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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
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
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
Gastroenteritis
Mucosal eosinophilic gastroenteritis
Diarrhea
Early satiety
Nausea
Vomiting
Abdominal bleeding
Acute onset of gastrointestinal bleeding
Black stool
Bleeding episodes
Blood in the vomitus
Colitis
Gi bleeding
Hemorrhagic complications
Melena
Occult blood
Stool guaiac-positive
Tarry stool
Bloody diarrhea
Discomfort or pain in upper belly
Discomfort or pain near the ribs
Upset stomach
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
Hiatus hernia
Hiatus hernia
Substernal region pain
Epigastric pain
Nausea
Postprandial fullness
Retching
Substernal region fullness
Auscultation reveal gastric sounds in chest
Dysphagia
Dyspnea
Heartburn
Hematemesis
Painful swallowing
Reflux of sour liquid material
Wheezing
Chills
Confusion
Fevers
Nonbilious vomiting
Oropharyngitis
Esophageal dysphagia
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
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
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