Diferencia entre revisiones de «Abdominal pain»

(Created page with "==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 ==DD...")
 
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==Workup==
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''For pediatric patients see [[Special:MyLanguage/Abdominal pain (peds)|Abdominal pain (peds)]]. See also [[Special:MyLanguage/abdominal pain (geriatrics)|abdominal pain (geriatrics)]] and [[Special:MyLanguage/Abdominal pain in pregnancy|Abdominal pain in pregnancy]].''




1) B-hCG
==Background==


2) CBC
*Patients with immunosuppression often have delayed or atypical presentations
*[[Special:MyLanguage/Fever|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 [[Special:MyLanguage/ectopic pregnancy|ectopic pregnancy]] until proven otherwise


3) Chem 7
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{{Abdominal pain location}}
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4) LFTs


5) Lipase


6) UA/Gm stain/UCx
==Clinical Features==


7) Guaiac
*Abdominal pain (see workup by location)
*May be associated with [[Special:MyLanguage/nausea|nausea]], [[Special:MyLanguage/vomiting|vomiting]] or [[Special:MyLanguage/diarrhea|diarrhea]]
*[[Special:MyLanguage/Fever|Fever]] may be present in pain from infectious etiology


8) IVF


9) ECG (>50 yo)


10) ?CXR
==Differential Diagnosis==


11) ?Coags
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{{Abdominal Pain DDX Diffuse}}
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{{Abdominal Pain DDX Epigastric}}
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{{DDX RUQ}}
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{{DDX LUQ}}
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{{Abd DDX RLQ}}
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{{LLQ DDX}}
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{{Pelvic pain DDX}}
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{{Extra-abdominal sources of abdominal pain DDX}}
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12) ?contrast --> CT


13) ?US


==Evaluation==


==DDX ==
*Workup is by location:
**[[Special:MyLanguage/RUQ pain|RUQ pain]]
**[[Special:MyLanguage/RLQ pain|RLQ pain]]
**[[Special:MyLanguage/Epigastric pain|Epigastric pain]]
**[[Special:MyLanguage/LUQ pain|LUQ pain]]
**[[Special:MyLanguage/LLQ pain|LLQ pain]]
**[[Special:MyLanguage/Diffuse abdominal pain|Diffuse abdominal pain]]
**[[Special:MyLanguage/Flank pain|Flank pain]]




=== ===


==Management==


Killers
*Treat underlying cause
*Multiple studies show [[Special:MyLanguage/pain medicine|pain medicine]] should not be withheld for fear of masking symptoms


* AAA
* Mesenteric Ischemia
* Bowel Perforation
* Small Bowel Obstruction
* Sigmoid Volvulus
* Ectopic Pregnancy
* Placental Abruption
* MI


===Diffuse===


==Disposition==


* Peritonitis
*Depends on etiology
* Acute pancreatitis
*The two most notoriously missed conditions are [[Special:MyLanguage/appendicitis|appendicitis]] and [[Special:MyLanguage/small bowel obstruction|small bowel obstruction]].<ref>Macaluso CR and McNamara RM. Evaluation and management of acute abdominal pain in the emergency department. Int J Gen Med. 2012; 5: 789–797. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3468117/</ref>. When discharging patients with abdominal pain, clear instructions should be given for return if there are red flags.
* Sickle cell crisis
* Early appendicitis
* Mesenteric thrombosis
* Gastroenteritis
* Dissecting/rupturing aneurysm
* Intestinal obstruction
* Diabetes


===RUQ===




* Acute cholecystitis/biliary colic
==See Also==
* Acute hepatitis
* Hepatic abscess
* Hepatomegaly due to CHF
* Perforated duodenal ulcer
* Acute pancreatitis (can be bilateral)
* Retrocecal appendicitis
* Herpes zoster
* Myocardial ischemia
* Right lower lobe pneumonia
* Bowel obstruction


