Abdominal Pain Differential Diagnosis
DIAGNOSIS OF ABDOMINAL PAIN BY ORGAN
A. Cholecystitis B.
Ileus C. Appendicitis D.
Diverticulitis E. Ulcer Perforation
F. Pancreatitis G. Crampy
Abdominal Pain H. Knife-Like Abdominal Pain
CHRONIC AND SUBACUTE ABDOMINAL PAIN
A. Epigastric Pain B.
Hypogastric Pain C. RUQ Pain
D. LUQ Pain E. RLQ
Pain F. LLQ Pain G.
Abdominal Wall Pain H. Intestinal Bloating
I. Organ Distension J.
Renal Pain K. Miscellaneous
L. Infection M. Inflammatory
Diseases N. Constipation Syndromes
O. Malabsorption
Abdominal Pain Differential Diagnosis REF: Outlines of Clinical Medicine |
A. Types of Pain B. Character of Pain C. Epigastric Pain D. Kidney Pain E. Clinical Evaluation Of Abdominal Pain |
A. Types of Pain
1. Focal: organ distension (parietal pain) 2. Diffuse: organ involvement (visceral pain)
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B. Character
of Pain
1. Burning: Peptic Ulcer, Reflux 2. Cramping: Biliary Colic, Irritable Bowel, Inflammatory Bowel, Mesenteric Ischemia 3. Colicky: appendicitis, impacted feces, cholecystitis, renal stone 4. Aching: appendiceal irritation 5. Knife-like: Pancreatitis, Aortic Dissection / Rupture 6. Gradual Onset: Infection, primary or secondary, retroperitoneal fibrosis 7. Sudden Onset a. Peptic ulcer b. Pancreatitis c. Obstruction d. Perforation e. Ruptured ectopic pregnancy * Opiate treatment may alter physical exam findings but no significant change in management in patients with abdominal pain |
C. Epigastric
Pain
1. Esophagus: a. Achalasia b. Esophageal Spasm c. Tumor d. Scleroderma e. Esophagitis f. Esophageal perforation (usually thoracic pain) 2. Gastrointestinal / Dyspepsia: a. Gastritis and Gastric Ulcer - usually worse with eating b. Duodenal Ulcer - usually better with eating c. Gastroesphageal Reflux Disease (GERD) d. Gastroparesis e. Gastric Neoplasm f. Gall bladder disease g. Malabsorption syndrome h. Pancreatitis i. Intestinal parasites j. Mesenteric Ischemia - usually worse 1/2 to 2 hours after eating 3. Lungs: a. Lower Lobe Pneumonia b. Collapse c. Pulmonary Infarction (lower lobes) 4. Heart: a. Angina / Myocardial Infarction (especially in women or Diabetes) b. Pericarditis c. Aortic Aneurysm
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D. Kidney Pain
1. Costovertebral angle (CVA) tenderness 2. Radiation anteriorly, including RUQ pain 3. Infection: urinalysis, culture 4. Renal Stone: often very painful on passing stone 5. Obstruction: rule out with ultrasound 6. Retroperitoneal fibrosis may mimic kidney pain |
E. Clinical
Evaluation Of Abdominal Pain
1. Women
2. Men with lower abdominal pain should have a genital examination 3. All patients with abdominal pain should have a rectal exam and stool guaiac exam 4. Orthostatic vital signs should ALWAYS be performed 5. Blood on Rectal or Stool Guaiac Positive - complete blood count ± reticulocyte count 6. Upper Abdominal Pain
7. Lower abdominal pain and/or flank pain should always include a urinalysis 8. Surgical Consultation
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DIAGNOSIS OF ABDOMINAL PAIN BY ORGAN |
A. Cholecystitis B. Ileus C. Appendicitis D. Diverticulitis E. Ulcer Perforation F. Pancreatitis G. Crampy Abdominal Pain H. Knife-Like Abdominal Pain |
DIAGNOSIS OF ABDOMINAL PAIN BY ORGAN
1. Acute
2. Chronic
3. Cholelithiasis with obstruction
|
A. Cholecystitis B. Ileus C. Appendicitis D. Diverticulitis E. Ulcer Perforation F. Pancreatitis G. Crampy Abdominal Pain H. Knife-Like Abdominal Pain |
B.
Ileus
1. Intestinal obstruction
2. Symptoms
3. Etiology
|
A. Cholecystitis B. Ileus C. Appendicitis D. Diverticulitis E. Ulcer Perforation F. Pancreatitis G. Crampy Abdominal Pain H. Knife-Like Abdominal Pain |
C.
Appendicitis
|
A. Cholecystitis B. Ileus C. Appendicitis D. Diverticulitis E. Ulcer Perforation F. Pancreatitis G. Crampy Abdominal Pain H. Knife-Like Abdominal Pain |
D.
