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Abdominal pain
From WikEM
For pediatric patients see Abdominal pain (peds)
Contents
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
- Abdominal aortic aneurysm
- Acute gastroenteritis
- Aortoenteric fisulta
- Appendicitis (early)
- Bowel obstruction
- Bowel perforation
- Gastroparesis
- Diabetic ketoacidosis
- Inflammatory bowel disease
- Mesenteric ischemia
- Pancreatitis
- Peritonitis
- Sickle cell crisis
- Spontaneous bacterial peritonitis
- Volvulus
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
RUQ Pain
- Gallbladder disease
- Peptic ulcer disease with or without perforation
- Pancreatitis
- Acute hepatitis
- Pyelonephritis
- Pneumonia
- Kidney stone
- Pancreatitis
- GERD
- Appendicitis (retrocecal)
- Pyogenic liver abscess
- Fitz-Hugh-Curtis Syndrome
- Hepatomegaly due to CHF
- Herpes zoster
- Myocardial ischemia
- Bowel obstruction
- Pulmonary embolism
- Abdominal aortic aneurysm
Left upper quadrant abdominal pain
- GERD
- Peptic ulcer disease with or without perforation
- Pancreatitis
- Splenic infarction/Splenic artery aneurysm rupture
- Pyelonephritis
- Bowel obstruction
- Myocardial Ischemia
- Pneumonia
- Pulmonary embolism
- Herpes zoster
- Pericarditis/Myocarditis
- Aortic Dissection
RLQ Pain
- Appendicitis
- Abdominal aortic aneurysm
- Crohn's disease (terminal ileitis)
- Diverticulitis (cecal, Asian patients)
- Ectopic
- Endometriosis
- Epiploic appendagitis
- Herpes zoster
- Inguinal hernia
- Ischemic colitis
- Meckel's diverticulum
- Mesenteric lymphadenitis
- Mittelschmerz
- Ovarian cyst
- Ovarian torsion
- PID
- Psoas abscess
- Testicular torsion
- Kidney stone
- Neutropenic enterocolitis (typhlitis)
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 Pain
Pelvic origin
- Urinary Tract Infection
- Ectopic
- Ovarian torsion
- Endometriosis
- PID
- Cervicitis
- Ectopic Pregnancy
- Ovarian Torsion
- Spontaneous abortion
- Septic abortion
- Myoma (degenerating)
- Ovarian cyst (rupture)
- Tubo-ovarian abscess
- Mittelschmerz
- Sexual assault/trauma
- Ovarian hyperstimulation syndrome
Abdominal origin
- Appendicitis
- Kidney stone
- Psoas abscess
- Mesenteric adenitis
- Incarcerated hernia
- Diverticulitis
- Pyelonephritis
Extra-abdominal Sources of Abdominal pain
- 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
- Acute intermittent porphyria
- Paroxysmal nocturnal hemoglobinuria
Evaluation
- Workup is by location:
Management
- Treat underlying cause
- Multiple studies show pain medicine should not be withheld for fear of masking symptoms
Disposition
- Depends on etiology
See Also
- Abdominal Pain (Geriatrics)
- Abdominal Pain (Peds)
- Abdominal Trauma
- Abdominal pain in pregnancy
- Pelvic Pain
