelvic Congestion Syndrome
- Endometriosis
Genitourinary
Gastrointestinal
- Gastroenteritis
- Appendicitis
- Bowel obstruction
- Perirectal abscess
- Diverticulitis
- Inflammatory bowel disease
- Irritable bowel syndrome
- Mesenteric adenitis
Musculoskeletal
- Abdominal wall hematoma
- Psoas hematoma, psoas abscess
- Hernia
Vascular
- Pelvic thrombophlebitis
- Abdominal aortic aneurysm
- Ischemic bowel (Mesenteric Ischemia)
Extra-Abdominal
- MI
- Aortic Dissection
- PNA
- PE
- Testicular Torsion
- Herpes Zoster
- Muscle spasm
- Strep Pharyngitis (peds)
- Mononucleosis
- DKA
- ETOH Ketoacidosis
- Uremia
- Sickle Cell Crisis
- SLE
- Vasculitis
- Glaucoma
- Hyperthyroidism
- Methanol Poisoning
- Heavy Metal toxicity
- Addison's Disease
- Porphyria
See Also
- Abdominal Pain (Geriatrics)
- Abdominal Pain (Peds)
- Abdominal Trauma
- Abdominal pain in pregnancy
- Pelvic Pain
Source
- Tintinalli
- ACEP Geriatric lecture series
- ↑ Norris DL, Young JD. UTI. EM Clin N Am. 2008; 26:413-30.