Differential Diagnosis for Abdominal Pain & Documentation Pearls
- History of Present Illness
- Risk Factors
- Physical Exam
- Course in the Office, Clinic, Urgent Care or ED. Document serial abdominal exams if patient’s evaluation lasts several hours. ...
- Medical Decision-Making. Address the results of all tests ordered. ...
- Plan. ...
- CAVEAT! ...
| Pain location | Possible diagnoses |
|---|---|
| Left lower quadrant | Colonic: colitis, diverticulitis, IBD, IBS |
| Gynecologic: ectopic pregnancy, fibroids, ovarian mass, torsion, PID | |
| Renal: nephrolithiasis, pyelonephritis | |
| Any location | Abdominal wall: herpes zoster, muscle strain, hernia |
What causes lower abdominal pain and how to treat it?
Some of the common causes of acute pain in the lower left region of the abdomen are:
- Constipation – the pain may be felt as cramps in the lower left part of the abdomen.
- Diverticulitis – this condition is characterized by the bulging or inflammation of the diverticulum at the end of the colon. ...
- Pseudomembranous colitis – this condition is caused by long-term use of antibiotics that kills the normal flora of the intestine. ...
How to identify abdominal pain?
Right Upper Quadrant
- Nausea
- Vomiting
- Belly pain (may worsen when taking deep breaths)
- Possible aches in back or right shoulder blade
What is your differential diagnosis?
What is differential diagnosis in mental health?
- Rule Out Malingering and Factitious Disorder.
- Rule Out Substance Etiology.
- Rule Out Disorder Due to a General Medical Condition.
- Determining the Specific Primary Disorder.
- Differentiate Adjustment Disorders From Residual Other or Unspecified Categories.
What causes pain in the lower center of abdomen?
What’s Causing Your Lower Abdominal Pain?
- Irritable bowel syndrome (IBS)
- Constipation
- Appendicitis
- Diverticulitis
- Urinary tract infection (UTI)
- Other causes of stomach pain
- When to see a doctor
What is the most likely diagnosis for abdominal pain?
Some of the most common causes of abdominal pain are appendicitis, gastroesophageal reflux disease (GERD), pancreatitis, gallbladder disease, diverticulitis, and small bowel obstruction.
What are the four types of abdominal pain?
There are four types of abdominal pain: upper, lower, right-sided and left-sided. Each type has specific symptoms and causes, and all are briefly discussed below (for detailed discussion click here).
What diseases have abdominal pain?
Conditions that may cause chronic abdominal pain include:Angina (reduced blood flow to the heart)Celiac disease.Endometriosis.Functional dyspepsia.Gallstones.Gastritis (inflammation of the stomach lining)Gastroesophageal reflux disease (GERD)Hiatal hernia.More items...•
What are the classification of abdominal pain?
Abdominal pain can be classified into three categories: acute abdomen, recurrent, and chronic functional.
What are symptoms of abdominal pain?
What is abdominal pain? Abdominal pain may be felt anywhere between the chest and groin region of your body. The pain may be generalized, localized, or it may feel like cramps in your belly. If you have cramping or discomfort in your stomach, it may be due to gas, bloating, or constipation.
What causes abdominal pain in females?
Abdominal pain can be cramp-like, localized, or colicky. Cramp-like pain. This type of abdominal pain may be associated with constipation, diarrhea, flatulence, or bloating. In women, however, the pain can be linked to miscarriage, menstruation, or complications in the female reproductive organs.
What are the main causes of abdominal pain?
What are the most common causes of abdominal pain?Indigestion.Gas and gas pain.Constipation.Diarrhea.Food allergies and intolerances.Food poisoning.
What is the cause of lower abdominal pain?
Lower abdominal pain is common and often results from trapped wind, period pain, or a UTI. However, long lasting or severe lower abdominal pain may signify an underlying condition, such as IBD. It is important that you seek medical help if you are concerned about your lower abdominal pain.
What kind of infection causes lower abdominal pain?
Viral or bacterial infections One of the most common causes of lower abdominal pain are infections caused by various viruses or bacteria known as gastroenteritis.
What are the five causes of acute abdomen?
The causes of an acute abdomen include appendicitis, perforated peptic ulcer, acute pancreatitis, ruptured sigmoid diverticulum, ovarian torsion, volvulus, ruptured aortic aneurysm, lacerated spleen or liver, and ischemic bowel.
What is the medical term for abdominal pain?
INTRODUCTION. Functional dyspepsia is the medical term for a condition that causes an upset stomach or pain or discomfort in the upper belly, near the ribs. Functional dyspepsia often comes back over time.
How is chronic abdominal pain diagnosed?
Diagnostic imaging is often not needed in patients with chronic abdominal pain, but when imaging is indicated, ultrasound, computed tomography scan, or MRI (including magnetic resonance cholangiopancreatography) should be chosen depending on suspected etiologies.
What are the 4 quadrants of the abdomen?
The four quadrants of the abdomen include the right upper quadrant, right lower quadrant, left upper quadrant, and left lower quadrant.
What causes abdominal pain?
Less serious causes of abdominal pain include constipation, irritable bowel syndrome, food allergies, lactose intolerance, food poisoning, and a stomach virus. Other, more serious, causes include appendicitis, an abdominal aortic aneurysm, a bowel blockage, cancer, and gastroesophageal reflux.
When should I go to the hospital for abdominal pain?
