Initial diagnostic evaluation

tests

CBC with differential, BMP with lytes, LFTs

UA

**If fever or unstable then do blood and urine cultures**

X-rays, US, CT scan

Bleeding scan

Endoscopy

Colonscopy

Diagnosis Clues

History: demographics

Pain Characteristics: onset, quality, radiation, site, symptoms associated with and course of time.

Pain Description: Visceral, Parietal, or Referred

Visceral Pain

• Ischemia, inflammation, or distension of hollow organs/ stretching of capsular organs can produce this pain.
• visceral pain fibers enter on many levels and can be confusing
• dull poorly localized pain felt midline

Parietal Pain

• Ischemia, inflammation, or stretching of peritoneum produces pain
• more distinct and localized
• stimulus transmitted to specific root ganglia at the level and dermatome as the pain

Referred Pain

• felt at site far away from actual organ
• gallbladder right back
• perfed duodenal ulcer with shoulder pain from diaphragmatic irritation
• caused by shared central afferent neurons (a= asending)

High Risk Abdominal Pain

History

• Early Pregnancy
• Comorbidities: RF, CA, IBD, Divertic, Stones
• CardioVascular Dz: HTN, PVD, CAD, A FIB
• Alcoholism
• Immunocompromised
• AGE= 65 or older

High Risk Abdominal Pain 

Pain Characteristics

• Sudden onset
• Maximal pain at onset
• Pain associated with vomiting
• Constant pain of 2 days or more

High Risk Abdominal Pain

Exam Findings

• Tense or rigid abdomen
• involuntary guarding
• SIGNS OF SHOCK

Right Upper Quadrant Pain

Think of organs in that location...liver, GB, lung, diaphragm.

• Hepatitis, Cholcystitis, Cholangitis, Pancreatitis
• Budd-Chiari syndrome: occulsion of hepatic vein
• PNA, Pleurisy, Empyema, subdiaphragmatic abscess 

Right lower Quadrant 

Pain

• Appendicitis, IBD, Mesenteric adenitis (yersina)
• Inguinal hernia
• Kidney stones
• Ectopic pregnancy, salpingitis

Epigatric Pain

• Ruptured aortic aneurysm, MI, pericarditis
• Pancreatitis
• Gastritis, GERD, PUD

Periumbilical Pain

• Ruptured aneurysm
• early appendicitis
• bowel obstruction
• gastroenteritis

Left Upper Quadrant

Pain

• Splenic abscess or infarct
• Pancreatitits
• Gastritis or gastric ulcers

Lower left quadrant

pain

• Kidney stones
• Inguinal hernia
• ectopic pregnancy or salpingitis
• diverticulitis, IBS, IBD

Diffuse Abdominal Pain

• Metabolic causes: DKA, porphyria (hereditary heme disfunction) or familial Mediterranean fever
• Mesenteric ischemia, bowel obstruction
• Gastroenteritis, peritonitis
• IBS
• Malaria