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DDxPro
Possible Diagnoses
Zollinger-ellison syndrome
Zollinger-ellison syndrome
Develop peptic ulcers
Abdominal pain
Peptic ulcer associated with endocrinopathy
Peptic ulcer refractory to treatment or persistent
Sporadic gastrinomas
Ulcers presenting with frank complications
Diarrhea
Steatorrhea
Associated with gastroesophageal reflux disease
Gastrointestinal bleeding
Associated with duodenal ulcer
Mild esophagitis
Chronic unexplained diarrhea
Ulcers in absence of nsaid ingestion
Perforation
Recurrent severe multiple peptic ulcers
Accelerate transit
Multiple recurrent complicated duodenal ulcers
Refractory diarrhea
Severe diarrhea
Peptic ulcer
Gastric ulcer
Awakes from sleep
Relief with anti secretory agents
Recurs when stomach is empty
When stomach is empty
Burning pain
Upper abdomen discomfort
At night
Epigastric pain
Hunger-like pain
Relieved by eating
Relief with antiacid
Awakes the patient from sleep
Discomfort or pain in upper belly
Discomfort or pain near the ribs
Upset stomach
three months
Diarrhea
Burning
Symptom onset at least six months
Abdominal pain
Duodenal ulcer
Awakes from sleep
Relief with anti secretory agents
Recurs several hours after a meal
Recurs when stomach is empty
When stomach is empty
Burning pain
Upper abdomen discomfort
At night
Epigastric pain
Hunger-like pain
Relieved by eating
Relief with antiacid
Awakes the patient from sleep
Vomiting after eating
Radiate to back
Meal related
Epigastric tenderness
Nausea relieved by eating
Severe abdominal pain
Discomfort or pain in upper belly
Acute peptic ulcer
Awakes from sleep
Relief with anti secretory agents
Abdominal pain
Intense pain
More localized pain
Recurs when stomach is empty
Sudden onset
When stomach is empty
Burning pain
Upper abdomen discomfort
At night
Epigastric pain
Hunger-like pain
Sudden severe abdominal pain
Relieved by eating
Relief with antiacid
Awakes the patient from sleep
Hematochezia
Vomiting
Diffused
Peptic ulcer
Centered in epigastrium
Epigastric pain
Awakes the patient from sleep
Relief with anti secretory agents
Recurs when stomach is empty
Burning pain
Upper abdomen discomfort
At night
Relieved by eating
Relief with antiacid
Gnawing pain
Worsens with eating
Dyspepsia
Patient show site of pain with one finger
Vomiting after eating
Radiate to back
Meal related
Recurrent abdominal pain
Weight loss
Anorexia
Pancreatic cancer
Pancreatic cancer
Asthenia
Weight loss
Anorexia
Abdominal pain
Intermittent pain
Epigastric pain
Jaundice
Intermittent abdominal pain
New onset of diabetes mellitus
Nausea
Midepigastric pain
Upper abdominal pain
Radiate to back
Radiate to sides
Hepatomegaly
Vomiting
Courvoisier sign
Trousseau syndrome
Palpable periumbilical mass
Abdominal mass
None
Giardiasis
Diarrhea
Malaise
Abdominal pain
Flatulence
Foul-smelling stools
Abdominal cramps
Belching
Bloating
Nausea
Frequent belching
Weight loss
Anterior uveitis
Cystic fibrosis
Immunocompromised individuals
Ingestion of contaminated water
Ingestion of raw food
Ingestion of uncooked food
Ingestion of untreated water
Poor sanitary conditions
Travelers
Hereditary angioedema
Hereditary angioedema
Extremities skin swelling
Face skin swelling
Genitals skin swelling
Skin swelling
Exacerbating by oral contraceptives
Abdominal distension
Abdominal pain
Gastrointestinal colic
Nausea
Vomiting
Diarrhea
Exacerbating by stress
Skin sensation of fullness
Skin sensation of irritation
Skin tingling
Chicken-wire pattern of erythematous discoloration
Erythema marginatum
Erythematous discoloration
Exacerbating by bacteriuria
Exacerbating by bicycle riding
Crohn disease
Crohn disease
Abdominal tenderness
Perianal skin tag
Sinus tracts
Abdominal pain
Diarrhea
Abdominal mass
Recurrence after surgery
