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| {{Infobox_Disease |
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| Name = Abdominal pain |
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| ICD10 = {{ICD10|R|10||r|10}} |
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| ICD9 = {{ICD9|789.0}} |
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| }}
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| {{SI}}
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| {{CMG}}
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| __NOTOC__ | | __NOTOC__ |
| '''Associate Editor-In-Chief:''' {{CZ}}
| | {| class="infobox" style="float:right;" |
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| {{Editor Help}}
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| ==Overview==
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| '''Abdominal pain''' can be one of the [[symptom]]s associated with transient disorders or serious disease. Making a definitive diagnosis of the cause of abdominal pain can be difficult, because many diseases can result in this symptom. Abdominal pain is a common problem. Most frequently the cause is benign and/or self-limited, but more serious causes may require urgent intervention.
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| ==Introduction==<!-- This section is linked from [[List of medical abbreviations]] -->
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| Abdominal pain is traditionally described by its chronicity (acute or chronic), its progression over time, its nature (sharp, dull, [[colic]]ky), its distribution (by various methods, such as abdominal quadrant (left upper quadrant, left lower quadrant, right upper quadrant, right lower quadrant) or other methods that divide the abdomen into nine sections, and by characterization of the factors that make it worse, or alleviate it.
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| Due to the many organ systems in the [[human abdomen|abdomen]], abdominal pain is a concern of [[general practitioner]]s/family physicians, [[surgery|surgeons]], [[internal medicine|internist]]s, [[emergency medicine]] doctors, [[pediatrics|pediatricians]], [[gastroenterology|gastroenterologists]], [[urology|urologists]] and [[gynecology|gynecologists]]. Occasionally, patients with rare causes can see a number of specialists before being diagnosed adequately (''e.g.'', [[chronic functional abdominal pain]])
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| ==Types and mechanisms==
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| #The pain associated with the abdomen of inflammation of the [[parietal]] [[peritoneum]] (the part of the peritoneum lining the abdominal wall) is steady and aching, and worsened by changes in the tension of peritoneum caused by pressure or positional change. It is often accompanied by tension of the abdominal muscles contracting to relieve such tension.
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| #The pain associated with obstruction of a hollow viscus (as opposed to peritoneal and solid organ pain) is often intermittent or "[[colic]]ky", coinciding with the peristaltic waves of the organ. Such cramps are exactly what is experienced with early acute [[appendicitis]] and [[gastroenteritis]] and are somewhat relieved by writhing and massage.
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| #The pain associated with abdominal vascular disturbances ([[thrombosis]] or [[embolism]]) can be sudden or gradual in onset, and can be severe or mild. Pain associated with the rupture of an [[abdominal aortic aneurysm]] may radiate to the back, flank, or genitals.
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| #Pain that is felt in the abdomen may be "referred" from elsewhere (''e.g.'', a disease process in the chest may cause pain in the abdomen), and abdominal processes can cause radiated pain elsewhere (''e.g.'', [[gall bladder]] pain—in [[cholecystitis]] or [[cholelithiasis]]—is often referred to the [[shoulder]]).