Diverticulitis
|
A. Cholecystitis B. Ileus C. Appendicitis D. Diverticulitis E. Ulcer Perforation F. Pancreatitis G. Crampy Abdominal Pain H. Knife-Like Abdominal Pain |
E.
Ulcer Perforation
|
A. Cholecystitis B. Ileus C. Appendicitis D. Diverticulitis E. Ulcer Perforation F. Pancreatitis G. Crampy Abdominal Pain H. Knife-Like Abdominal Pain |
F.
Pancreatitis
|
A. Cholecystitis B. Ileus C. Appendicitis D. Diverticulitis E. Ulcer Perforation F. Pancreatitis G. Crampy Abdominal Pain H. Knife-Like Abdominal Pain |
G.
Crampy Abdominal Pain
|
A. Cholecystitis B. Ileus C. Appendicitis D. Diverticulitis E. Ulcer Perforation F. Pancreatitis G. Crampy Abdominal Pain H. Knife-Like Abdominal Pain |
H.
Knife-Like Abdominal Pain
|
CHRONIC AND SUBACUTE ABDOMINAL PAIN |
A. Epigastric Pain B.
Hypogastric Pain C. RUQ Pain
D. LUQ Pain E. RLQ
Pain F. LLQ Pain G.
Abdominal Wall Pain H. Intestinal Bloating
I. Organ Distension J. Renal Pain K. Miscellaneous L. Infection M. Inflammatory Diseases N. Constipation Syndromes O. Malabsorption |
CHRONIC AND SUBACUTE ABDOMINAL PAIN
|
B. Hypogastric
Pain (Lower Abdominal Pain)
|
A. Epigastric Pain B.
Hypogastric Pain C. RUQ Pain
D. LUQ Pain E. RLQ
Pain F. LLQ Pain G.
Abdominal Wall Pain H. Intestinal Bloating
I. Organ Distension J. Renal Pain K. Miscellaneous L. Infection M. Inflammatory Diseases N. Constipation Syndromes O. Malabsorption |
C. Right Upper
Quadrant (RUQ) Pain
|
D. Left Upper
Quadrant (LUQ) Pain
|
A. Epigastric Pain B.
Hypogastric Pain C. RUQ Pain
D. LUQ Pain E. RLQ
Pain F. LLQ Pain G.
Abdominal Wall Pain H. Intestinal Bloating
I. Organ Distension J. Renal Pain K. Miscellaneous L. Infection M. Inflammatory Diseases N. Constipation Syndromes O. Malabsorption |
E. Right Lower
Quadrant (RLQ) Pain
|
F. Left Lower
Quadrant (LLQ) Pain
|
A. Epigastric Pain B.
Hypogastric Pain C. RUQ Pain
D. LUQ Pain E. RLQ
Pain F. LLQ Pain G.
Abdominal Wall Pain H. Intestinal Bloating
I. Organ Distension J. Renal Pain K. Miscellaneous L. Infection M. Inflammatory Diseases N. Constipation Syndromes O. Malabsorption |
G. Abdominal
Wall Pain
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H. Intestinal
Bloating
|
A. Epigastric Pain B.
Hypogastric Pain C. RUQ Pain
D. LUQ Pain E. RLQ
Pain F. LLQ Pain G.
Abdominal Wall Pain H. Intestinal Bloating
I. Organ Distension J. Renal Pain K. Miscellaneous L. Infection M. Inflammatory Diseases N. Constipation Syndromes O. Malabsorption |
I. Organ
Distension: Stomach, Spleen, Liver, Gall Bladder, Kidney, Urinary
Bladder, Intestine, Uterus, Ovary
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K. Miscellaneous
|
A. Epigastric Pain B.
Hypogastric Pain C. RUQ Pain
D. LUQ Pain E. RLQ
Pain F. LLQ Pain G.
Abdominal Wall Pain H. Intestinal Bloating
I. Organ Distension J. Renal Pain K. Miscellaneous L. Infection M. Inflammatory Diseases N. Constipation Syndromes O. Malabsorption |
L. Infection
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N. Constipation
Syndromes
|
A. Epigastric Pain B.
Hypogastric Pain C. RUQ Pain
D. LUQ Pain E. RLQ
Pain F. LLQ Pain G.
Abdominal Wall Pain H. Intestinal Bloating
I. Organ Distension J. Renal Pain K. Miscellaneous L. Infection M. Inflammatory Diseases N. Constipation Syndromes O. Malabsorption |
O. Malabsorption
|
A. Epigastric Pain B.
Hypogastric Pain C. RUQ Pain
D. LUQ Pain E. RLQ
Pain F. LLQ Pain G.
Abdominal Wall Pain H. Intestinal Bloating
I. Organ Distension J. Renal Pain K. Miscellaneous L. Infection M. Inflammatory Diseases N. Constipation Syndromes O. Malabsorption |
2007