===Epigastric===
*[[Special:MyLanguage/Abdominal Pain (Geriatrics)|Abdominal Pain (Geriatrics)]]
 
*[[Special:MyLanguage/Abdominal Pain (Peds)|Abdominal Pain (Peds)]]
 
*[[Special:MyLanguage/Abdominal Trauma|Abdominal Trauma]]
* Gallbladder disease
*[[Special:MyLanguage/Abdominal pain in pregnancy|Abdominal pain in pregnancy]]
* GERD
*[[Special:MyLanguage/Pelvic Pain|Pelvic Pain]]
* PUD
* Gastritis
* Acute pancreatitis
* Splenic enlargement/rupture/infarction/aneurysm
* Myocardial ischemia
* Pericarditis/Myocarditis
* Aortic dissection
 
===LUQ===
 
 
* Gastritis
* Acute pancreatitis
* Splenic enlargement/rupture/infarction/aneurysm
* Myocardial ischemia
* Left lower lobe pneumonia
 
===RLQ===
 
 
* Appendicitis
* Regional enteritis
* Meckel's diverticulitis
* Cecal diverticulitis
* Leaking aneurysm
* Abdominal wall hematoma
* Ruptured ectopic
* Twisted ovarian cyst
 
===LLQ===
 
 
* Sigmoid diverticulitis
* Leaking aneurysm
* Ruptured ectopic
* Mittleshmerz
* Twisted ovarian cyst
 
===Pelvic===
 
 
* Mittelschmerz
* Endometriosis
* Ureteral calculi
* Seminal vesiculitis
* Psoas abscess
* Mesenteric adenitis
* Incarcerated hernia
* Endometriosis
 
===Extra-Abdominal===
 
 
* MI
* Aortic Dissection
* AAA
* PNA
* PE
* Testicular Torsion
* Herpes zoster
* Muscle spasm
* Strep pharyngitis (children)
* Mononucleosis
* DKA
* ETOH ketoacidosis
* Uremia
* Sickle cell disease
* Porphyria
* SLE
* Vasculitis
* Glaucoma
* Hyperthyroidsim
* Methanol poisoning
* Heavy metal toxicity
* Addison's Disease
* Acute Porphyria
 
==Source ==
 
 
3/20/06 DONALDSON (adapted from Rosen)






==References==


<references/>
[[Category:GI]]
[[Category:GI]]
[[Category:Misc/General]]
[[Category:Symptoms]]
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Revisión actual - 21:04 17 ene 2026

For pediatric patients see Abdominal pain (peds). See also abdominal pain (geriatrics) and Abdominal pain in pregnancy.


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


Classification by Abdominal pain location

Side-by-side comparison of quadrants and regions.
Chart of commonly reported referred pain sites.
RUQ pain Epigastric pain LUQ pain
Flank pain Diffuse abdominal pain Flank pain
RLQ pain Pelvic pain LLQ pain


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


Epigastric Pain

RUQ Pain

Left upper quadrant abdominal pain


RLQ Pain

LLQ Pain

Acute Pelvic Pain

Differential diagnosis of acute pelvic pain

Gynecologic/Obstetric

Genitourinary

Gastrointestinal

Musculoskeletal

Vascular

Extra-abdominal Sources of Abdominal pain


Evaluation


Management

  • Treat underlying cause
  • Multiple studies show pain medicine should not be withheld for fear of masking symptoms


Disposition

  • Depends on etiology
  • The two most notoriously missed conditions are appendicitis and small bowel obstruction.[2]. When discharging patients with abdominal pain, clear instructions should be given for return if there are red flags.


See Also


References

  1. ↑ Norris DL, Young JD. UTI. EM Clin N Am. 2008; 26:413-30.
  2. ↑ Macaluso CR and McNamara RM. Evaluation and management of acute abdominal pain in the emergency department. Int J Gen Med. 2012; 5: 789–797. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3468117/
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