Approach to pediatric abdominal pain learn pediatrics. Abdominal pain and acute abdomen emergent and urgent. The differential diagnosis can then be limited to a subset of conditions that cause pain in that particular quadrant of the abdomen. Pdf diagnostic approach and management of acute abdominal. Diagnosis and management of patients with chronic abdominal pain is often challenging, and can be a frustrating experience for physician and patient. Differential diagnosis for abdominal pain acute oxford. However, the physiologic changes associated with pregnancy must be considered in the interpretation of findings from the history and physical examination. Selected differential diagnosis of abdominal pain pain location possible diagnoses right upper quadrant biliary. While a variety of diagnostic imaging tests can rule in or out a particular diagnosis, the clinician must make several judgment calls before getting to that point. Differential diagnosis of acute abdomen is often carried out depending on the location of pain in abdominal quadrants and further characteristics of pain. Abdominal organs produce symptoms based on their location, e.
Feverweaknesssyncopealtered mental statusseizuredizziness and vertigoheadachesore throatdyspneachest painabdominal painnausea and vomitinggastrointestinal bleedingacute pelvic painback pain pathophysiology of abdominal pain. Symptoms include abdominal discomfort or pain, early satiety, nausea, palpable abdominal mass, hepatomegaly or jaundice due to extrinsic compression of the bile ducts. Apr 07, 2020 the diagnostic approach to pregnant patients with severe abdominal pain is very similar to that for nonpregnant patients with acute abdomen. Differential diagnosis for abdominal pain abdominal pain is a very common health problem that almost everyone of us have suffered from. In order to successfully manage a patient presenting with abdominal. What was your differential, weight the evidence for or against each diagnosis. Differential diagnosis for central abdominal pain acute common and important causes of central abdominal pain acute for doctors and medical students this page is currently being written and will be available soon. Imaging of abdominal pain and liver disease an algorithm for ordering and understanding the appropriate imaging modalities that are currently available. Download differential diagnosis of acute abdominal pain book pdf free download link or read online here in pdf. Therefore, the differential diagnosis of abdominal pain can be organized based on whether patients are presenting with their first episode of acute abdominal pain, a recurrent episode of acute abdominal pain, or chronicsubacute abdominal pain. Diagnosis of right lower quadrant pain and suspected. The pain can arise due to various serious or nonserious causes. Acsase medical student core curriculum intraabdominal.
A history and focused physical examination will lead to a differential diagnosis of abdominal pain, which will then inform. The emergency and nonurgent evaluation of abdominal pain of adults. Differential diagnosis for central abdominal pain acute. Physicians should keep a broad differential in mind, have a high index of suspicion, and consider atraumatic splenic rupture as a differential diagnosis in patients presenting with sudden leftsided abdominal pain in the absence of trauma and any unknown underlying conditions. In the majority of patients with aids, abdominal pain is directly related to hiv and its consequences 33, but the more common causes of abdominal pain in the general population also need to be considered. Assessing abdominal pain through history taking and physical examination abdominal pain can be a distressing experience for patients and presentations in primary or acute care pose diagnostic challenges to practitioners. Risk factors include age 60, atrial fibrillation, chf and atherosclerosis. Evaluation of acute abdominal pain in adults american. Differential diagnosis of pediatric acute abdominal pain. Abdominal pain is an essentially a widespread experience in pregnancy. The diagnosis of abdominal aneurysm should be considered with abdominal pain in patients over 50. Factors that contribute to this include poor sensitivity of the history and physical examination, a broad differential diagnosis that crosses several specialties, and an often negative diagnostic. Up to 10% of all presentations to the emergency department ed are patients presenting with abdominal pain.
Assessment of acute abdomen differential diagnosis of symptoms. Approach to abdominal pain department of emergency medicine. Consider referred pain from other systems cardiac, urologic, gynecologic. Differential diagnosis of abdominal pain flashcards quizlet. Assessing abdominal pain through history taking and physical. Cardinal presentations this post is part of a series called cardinal presentations, based on rosens emergency medicine 8th edition. Acute abdomen symptoms and differential diagnoses medical. Choose from 500 different sets of abdominal pain diagnosis flashcards on quizlet. The differential diagnosis of abdominal pain is the first book of a series of monographs to be published by the. There are a variety of conditions that may cause acute abdominal pain in a child. In many cases, primary care clinicians can make symptombased diagnoses and initiate treatment on the. Orthostatic vs do not need tobe assessed on obviously hypotensive patients.
