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DDxPro
Possible Diagnoses
Gastroparesis
Gastroparesis
Nausea
Upper abdominal pain
Easy satiety
Pain with sleeping
Mild bloating
Gastric residual in four hours
Vomiting
Exacerbate after eating
Bloating
Postprandial fullness
Weight loss
Epigastric pain
Postprandial nausea
Abdominal discomfort
Burning sensation
Crampy sensation
Epigastric distention
Epigastric tenderness
Gastric retention
Localized pain
Pancreatitis
Acute pancreatitis
Nausea
Vomiting
Mild discomfort
Left upper quadrant pain
Alleviated in fetal position
Worsens with movement
Acute upper abdominal pain
Boring pain
Periumbilical pain
Relief on bending forward
Relieved by sitting up
Epigastric pain
Pain radiate to back
Signs of hypovolemia
Anorexia
Hypotension
Abdominal distention
Blue-red-purple of flanks
Clinical signs of hypocalcemia
Gradual pain
Gallstone pancreatitis
Discomfort
Left upper quadrant pain
Alleviated in fetal position
Worsens with movement
Acute upper abdominal pain
Boring pain
Periumbilical pain
Relief on bending forward
Relieved by sitting up
Epigastric pain
Vomiting
Pain radiate to back
Nausea
Clinical signs of hypocalcemia
Gradual pain
Worse when supine
Sudden onset
Fever
Guarding
Increased pain several weeks after onset
Cholecystitis
Acute cholecystitis
Sudden onset
Pain persisting beyond 5 hours
Prolonged biliary pain
Prolonged right upper quadrant pain
Epigastric pain
Acute onset of upper abdominal pain
Upper abdominal pain
Abdominal pain
Steady pain
More severe than biliary colic
Severe pain
Positive murphy sign
Right upper quadrant pain
Unremitting right upper quadrant pain
Fever
Nausea
Murphy's sign
Vomiting
Previous episode of biliary pain
Low grade fever
Sigmoid volvulus
Sigmoid volvulus
Abdominal pain
Tenderness
Abdominal distension
Obstipation
Constipation
Nausea
Colicky pain
Continuous pain
Severe pain
Tympanitic abdomen
Recurrent pain
Vomiting
Lead to gangrene
Peritonitis
Sepsis
Acute appendicitis
Acute appendicitis
Abdominal tenderness
Onset of abdominal pain
Right lower quadrant tenderness
Shift to the left
Anorexia
Mild vomiting
Nausea
Vague discomfort
Vague pain
More localized to right lower quadrant pain after several hours
Vague periumbilical pain
Migratory right iliac fossa pain
Pain migration from periumbilical to right lower quadrant
Mcburneys point tenderness
Sharper pain
Positive alvarado score
Rebound tenderness
Rebound tenderness in the right iliac fossa
Tenderness in the right iliac fossa
Fever
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
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
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
Acute fatty liver of pregnancy
Acute fatty liver of pregnancy
Nausea
Vomiting
In third trimester
Multiple gestations
Jaundice
Abdominal pain
Anorexia
Confusion
Edema
Epigastric pain
Hepatic encephalopathy
Hypertention
Lactic acidosis
Malaise
Signs of preeclampsia
Before delivery
Polydipsia
Dic
Infection
Long ptt
Intussusception
Intussusception
Abdominal pain
Constipation
Fever
Intermittent abdominal pain
Intermittent pain
Nausea
Vomiting
Weight loss
Rectal bleeding
Redcurrant jelly stools
Chronic
Progressive lethargy
Colicky pain
Intermittent partial bowel obstruction
Abdominal distention
Palpable abdominal mass
Leading to bowel perforation
Leading to secondary bacterial peritonitis
Peritonism
Hypovolemic shock
Choledochal cyst
Choledochal cyst
Abrupt onset abdominal pain
Acute abdominal pain
Cramping abdominal pain
Diffuse abdominal pain
Frank abdominal pain
Gastrointestinal colic
Gi disturbance
Left sided abdominal pain
Lower abdominal pain
Mid-abdominal pain
Periumbilical pain
Postprandial abdominal pain
Progressive abdominal pain
Recurrent abdominal pain
Right sided abdominal pain
Upper abdominal pain
Relieved by sitting up
Abdominal mass
Biliary lithiasis
Gradual
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
Nausea and Vomiting
History, PE, Laboratory evaluation
Assess for mechanical obstruction, peritonitis, dehydration, or bleeding
YES (mechanical obstruction, peritonitis, dehydration, or bleeding)
Replace fluids, Consider hospitalization
NO (mechanical obstruction, peritonitis, dehydration, or bleeding)
Regurgitation of undigested food? rumination, esophageal stricture, Zenker’s diverticulitis
Assess for pharmacologic or toxic causes
YES (pharmacologic or toxic causes)
Discontinue offending agent Treat toxicity
NO (pharmacologic or toxic causes)
Constant or recurrent, intermittent
Consider: Migraines, Seizure disorder, Cyclic vomiting, CNS lesions
Duration < 1 wk
Consider: Food poisoning, Gastroenteritis
Fluid and electrolyte replacement, observation, antiemetics
Duration > 7 days
Predominantly AM vomiting
Consider: Pregnancy, Uremia, Alcohol use, Increased intracranial pressure
Focal defects, Brainstem Posterior fossa, Abdominal migraine
Etiology still uncertain
Consider: Electrogastrography, MRI of brain
Vomiting > 1 hr after meal
Gastric emptying study
Prolonged emptying
Consider: Gastroparesis, Trial prokinetic agents, Gastric outlet obstructions
EGD
Normal emptying
Consider: Conversion reaction, Depression
Psychological evaluation
Vertigo
Consider: Labyrinthine disorder
Etiology still uncertain
Consider: Electrogastrography, MRI of brain
Vomiting immediately after meals
Consider: Gastroesophageal reflux disease, Bulimia
Etiology still uncertain
Consider: Electrogastrography, MRI of brain
Chronic orthostatic hypotension, hyponatremia
Consider: Adrenal insufficiency
Etiology still uncertain
Consider: Electrogastrography, MRI of brain
Weight loss
Consider: Malignancy, Gastroparesis, Gastric outlet obstruction
EGD
Etiology still uncertain
Consider: Electrogastrography, MRI of brain