Abdominal pain DDx
Overview
Acute abdomen is abdominal pain in the presence of tenderness and rigidity and is a surgical emergency. Abdominal pain can be considered in terms of surgical, Ob/Gyn and medical causes.
- The causes of abdominal pain are best dealt with according to the different regions of the abdomen. If pain is localised to a specific region of the abdomen, also consider nearby regions as the possible source of the pain.
- Don’t forget the abdominal wall as a source of the pain (e.g. haematomas, herpes zoster, etc) and that abdominal pain may originate from above the diaphragm!
- See also medical causes of abdominal pain.
Causes
Generalised abdominal pain with tenderness and rigidity
- perforated peptic ulcer
- perforation of other intra-abdominal organs
- AAA rupture
- aortic dissection
- pancreatitis
- ectopic pregnancy
- ischaemic gut
Central/ peri-umbilical pain without abdominal signs
- acute small bowel ischemia
- acute appendicitis
- acute small bowel obstruction
- acute pancreatitis
- testicular torsion
- medical causes of abdominal pain
Epigastric pain
Gastrointestinal
- gastritis
- peptic ulcer
- reflux oesophagitis
- pancreatitis
- cancer (gastric, pancreatic)
- Boerhaave syndrome (esophageal rupture)
- dyspepsia
- irritable bowel syndrome
Pain from nearby areas
- abdominal: central, RUQ pain
- cardiac: e.g. myocardial infarction, pleuritis
- pulmonary: e.g. pneumonia, pleurisy
Right hypochondrium/ upper quadrant pain
Gall bladder
- biliary colic
- cholecystitis
- cholangitis
Liver
- hepatitis
- hepatomegaly (e.g. liver congestion in right heart failure)
- hemorrhage into hepatic tumour
- trauma
- hepatic or subdiaphragmatic abscess
- Fitz-Hugh-Curtis syndrome (peri-hepatitis due to PID)
- Pre-eclampsia and HELLP
Other gastrointestinal
- appendicitis with high appendix (e.g. pregnancy)
- perforated or penetrating duodenal ulcer
- colon cancer
Pain from nearby areas
- abdominal: epigastric, central, RIF, loin, groin pain
- right lower lobe pneumonia, pleurisy or other lung disease
- subphrenic abscess
- acute pyelonephritis
Left hypochondrium/ upper quadrant pain
- pancreatitis
- subphrenic abscess
- diverticulitis
- ruptured spleen
- acute pyelonephritis
- leaking aneurysm of the splenic artery
- acute gastric distention
Right iliac fossa pain
Gastrointestinal
- appendicitis
- Crohn’s disease
- inflamed Meckel diverticulum
- cholecystitis with low gall bladder
- mesenteric adenitis
- epiploic appendagitis
- colon cancer
- constipation
- irritable bowel syndrome
Reproductive (female)
- ectopic pregnancy
- acute ovarian event (cyst rupture, hemorrhage, torsion)
- Mittelschmerz (ovulation pain mid-cycle)
- Pelvic inflammatory disease
- Endometriosis
Reproductive (male)
- seminal vesiculitis
- undescended testicle pathology
Urinary
- renal colic
- UTI
Pain from nearby areas
- abdominal: RUQ, central, groin pain
- hip pathology
- psoas abscess
- rectus sheath haematoma
- right lower lobe pneumonia
Left iliac fossa pain
Gastrointestinal
- diverticulitis
- colitis
- colon cancer
- constipation
- irritable bowel syndrome
Reproductive (female)
- ectopic pregnancy
- acute ovarian event (cyst rupture, hemorrhage, torsion)
- Mittelschmerz (ovulation pain mid-cycle)
- Pelvic inflammatory disease
- Endometriosis
Reproductive (male)
- seminal vesiculitis
- undescended testicle pathology
Urinary
- renal colic
- UTI
Pain from nearby areas
- abdominal: LUQ, central, groin pain
- hip pathology
- psoas abscess
- rectus sheath haematoma
- left lower lobe pneumonia
Suprapubic pain
- urinary retention
- cystitis
- uterine in origin (e.g. PID, fibroid, menstruation)
- origin from RIF and/ or LIF causes
Loin pain
Renal tract
- infection e.g. pyelonephritis
- obstruction, e.g. renal colic
- renal carcinoma
- renal vein thrombosis
- polycystic kidney disease
- adrenal hemorrhage
Other
- retroperitoneal hemorrhage
- retroperitoneal infection
- vertebral pathology
Groin pain
- renal calculi
- scrotal pain e.g. testicular torsion, epididymo-orchitis, trauma
- inguinal hernia
- hip pathology
- pelvic fracture
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Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
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