Several other pivotal points can help narrow the differential diagnosis including 1 the time course of the pain, 2 peritoneal findings on exam, 3 unexplained hypotension, and 4 abdominal distention. Miscarriage, ectopic pregnancy, ovarian torsion, ruptured ovarian cystcorpus luteum, pelvic inflammatory disease, red degeneration of fibroid, heterotopic pregnancy, gastrointestinal tract pathology and urinary tract pathology should all be considered. Mar 18, 2020 differential diagnosis of acute abdomen is often carried out depending on the location of pain in abdominal quadrants and further characteristics of pain. Objectives aftercompleting thisarticle,readers shouldbeableto. Differential diagnosis of abdominal pain, according to location and corresponding anatomy location anatomy gi causes nongi causes ruq liver, gallblader, pancreas hepatitisabscess, cholecystitis, cbd stone, pancreatitis, duodenitis. Abdominal pain in elderly persons differential diagnoses. Apr 01, 2008 acute abdominal pain can represent a spectrum of conditions from benign and selflimited disease to surgical emergencies. Obgyn special edition, vol 2, 2001 elizabeth hampton pt, wcs, bcb. Abdominal pain is the most common cause for hospital admission in the united states. All books are in clear copy here, and all files are secure so dont worry about it.
The most common causes of acute abdomen are appendicitis, biliary colic, cholecystitis, diverticulitis, bowel obstruction, visceral perforation. Make symptombased diagnoses of functional abdominal pain disorders. Get a printable copy pdf file of the complete article 1. Rapid and accurate diagnosis is of importance to start treatment as. The age of the child determines the differential diagnosis. If the patient is febrile, this should raise suspicion of a pyogenic liver abscess or some other type of infection. Rapid and accurate diagnosis is of importance to start treatment as soon as possible to ensure the best possible outcome. Christopher cheung approach to pediatric abdominal. Abdominal pain can also be caused by complications from surgery in transplant patients such as nosocomial infections, including pneumonia or urinary tract infection. Mesenteric ischemia presents with severe pain with limited exam findings. When evaluating a patient with acute abdominal pain, the most important elements in making an accurate early diagnosis are the history and physical examination.
Abdominal pain in the immunocompromised patienthuman. Chronic abdominal pain is covered in a different podcast. Nov 14, 2015 cardinal presentations this post is part of a series called cardinal presentations, based on rosens emergency medicine 8th edition. Differential diagnosis of chronic pelvic pain chart 20. Due to the nature of the female pelvic anatomy, the underlying etiology includes a wide range of differential diagnoses. The contents of the abdomen can be divided into the foregut, midgut, and hindgut. Evaluation of acute abdomen differential diagnosis of symptoms. Jul 17, 2018 in elderly patients with abdominal pain, do not rely on descriptions of the classic presentation for diseases in the diagnosis of acute abdomen, and do not rely on the presence of fever or leukocytosis as a sign of infection. Maintaining a broad differential diagnosis is required in immunocompromised patient. Differential diagnosis of acute pain in the upper abdomen. Assessment and differential diagnosis of abdominal pain.
It is important to remember that abdominal pain can be caused by many different disease processes. In people with acute abdominal pain with an undiagnosed cause, how does the use of opioid analgesia affect the clinical evaluation process. Read online differential diagnosis of acute abdominal pain book pdf free download link book now. Learn about abdominal pain symptoms, tests, diagnosis and the best treatment techniques, including medication or surgery, from aurora health care, serving eastern wisconsin and northeastern illinois. Feverweaknesssyncopealtered mental statusseizuredizziness and vertigoheadachesore throatdyspneachest painabdominal painnausea and vomitinggastrointestinal bleedingacute pelvic painback pain pathophysiology of abdominal pain visceral. Christopher cheung approach to pediatric abdominal pain. Pdf differential diagnosis of abdominal pain in women of.