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| ==Differential Diagnosis According to Localization==
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| ===Diffuse Abdominal Pain ===
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| <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:5 ISBN 140510368X</ref> <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:6 ISBN 1591032016</ref> <ref>Raftery, Andrew, Lim, Eric. Churchill's Pocketbook of Differential Diagnosis. London, UK: Elsevier Limited, 2005:17-21 ISBN 0443100616</ref>
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| *[[aortic aneurysm|Abdominal aortic aneurysm]]
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| *[[Appendicitis]]
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| *[[Colitis]]
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| *[[Gastroenteritis]]
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| *[[Ileus]]
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| *[[Inflammatory bowel disease]]
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| *[[Intussusception]]
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| *[[Leukemia]]
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| *[[adenitis|Mesenteric adenitis]]
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| *Metabolic, toxic, bacterial causes
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| *[[Pancreatitis]]
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| *[[Peritonitis]]
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| *[[Sickle cell anemia|Sickle cell crisis]]
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| ===Epigastric and upper quadrant===
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| *[[Aortic aneurysm|Aortic aneurysms]]
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| *[[pneumonia|Basal pneumonia]]
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| *[[Cholecystitis]]
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| *[[Cholecystolithiasis]]
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| *Chronic [[infection]]s
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| *[[Colon cancer]]
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| *Diseases of the [[spine]] with pain radiating into the [[abdominal cavity]]
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| *[[Dyspepsia]]
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| *[[Gastric cancer|Gastric tumors]]
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| *[[Gastritis]]
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| *[[Gastroesophageal reflux disease]] ([[GERD]])
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| *[[Giardiasis|Lamblia]]
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| *[[Hepatocellular carcinoma|Hepatic tumors]]
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| *[[Hepatomegaly|Congested liver]]
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| *Irritable [[stomach]]
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| *[[Kidney cancer]]
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| *[[Lymphomas]]
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| *[[Myocardial ischemia]]
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| *[[Pancreatic cancer|Pancreatic tumors]]
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| *[[Pancreatitis]]
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| *[[Parasitosis]] of the [[liver]]
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| *[[Peptic ulcer disease]]
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| *[[Pleuritis]]
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| *[[Postcholecystectomy syndrome]]
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| *[[Pulmonary embolism]]
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| *[[Pyelonephritis]]
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| *[[Splenic]] cancer
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| *[[Splenic infarction]]
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| *[[Splenic]] rupture
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| *[[Stomach]] emptying disorder
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| *[[Tuberculosis]]
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| *Tumors of the [[gall bladder]] and [[bile ducts]]
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| *[[Ulcerative colitis]]
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| ===Right upper quadrant===
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| *[[Budd-Chiari syndrome]] ([[Budd-Chiari syndrome|hepatic vein obstruction]])
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| *[[Cholecystitis]]
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| *[[Choledocholithiasis]]
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| *[[Liver abscess|Hepatic abscess]]
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| *[[Liver tumor|Hepatic tumor]]
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| *[[Hepatitis]]
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| *[[Hepatomegaly]]
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| *[[Ileus]]
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| *[[Invagination]]
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| *[[Mesenteric infarction]]
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| *Mesogastrium
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| *[[Pancreatitis]]
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| *[[Peptic ulcer]]
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| *[[Pleuritis]]
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| *[[Pulmonary infarction]]
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| *[[Renal colic|Renal pain]]
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| *[[volvulus|Sigmoid volvulus]]
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| ===Left upper quadrant===
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| *[[pneumonia|Basal pneumonia]]
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| *[[Empyema]]
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| *[[Gastritis]]
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| *[[Peptic ulcer|Gastroduodenal ulcer]]s
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| *[[Kidney cancer]]
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| *[[Pancreatitis]]
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| *[[Pericarditis]]
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| *[[Pleuritis]]
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| *[[Pulmonary infarction]]
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| *[[Pyelonephritis]]
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| *[[Renal colic|Renal pain]]
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| *[[Spleen]] [[tumor]]
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| *[[Splenic infarction]]
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| *[[Splenic]] rupture
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| *[[Splenomegaly]]
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| === Left Lower Quadrant ===
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| * [[Appendicitis]]
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| * [[Adnexitis]]
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| * [[Aortic aneurysm]]
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| * [[Crohn's disease]]
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| * [[Colitis]]
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| * [[Colon carcinoma]]
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| * [[Diverticulitis]]
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| * [[Ectopic pregnancy]]
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| * [[Endometriosis]]
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| * [[Faeces]]
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| * [[Gastritis]]
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| * [[Gastroenteritis]]
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| * [[Inflammatory bowel disease]]
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| * [[Inguinal hernia]]
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| * [[Intestinal obstruction]]