Response to antibiotics
Prolonged diarrhea
Chronic diarrhea
Tender mass is palpable
Fever
Fatigue
Weight loss
Episodes of colonic obstruction
Episodes of small bowel obstruction
Frequently right lower quadrant pain
Crampy abdominal pain
Right lower quadrant mass
Pain relieved by defecation
Gastroenteritis
Bacterial gastroenteritis
Signs of volume depletion
Abdominal pain
Diarrhea
Watery diarrhea
Bloody diarrhea
Continuous pain
Radiates to right iliac fossa
Colicky pain
Pain is less marked
Cramping pain
Severe pain
Abdominal tenderness
Dry mucous membranes
Hypotension
Tenesmus
8-10 bowel movements on day
Abdominal discomfort
Anorexia
Increased bowel sounds
Lethargy
Amebiasis
Intestinal entamoeba histolytica amebiasis
Bloody diarrhea
Bloody stools
Diarrhea
Mild diarrhea
Several weeks diarrhea
Watery diarrhea
Exposure in endemic area
Abdominal pain
Lower abdominal pain
Amebic dysentery
Back pain
Diarrhea with blood in stools
Environmental enteropathy
Hematophagous trophozoites
Impoverished gut
Malaise
Weight loss
Fever
Colitis
Malnutrition
Irritable bowel syndrome
Irritable bowel syndrome
Change in bowel habit
Constipation alternating with diarrhea
Change in stool appearance
Change in stool form
Abdominal pain
Chronic abdominal pain
Abdominal bloating
Abnormal stool frequency
Change in form (appearance) of stool
Change in form or consistency of stool at onset of pain
Fecal urgency
Feeling of incomplete evacuation
Looser stools at onset of pain
More frequent stools at onset of pain
Mucus discharge with stools
Occur once a week
Recurrent abdominal discomfort
Recurrent abdominal pain
Recurrent abdominal pain or discomfort
Relieved by defecation
Acute Abdominal Pain
History and physical examination
Unstable or Obvious surgical indication
Consider: Hemorrhage Perforation Acute peritonitis Bowel obstruction Ischemia
Resuscitation
Surgical consultation
LAPAROTOMY
Stable
Observation
Exclude: Medical causes
Consider: Inadequate physical manifestations
Further studies
Decreased pain
Observation
Continued pain Increased pain
Surgical Consultation
Chronic Abdominal Pain
History Physical examination, Laboratory tests
Evidence suggestive of visceral organ source
Stomach
Consider: Peptic ulcer Gastric tumor
Endoscopy Upper GI Series
Small bowel
Consider: Inflammation Tumor Obstruction
Small Bowel Follow-Through or Enteroclysis CT
Pancreas
Consider: Pancreatitis Cyst/tumor
Ultrasonography CT ERCP Pancreatic Function Test
Hepatobiliary
Consider: Gallstones Biliary obstruction Tumor/cyst Infiltration Chronic hepatitis Engorgement
Ultrasonography CT ERCP Liver Biopsy
Renal
Consider: Pyelonephritis Nephrolithiasis Tumor/cyst
Ultrasonography CT IV Pyelography
Colon
Consider: Inflammation Tumor Obstruction Diverticulosis
Barium Enema and/or Endoscopy
Abdominal wall source
Referred spinal nerve source
Vascular aneurysm
Ultrasonography CT Angiography
Pelvic source
Ultrasonography Laparoscopy
Nonlocalized or inapparent source
Consider: Metabolic disorders
Functional pain/dysmotility
IBS Nonulcer dyspepsia Postcholecystectomy syndrome
Chronic mesenteric ischemia Vasculitis
Angiography
Consider: Drug effect Lead toxicity
Consider: Tumor/cyst Infection Inflammatory process: Peritoneum Mesentery Omentum Retroperitoneum
Ultrasonography CT Laparoscopy Laparotomy
Heartburn
History, Physical examination
Typical symptoms
PPI
Relief by PPI
Step-down therapy
Infrequent recurrence
Treat again
Frequent recurrence
Maintenance PPI
Failure by PPI
Twice-Daily PPI Therapy
Relief by twice-PPI
Maintenance PPI
Failure by twice-PPI
Document reflux: 24-hr pH on PPI
Normal 24-hr pH
Alternative therapy
Reflux 24-hr pH
Increase PPI dose
Upper endoscopy for patient at high risk for Barrett’s esophagus
Alarm symptoms and signs
Upper Endoscopy