Seek immediate medical attention if you experience any of these symptoms along with stomach pain:Extremely hard abdomen.Abdominal tenderness when touched.Coughing up or vomiting blood.Vomiting that won't stop.Bloody diarrhea.Chest pain or pressure.Trouble breathing.Dizziness.More items...•
What is parietal pain vs visceral pain?
Visceral pain is experienced when the walls of an organ are stretched and the nerves send signals to the brain. Due to the lack of nerves, the pain is poorly localized and often described as an ache or cramp. Parietal pain is caused by irritation of the peritoneal lining that surrounds the abdominal cavity.
What is differential diagnosis of abdominal pain?
While diagnosing an individual with abdominal pain of acute nature, the doctor usually concentrates on regular conditions that bring about stomach pain or abdominal pain and additionally on more severe conditions. The point of pain or the location of the abdominal pain will usually help in diagnosis.
What is the condition when pain is detected in the epigastric region of the abdomen?
If the pain location is detected in the vascular location of the epigastric region of the abdomen then the potential conditions could be mesenteric ischemia or aortic dissection.
What is the condition of the abdomen if the pain is detected in the vascular location of the periumbilical?
If the pain location is detected in the vascular location of the periumbilical region of the abdomen then the potential conditions could be mesenteric ischemia or aortic dissection.
What are the conditions that can be caused by pain in the epigastric region?
If the pain location is detected in the biliary location of the epigastric region of the abdomen then the potential conditions could be cholangitis, cholecystitis or cholelithiasis.
What are the conditions that can cause pain in the periumbilical region of the abdomen?
If the pain location is detected in the gastric location of the periumbilical region of the abdomen then the potential conditions could be small bowel mass or blockage, gastritis, peptic ulcer or esophagitis.
What is the pain in the epigastric region of the abdomen?
If the pain location is detected in the gastric location of the epigastric region of the abdomen then the potential conditions could be peptic ulcer, gastritis or esophagitis.
What is the condition if you feel pain in the pancreas?
If the location of the pain is detected in the pancreatic region of the upper left quadrant then the potential conditions could be pancreatitis or a mass.
The location and type of abdominal pain can help identify the cause
The specific areas that hurt and the way the pain feels to you offer healthcare providers important clues to evaluate your abdominal pain. Both characteristics can really help them narrow down the potential causes of your pain.
Diagnostic tests for abdominal pain
There are many possible tests that can help confirm or rule out the most likely diagnosis for abdominal pain. Some of the more common tests that your provider may recommend in your workup for abdominal pain include blood tests, urinalysis, ultrasound studies, and CT scans. We’ll review each in more detail.
When should I go to the hospital for abdominal pain?
Everyone has abdominal pain now and then. And most of the time it goes away with time and rest. But there are a few warning signs that you should go to the emergency room to have a provider evaluate your abdominal pain:
The bottom line
Abdominal pain is a common symptom that often gets better without any treatment. But there are some situations when a medical professional should check out what’s going on. Your provider will do a physical exam and run diagnostic tests to figure out if your pain is linked to a serious condition.
What is abdominal pain evaluation?
INTRODUCTION — 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. All patients do not have classic presentations. Thus, unusual causes of abdominal pain must also be considered, especially in elderly and immunocompromised patients.
What are the different types of abdominal pain?
An epidemiologic assessment of acute abdominal pain found that 10 diagnostic groups could be classified in outpatients complaining of abdominal pain on their first visit to primary care physicians: whole abdominal; epigastric; right subcostal; left subcostal; right flank; left flank; periumbilical; right-lower; mid-lower; and left-lower ( show table 1) [ 1]. The overall sensitivity of history taking and physical examination was poor. Specificity was highest in patients with epigastric pain caused by gastroduodenal diseases; right subcostal pain caused by hepatobiliary diseases; and mid-lower pain caused by gynecologic diseases.
How long does pain last in diverticulitis?
Only 17 percent in one series had symptoms for less than 24 hours [ 21]. Another helpful diagnostic finding is that up to one-half have had one or more previous episodes of similar pain. ( See "Clinical manifestations and diagnosis of colonic diverticular disease" ).
Why do women have lower abdominal pain?
Pelvic pain — Lower abdominal pain in women is frequently due to disorders of the reproductive organs. ( See "Women" below ).
What is the purpose of the pain receptors in the abdomen?
NEUROLOGIC BASIS OF ABDOMINAL PAIN — Pain receptors in the abdomen respond to mechanical and chemical stimuli. Stretch is the principal mechanical stimulus involved in visceral nociception, although distention, contraction, traction, compression, and torsion are also perceived [ 2]. Visceral receptors responsible for these sensations are located on serosal surfaces, within the mesentery, and within the walls of hollow viscera, in which they exist between the muscularis mucosa and submucosa.
Why does the midline of the digestive tract feel pain?
Most digestive tract pain is perceived in the midline because of bilaterally symmetric innervation ( show figure 1) [ 2,7]. Pain that is clearly lateralized most likely arises from the ipsilateral kidney, ureter, ovary, or somatically innervated structures, which have predominantly unilateral innervation.
When should an intestinal obstruction be considered?
Intestinal obstruction should be considered when the patient complains of pain, vomiting, and constipation. Physical findings of abdominal distention and tenderness to palpation are common.
What tests are needed for abdominal pain?
Other investigations which may be deemed necessary include an abdominal xray, abdominal ultrasound, MRI, barium xray or CT.
Can peritoneal pain cause fever?
Peritonitis can occur suddenly with severe abdominal pain, chills and high fever.
