Therefore, the differential diagnosis of abdominal pain can be organized based on whether patients are presenting with their first episode of acute abdominal. Christopher cheung approach to pediatric abdominal. Osce 2 presents a clinical encounter of a 64yearold stockbroker who presents with pain in the upper part of the abdomen, which has spread to the back. 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. Approach to abdominal pain department of emergency medicine. There are a variety of conditions that may cause acute abdominal pain in a child. In most cases, a thorough history and physical exam can narrow the broad differential.
Differential diagnosis for central abdominal pain acute. Abdominal pain in children varies with age, associated symptoms, and pain location. Differential diagnosis of acute abdominal pain pdf book. Read online differential diagnosis of acute abdominal pain book pdf free download link book now. Acute abdominal pain in children pubmed central pmc. The emergency and nonurgent evaluation of abdominal pain of adults. Because of the spectrum of etiologies that manifest as abdominal pain, the differential remains broad and diagnosis can be challenging. Acute abdominal pain in children differential diagnosis. Approach to pediatric abdominal pain learn pediatrics. Intestinal malrotation is an important cause of abdominal pain and should be considered in the differential diagnosis of. The most frequent reasons for abdominal pain are gastroenteritis %, irritable bowel syndrome 8%, urinary tract problems 5%, inflammation of the stomach 5% and constipation 5%. The differential diagnosis of abdominal pain is extensive and requires a logical evaluation. 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.
Differential diagnosis of chronic pelvic pain chart 20. Unusual differential diagnosis of upper abdominal pain. Acute abdominal pain american academy of pediatrics. Approximately 20% of patients evaluated for abdominal pain in the ed require hospitalet admission for intervention. This article will tell you about the various diagnosis for abdominal pain, arising in different parts of your abdomen. This study provides guidelines for the evaluation of acute abdominal pain in adults, including history and physical examination, diagnostic testing, and special patient populations. Evaluation of abdominal pain in the emergency department. Obgyn special edition, vol 2, 2001 elizabeth hampton pt, wcs, bcb. Evaluation of the adult with abdominal pain uptodate. Develop a differential diagnosis based on age and symptoms. Differential diagnosis of recurrent abdominal pain. A delay or lack of treatment for acute appendicitis usually results in appendix. The differential diagnosis includes intestinal vasculitis 45. Selected differential diagnosis of abdominal pain pain location possible diagnoses right upper quadrant biliary.
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. And so there is a different differential diagnosis for pain in different areas of the abdomen. Cause grouping differentials classical history classic examination findings investigation findings initial test, diagnostic test. Pdf on feb 1, 2004, dori l dahlberg and others published differential diagnosis of abdominal pain in women of childbearing age. The frequency of abdominal pain as a symptom in patients with aids is unknown. The patient evaluated with no postoperative complications and was discharged from the hospital the next day. Differential diagnosis of pediatric acute abdominal pain. The acute abdomen is defined as a sudden onset of severe abdominal pain of less than 24 hours duration. Timely evaluation and intervention are critical in preventing untoward sequelae in children presenting with abdominal pain. When evaluating a patient with acute abdominal pain, the most important elements in making an accurate early diagnosis are the history and physical examination. Acute abdominal pain is a common clinical presentation in the emergency department and primary care setting. Acute abdominal pain is a common complaint in childhood, and it can be caused by a wide range of underlying surgical and nonsurgical conditions. A history and focused physical examination will lead to a differential diagnosis of abdominal pain, which will then inform. The mainstay of diagnosis in acute abdominal pain in children is detailed history and thorough physical examination.
The specific injuries to be concerned with after blunt abdominal trauma can be broken down into several categories. 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. Tachycardia heart rate exceeds 110 bpm leukocytosis with neutrophil s 75% peritoneal signs. Evaluation of acute abdomen differential diagnosis of symptoms. Pdf the incidence of acute abdominal pain ranges between 510% of all visits at. Evaluating abdominal pain requires an approach that relies. Formulate a plan for evaluation and management of acute abdominal pain. Evaluation of acute abdominal pain in adults american. Table 31 outlines the typical time course associated with different diseases causing abdominal pain. In many cases, primary care clinicians can make symptombased diagnoses and initiate treatment on the. Confirm an intestinal malrotation with an upper gastrointestinal series that documents the. The pain can arise due to various serious or nonserious causes. Differential diagnosis of acute abdomen is often carried out depending on the location of pain in abdominal quadrants and further characteristics of pain. It has a large number of possible causes and so a structured approach is required.
Understand the causes and frequency of acute abdominal pain in childhood. Differential diagnosis of abdominal pain in adults part 01. The age of the child determines the differential diagnosis. A 16yearold girl with chronic intermittent abdominal pain. Cardinal presentations this post is part of a series called cardinal presentations, based on rosens emergency medicine 8th edition. Assessment and differential diagnosis of abdominal pain. The most common nonsurgical condition is gastroenteritis, while the most common surgical condition is appendicitis. Started in 1995, this collection now contains 6769 interlinked topic pages divided into a tree of 31 specialty books and 732 chapters. Blunt force injuries to the abdomen can generally be explained by 3 mechanisms. 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.
