Abdominal Pain

Differential:


Pregnancy related:
-first half of pregnancy
--Ectopic Pregnancy
--Miscarriage (pregnancy loss before 20 wks gestation)
-second half of pregnancy
--Labor
--Liver related
---HELLP Syndrome (Hemolysis: microangiopathic, Elevated Liver Enzymes, Low Platelets)
---Acute Fatty Liver
---Severe Preeclampsia
--Intraamniotic infection
--Placental Abruption
--Uterine Incarceration: 14 to 16 wks gestation. with difficulty voiding.
--Ovarian Torsion
--Fallopian Tube Torsion
--Ovarian Cyst: Hemorrhagic or Ruptured
--Fibroid degeneration or torsion
--Pelvic Inflammatory Disease (PID) with fever, very rare.
--Ovarian vein thrombophlebitis (OVT), usually within one week after delivery (usually Right) --nausea and ileus only mild as opposed to severe in appendicitis.
--Endometritis: with fever
--Spontaneous Hemoperitoneum (VERY rare only 50 cases in last 2 decades)

Upper abdominal/Epigastric:
-GERD
-Gastritis
-Stomach Ulcer
-Gallbladder disease: Cholecystitis, Cholelithiasis, Cholestasis
-Biliary Colic (gallstone blocking a bile duct)
-Acute Hepatitis
-Pancreatic Disease
-Adhesions: often after surgery or sexually transmitted disease including Chlamydia and Ghonorrhea
-Lower Lobe Pneumonia
-Bronchitis
-Impacted Stool/Bowel Obstruction
-Perforated Peptic Ulcer: Duodenal Ulcer or Gastric Ulcer
-Splenic Rupture (2/2 pregnancy or Infectious mononucleosis 2/2 Epstein Barr Viral Infection)
-Hiatal Hernia (likelihood increased if bariatric surgery in past)
-Rectus Sheath Hematoma, often in pregnancy
-Adrenal Hemorrhage, with Hypotension

Lower Abdominal:
-Acute Appendicitis (usually McBurney's Pt (2/3 from umbiLIcus to ASIS) after periumbilical pain)
-Nephrolithiasis (due to referral pattern)
-IBS
-Diverticulitis, usually with fever
Colon Cancer

Diffuse or Variable:
-Sickle Cell Crisis: usually African ancestry, often RUQ 2/2 hepatic involvement
-Trauma
-Gastroenteritis: Stomach Virus
-Arterial Dissection and Rupture
-Mesenteric venous thrombosis
-Hereditary angioedema
-Colitis: C. difficilis subtype

Necrotizing Fasciitis

Right Upper Quadrant:
-Hepatitis
-Gallbladder disease: Cholecystitis, Cholelithiasis, Cholestasis
-Biliary Colic (gallstone blocking a bile duct)

MOTHRR: Analgesics if indicated; Myofascial release if tolerable; CBC, UA, Liver, Pancreatic tests including AST, ALT, ALP, Bilirubin, Lipase, Amylase; express concern over pain; refer as necessary; return as necessary: very wide differential.

Variants: Clostridium difficilis