Though bloating is typically not as serious as abdominal pain from the physicians perspective, patients often report significant difficulties due to bloating in terms of their ability to work and participate in social or recreational activities. Acute abdominal pain in children differential diagnosis. Learn abdominal pain diagnosis with free interactive flashcards. Abdominal pain can be referred to as visceral pain or peritoneal pain.
Differential diagnosis for abdominal pain based on history and physical examination in spite of the fact that area of stomach pain or abdominal pain directs the underlying assessment, related signs and indications are prescient of certain reasons for pain in the abdomen and can limit the differential diagnosis. Acute abdominal pain the goal of the evaluation of the patient with acute abdominal pain is an early, efficient, and accurate diagnosis. Bloating is also related to increases in sick days. This article will tell you about the various diagnosis for abdominal pain, arising in. Most patients have a benign andor selflimited etiology, and the initial goal of evaluation is to identify those patients with a serious etiology that may require urgent intervention. He complained of pain consistent with gastritis, loss of appetite, and minor weight loss, but could not remember a particular situation or time when the pain first started.
The frequency of abdominal pain as a symptom in patients with aids is unknown. Abdominal pain is usually a feature, but a painfree acute abdomen can occur, particularly in older people, children, and the. Abdominal pain as a chief complaint can present a significant diagnostic challenge in the primary care setting. Vascular catastrophe should be at the top of your differential diagnosis of any patient who presents with hypotension and abdominal pain because there is a very small window for intervention.
Differential diagnosis of abdominal pain in women of childbearing age. May 25, 2018 differential diagnosis for abdominal pain based on history and physical examination in spite of the fact that area of stomach pain or abdominal pain directs the underlying assessment, related signs and indications are prescient of certain reasons for pain in the abdomen and can limit the differential diagnosis. The differential diagnosis is very broad and covers multiple specialties. Abdominal pain symptoms, diagnosis, treatment and prevention. The diagnostic approach to pregnant patients with severe abdominal pain is very similar to that for nonpregnant patients with acute abdomen. A 38yearold man was admitted to our hospital with a threemonth history of upper abdominal pain. Acsase medical student core curriculum intraabdominal and. The differential diagnosis of abdominal pain is extensive making a concise approach sometimes difficult.
The evaluation of abdominal pain requires an understanding of the possible mechanisms responsible for pain, a broad differential of common causes, and recognition of typical patterns and clinical presentations. The diagnosis of abdominal aneurysm should be considered with abdominal pain in patients over 50 yo. I really like the chapter abdominal pain from the textbook symptoms to diagnosis rdan evidencebased guide. Narrow the differential diagnosis of acute abdominal pain based on. The differential diagnosis includes pregnancy related and nonpregnancy related pathology. Pdf on feb 1, 2004, dori l dahlberg and others published differential diagnosis. Unusual differential diagnosis of upper abdominal pain. In elderly patients with abdominal pain, do not rely on descriptions of the classic presentation for diseases in the diagnosis of acute abdomen, and do not rely on the presence of fever or leukocytosis as a sign of infection.
Churchills pocketbook of differential diagnosis is the best differential diagnosis book for medical students who are working or are looking forward to more of the clinical approach to the field. Differential diagnosis of acute abdominal pain pdf book. The foregut contains the pharynx, lower respiratory tract, portions of the esophagus, stomach, portions of the duodenum proximal, liver, biliary tract including the gallbladder and bile ducts, and the pancreas. Churchills pocketbook of differential diagnosis pdf 4th. Table 31 outlines the typical time course associated with different diseases causing abdominal pain. Differential diagnosis for central abdominal pain acute common and important causes of central abdominal pain acute for doctors and medical students this page is.585 345 412 1518 660 974 65 1250 120 251 905 192 172 704 645 1111 621 604 1196 615 718 541 999 881 1298 584 491 684 1317 127 1486 799 1430 1074 1071 1137 50 1283 1056 157 345 916 1253 611 3