Differential diagnosis of abdominal pain in women of childbearing age. The lack of abnormalities in vitals signs despite serious. Assessment of abdominal pain in children differential. Diagnosis and management of acute abdominal pain for students slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising.
Abdominal organs produce symptoms based on their location, e. Make symptombased diagnoses of functional abdominal pain disorders. Acute abdominal pain is a frequent and challenging problem facing. Many of these causes will be benign and selflimited, while others are medical urgencies or even surgical emergencies. Choose the appropriate imaging study for various diagnoses. 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. Acute abdominal pain can represent a spectrum of conditions from benign and selflimited disease to surgical emergencies. Download differential diagnosis of acute abdominal pain book pdf free download link or read online here in pdf. Abdominal pain among older adults is a common complaint with broad differential diagnosis. If you continue browsing the site, you agree to the use of cookies on this website.
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. Evaluation of abdominal pain in the emergency department hartmut gross, m. The sesam2 study found the most common diagnoses in patients presenting to general practitioners with abdominal pain to be gastritis and duodenitis 24. Abdominal distension abdominal pain acute illness anaesthetics arm weakness atls back pain bleeding problems cardiac arrest chest pain clinical cases clinical presentations collapse cough diarrhoea differential diagnosis dizziness emergencies examination fatigue gastroenterology cases gi bleeding headache itch jaundice joint problems leg pain. About 10% of cases have a more serious cause including gallbladder gallstones or biliary dyskinesia or pancreas. A diagnosis of pediatrie frap is defined by the rome. Pdf differential diagnosis of abdominal pain in women of. Evaluation of abdominal pain in children differential. Assessment of acute abdomen differential diagnosis of symptoms.
Most frequently the cause is benign andor selflimiting, but more serious causes may require urgent intervention. Abdominal pain in elderly persons differential diagnoses. It is a common problem and, although the vast majority of these episodes are benign and selflimiting, persistent abdominal pain may signify an underlying pathology requiring urgent intervention. In about 30% of cases, the cause is not determined. Abdominal pain as a chief complaint can present a significant diagnostic challenge in the primary care setting. You should also ask about onset, duration, things that. How to create a differential diagnosis part 1 of 3 duration. Differential diagnosis for abdominal pain abdominal pain is a very common health problem that almost everyone of us have suffered from. Pdf diagnostic approach and management of acute abdominal. 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. A sh is generally an interparietal hernia, meaning that the preperitoneal fat and the hernia sac penetrate the trasnversus abdominis and internal oblique muscles but remain behind the external oblique aponeurosis. Feverweaknesssyncopealtered mental statusseizuredizziness and vertigoheadachesore throatdyspneachest painabdominal painnausea and vomitinggastrointestinal bleedingacute pelvic painback pain. Evaluating abdominal pain requires an approach that relies on the.
The differential diagnosis of abdominal pain is extensive making a concise approach sometimes difficult. Objectives aftercompleting thisarticle,readers shouldbeableto. Acute abdominal pain the goal of the evaluation of the patient with acute abdominal pain is an early, efficient, and accurate diagnosis. Differential diagnosis of abdominal pain flashcards quizlet. Back pain colicky pain peritoneal pain vomiting every pain presenting with new onset back pain 60 yrs. Acute abdominal pain is a frequent presentation in the emergency department. The etiology of the pain may be any of a large number of processes. A patient presenting with abdominal pain to the general. Diagnosing the cause of abdominal pain can be difficult, because many diseases can cause this symptom.
Af, cvs risk factors hypovolaemia shock soft abdomen pain out of proportion to exam. A differential diagnosis in chronic lower abdominal pain. We here present an interesting unusual case of upper abdominal pain. The patient was a 38yearold man, who was admitted to our hospital complaining of right upper quadrant pain caused by a toothpick that perforated the anterior gastric wall and penetrated segment i of the liver. Intraabdominal injuries secondary to blunt force are attributed to collisions between the injured person and the external environment and to acceleration or deceleration forces acting on the persons internal organs. Through the assessment of symptoms duration, intensity, physical exam findings and consideration of the incidence of specific etiologies, the differential diagnosis of acute abdominal pain can be narrowed to facilitate efficient use of diagnostic testing. A 38yearold man was admitted to our hospital with a threemonth history of upper abdominal pain. Abdominal pain is a relatively common symptom in the general population, with a reported prevalence of up to 17%, 61 and 43% of patients present to primary care clinics with complaints of abdominal pain.
Abdominal pain differential escambia county, florida alsbls medical protocol approved. Narrow the differential diagnosis of acute abdominal pain based on. The initial assessment should attempt to determine if the patient has an acute surgical problem that requires immediate and prompt surgical intervention, or urgent medical therapy. Paediatric abdominal pain is often a diagnostic dilemma.