Abdominal Pain & Masses

 

• DDx: Generalized abdominal pain

  • Organ perforation and/or generalised peritonitis.
  • Ruptured abdominal aortic aneurysm (AAA).
  • Acute mesenteric ischaemia.
  • Gastroenteritis
  • Non-GI: DKA, Addison's, functional/IBS.
  • In practice, many of the 'localized' causes described below may be felt and/or reported as generalized pain.

• DDx: Localized abdominal pain

  Any region

  • Musculoskeletal
  • Cancer
  • Shingles

  Right upper quadrant

  • Gallbladder disease.
  • Duodenal ulcer.
  • Liver disease.
  • Subphrenic abscess.
  • Right lower lobe pneumonia.

  Epigastric

  • GORD
  • Peptic ulcer disease (PUD), including perforation.
  • Pancreatitis. Distinguished from perfed PUD by lots of vomiting.
  • AAA
  • Acute cholecystitis.
  • Gastric cancer.
  • MI
  • Gastroenteritis

  Left upper quadrant

  • Gastric ulcer.
  • Acute pancreatitis.
  • Ruptured spleen.
  • Subphrenic abscess.
  • Left lower lobe pneumonia.

  Left and right flank

  • Pyelonephritis. Radiates to back.
  • Renal or ureteric stones. Causes renal colic, a severe, waxing and waning pain which radiates from loin to groin.

  Umbilical

  • Intestinal obstruction.
  • Early appendicitis.
  • AAA
  • Gastroenteritis

  Right lower quadrant

  • Appendicitis
  • Meckel's or cecal diverticulitis.
  • Crohn's
  • Ruptured ectopic.
  • Strangulated hernia.
  • Genitourinary problems.
  • Mesenteric adenitis.
  • Psoas abcess.

  Suprapubic

  • Gynae: UTI, PID, ectopic, ovarian tumour, endometriosis.
  • Bladder: retention, cancer.

  Left lower quadrant

  • Sigmoid diverticulitis.
  • Constipation
  • Ulcerative colitis (crampy).
  • IBS
  • Rectal cancer.
  • Ischaemic colitis.
  • Ruptured ectopic.
  • Strangulated hernia.
  • Genitourinary problems.

• Medical abdomen

  The following conditions may present with abdominal pain ± other GI symptoms, but be missed due to their non-surgical nature, rarity, and/or the fact that they are not primarily GI diseases:

  • Diseases in lower thorax presenting as upper abdominal pain: inferior MI, lower-lobe pneumonia/PE. Alternatively, 'silent' MI (e.g. in diabetes) may present with no pain but vomiting and diarrhoea only.
  • Endocrine: DKA, Addison's, hypercalcaemia.
  • Autoimmune: vasculitis (e.g. HSP), SLE.
  • Haematological: acute intermittent porphyria, sickle cell crisis, hereditary angioedema, paroxysmal nocturnal haemoglobinuria.