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DDxPro
Possible Diagnoses
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
Chronic pancreatitis
Abdominal pain
Epigastric pain
Relieved by sitting up
Pain radiate to back
Weight loss
Nausea
Jaundice
Aching
Worse 15 to 30 minutes after eating
Back pain
Chronic diarrhea
Clusters of severe pain
Diabetes mellitus
Fatigue
Maldigestion
Mild pain
Moderate pain
Pain lasts several days
Pain to left of abdominal midline
Paralytic ileus
Dyspepsia
Dyspepsia
Burning
Early satiety
Epigastric pain
No evidence of structural disease to explain the symptoms
Postprandial fullness
Symptom onset at least six months
Discomfort or pain in upper belly
Ribs area pain
Upper belly disomfort
Upper belly pain
Upset stomach
Fullness
Last three months
Meal related
Bloating
Abdominal discomfort
Centered in the upper abdomen
Epigastric pain syndrome
Persistent abdominal pain
Postprandial distress syndrome
Gastric outlet obstruction
Gastric outlet obstruction
Epigastric pain
Vomiting
Increase of postprandial abdominal pain
Succussion splash
Nausea
Weight loss
Early satiety
Bloating
Malnutrition
Hypochloremic metabolic alkalosis
Hypokalemic hypochloremic metabolic alkalosis
Recurrent vomiting
Presence of chronic dehydration
Dilated stomach
Epigastric tympanitic mass
Left upper quadrant tympanitic mass
Palpable abdominal mass
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
Peptic ulcer
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
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
Travelers diarrhea
Travelers diarrhea
Watery diarrhea
Abdominal cramps
Abdominal discomfort
Fecal urgency
Dehydration
Colitis
Anorexia
Belching
Blind loop syndrome
Bloating
Cimetidine
Famotidine
Malaise
Prior ulcer surgery
Ranitidine
Taking histamine blocker
Unable to proceed with planned activities
Bloody diarrhea
Fever
Tenesmus
Ovarian cancer
Ovarian cancer
Bloating
Abdominal mass
Abdominal pain
Frequently
Increased abdominal size
Difficulty eating
Pelvic pain
Urinary urgency
Constipation
Triad of bloating, increased abdominal size and urinary urgency
Urinary frequency
Urinary symptoms
Persistent
Postmenopausal bleeding
Appetite loss
Atypical glandular cells on cervical cytology
Pelvic mass
Pelvic pressure
Gastrointestinal symptoms
Back pain
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
Biliary colic
H / PE / Lab
Abdominal ultrasonography
No gallstones
Biliary Scintigraphy
No gallstones
EGD
Ulcer disease
Specific Therapy
Normal
ERCP Biliary Manometry
Choledocholithiasis
SPHINCTEROTOMY and STONE EXTRACTION
Biliary dyskinesia
SPHINCTEROTOMY
Normal
Functional pain syndrome
Gallstones
Evidence of choledocholithiasis
ERCP
Choledocholithiasis
ERCP +- CHOLECYSTECTOMY
CHOLECYSTECTOMY and CBD EXPLORATION
Normal
CHOLECYSTECTOMY or Gallstone Dissolution
No evidence of CBD pathology
CHOLECYSTECTOMY or Gallstone Dissolution
Flatulence
History / Physical examination
If stools are loose, examine for ova, parasites...see sesc...
Abnormal
Treat Accordingly
Normal
Eliminate offending agents in diet
Effective
No further evaluation
Not effective
Sigmoidoscopy and Barium Enema or Colonoscopy
Abnormal
Treat Accordingly
Normal
Consider: Upper GI and small bowel x-ray series Abdominal ultrasonography
Abnormal
Treat Accordingly
Normal
Consider: Gut motility testing or hygrogen breath testing
Consider: Treatment with bulking agents, antispasmodics, or stress reduction
Eliminate offending agents in diet
Effective
No further evaluation
Not effective
Sigmoidoscopy and Barium Enema or Colonoscopy
Abnormal
Treat Accordingly
Normal
Consider: Upper GI and small bowel x-ray series Abdominal ultrasonography
Abnormal
Treat Accordingly
Normal
Consider: Gut motility testing or hygrogen breath testing
Consider: Treatment with bulking agents, antispasmodics, or stress reduction
Asymptomatic Abnormal Liver Aminotransferases
Elevated ALT and AST<5 times normal
History and physical examination,* Discontinuation of hepatotoxic medications
Confirm abnormality if an error is suspected
Liver chemistries, PT, albumin ... see desc ...
Negative serology, asymptomatic patient without hepatic decompensation
Lifestyle modification: ...see desc ...
6 months
Repeat liver chemistries
Normal
Observation
Abnormal
Ultrasound and serologic evaluation: ...see desc...
Liver biopsy