Abdominal Pain

Adult

Diffuse or Ill-Defined (Visceral Pain)

• Cardiovascular: Ischemia

• Abdominal cavity: Abdominal ascites, spontaneous bacterial peritonitis

• GI

  • Functional dyspepsia

  • Stool: Acute gastroenteritis (diarrhea), constipation, small bowel obstruction

  • Bowel perforation

• Renal: Pyelonephritis, nephrolithiasis

• Musculoskeletal

  • Hernia: Indirect inguinal (75% of all hernias), direct inguinal, femoral

  • Anterior cutaneous nerve entrapment syndrome (ACNES)

• Hyperglycemia: Diabetic ketoacidosis, hyperosmolar nonketotic state

Epigastric/Periumbilical

• CV: Acute coronary syndrome, aortic dissection, mesenteric ischemia

• GI: Esophagitis, peptic ulcer disease, appendicitis (early manifestation), pancreatitis (acute vs. chronic)

Upper

• Generalized: Pneumonia

• RUQ

  • Hepatic: Hepatitis, hepatic abscess/mass

  • Biliary complications including acute cholecystitis, choledocolithiasis, ascending cholangitis

• LUQ: Gastric and splenic pathologies

Lower

• Generalized

  • GI

    • Irritable bowel syndrome (IBS)

    • Inflammatory bowel disease (IBD): Crohn’s disease, ulcerative colitis

  • Gynecologic

    • Dysmenorrhea

    • Endometriosis

    • Pelvic inflammatory disease

    • Adnexal mass: Fibroids, ectopic pregnancy, ovarian torsion

• Localized

  • RLQ: Appendicitis

  • LLQ: Diverticulitis

  • Suprapubic: Uncomplicated UTI vs. complicated UTI

Pediatric

Urgent/Surgical

• GI: Appendicitis, intussusception, inguinal hernia

• Ovarian torsion

Constipation/Diarrhea

• Constipation: Functional constipation, Hirschsprung disease

• Diarrhea: Infectious diarrhea, celiac disease

• Irritable bowel syndrome

Neuropsychiatric/Other

• Functional abdominal pain

• Abdominal migraine

• Lead toxicity

Additional Considerations

Etiology

• Organic disease

  • Typically associated with fever, vomiting, bloody stools, and/or history of UTI

  • Rash present: Consider HSP

• Sexually transmitted infection: Promptly report suspected sexual abuse!

Abdominal Mass

• Infants

  • Flank (65%)

    • Renal (55%): Hydronephrosis, PCKD, Wilms tumor, etc.

    • Non-renal (10%): Neuroblastoma, etc.

  • Intraperitoneal (20%)

    • GI (15%): Meconium ileus, etc.

    • Hepatobiliary (5%)

  • Pelvic (15%): Ovarian cyst, etc.

• Children/Adolescent

  • Flank (78%)

    • Renal (55%): Hydronephrosis, PCKD, Wilms tumor

    • Non-renal (23%): Neuroblastoma, teratoma

  • Intraperitoneal (18%)

    • GI (12%): Appendiceal abscess, etc.

    • Hepatobiliary (6%)

  • Pelvic (4%): Ovarian cyst, etc.