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| * [[Mesenteric]] [[lymphadenitis]] or [[thrombosis]]
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| * [[Dysmenorrhea|Middle pain]]
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| * [[Nephrolithiasis]]
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| * [[Ovarian cyst]] or [[torsion]]
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| * [[Psoas]] [[abscess]]
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| * [[Pyelonephritis]]
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| * [[Renal pain]]
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| * [[Salpingitis]]/[[Pelvic inflammatory disease]]
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| * Seminal vesiculitis
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| * [[Splenomegaly]]
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| * [[Strangulated hernia]]
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| * [[Volvulus]]
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| === Pelvic/Hypogastric Region ===
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| * [[Abdominal aortic aneurysm]]
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| * [[Appendicitis]]
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| * [[Bladder]] distention
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| * [[Cystitis]]
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| * [[Diverticulitis]]
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| * [[Ectopic pregnancy]]
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| * [[Endometriosis]]
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| * [[Malignancy]]
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| * [[Nephrolithiasis]]
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| * [[Ovarian cyst]]
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| * [[Ovarian torsion]]
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| * [[Prostatitis]]
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| * [[Salpingitis]]/[[Pelvic inflammatory disease]]
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| * Strangulated [[hernia]]
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| === Right Lower Quadrant ===
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| * [[Adnexitis]]
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| * [[Appendicitis]]
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| * Caecal [[volvulus]]
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| * [[Carcinoma]]
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| *:* [[Colon]]
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| *:* [[Caecum]]
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| * [[Crohn's disease]]
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| * [[Diverticulitis]]
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| * [[Ectopic pregnancy]]
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| * [[Faeces]]
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| * [[Endometriosis]]
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| * [[Endometritis]]
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| * [[Hemorrhage]] or rupture of [[ovarian cyst]]
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| * Inflamed ileal diverticulum
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| * [[Inguinal hernia]]
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| * [[Intussusception]]
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| * Leaking [[aortic aneurysm]]
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| * [[Middle pain]]
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| * [[Ovarian cyst]] or [[torsion]]
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| * [[Perforated ulcer]]
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| * [[Psoas]] [[abscess]]
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| * [[Renal]] [[calculus]]
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| * [[Renal pain]]
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| * [[Salpingitis]]/[[Pelvic inflammatory disease]]
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| * Seminal vesiculitis
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| * Terminal [[ileitis]] ([[Inflammatory bowel disease]])
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| * Uteral [[colic]]
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| * Ureteral [[colic]]
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| == '''Intraperitoneal Causes of Acute Abdominal Pain''' ==
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| ===Inflammatory===
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| ====Peritoneal====
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| *Chemical and nonbacterial peritonitis
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| **Perforated peptic ulcer/biliary tree, pancreatitis, ruptured ovarian cyst, mittelschmerz
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| *[[Bacterial peritonitis]]
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| **Primary peritonitis (Pneumococcal, streptococcal, tuberculous; spontaneous bacterial peritonitis)
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| **Perforated hollow viscus
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| ====Hollow visceral====
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| * [[Appendicitis]]
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| * [[Cholecystitis]]
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| * [[Peptic ulcer]]
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| * [[Gastroenteritis]]
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| * [[Gastritis]]
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| * [[Duodenitis]]
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| * [[Inflammatory bowel disease]]
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| * Meckel diverticulitis
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| * [[Colitis]] (bacterial, amebic)
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| * [[Diverticulitis]]
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| ====Solid visceral====
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| * [[Pancreatitis]]
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| * [[Hepatitis]]
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| * [[Abscess]] ([[pancreatic]], [[hepatic]], [[splenic]], etc.)
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| ====Mesenteric====
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| * [[Lymphadenitis]] (bacterial, viral)
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| * Epiploic appendagitis
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| ====''Pelvic''====
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| * [[Pelvic inflammatory disease]] ([[salpingitis]])
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| * [[Fallopian tube|Tubo]]-[[ovarian]] [[abscess]]
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| * [[Endometritis]]
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| ===Mechanical (obstruction, acute distention)===
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| ====Hollow visceral====
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| *[[Intestinal obstruction]]
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| ** [[Adhesion]]s, [[hernia]]s, [[neoplasm]]s, [[volvulus]]
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| ** [[Intussusception]], [[gallstone]] [[ileus]], [[foreign bodies]]
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| ** [[Bezoar]]s, [[parasites]]
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| * [[Biliary]] [[obstruction]]
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| ** [[Calculi]], [[neoplasm]]s, [[choledochal cyst]], hemobilia
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| ====Solid visceral====
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| * Acute [[splenomegaly]]
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| * Acute [[hepatomegaly]], ([[congestive heart failure]], [[Budd-Chiari syndrome]])
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| ====Mesenteric====
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| * Omental [[torsion]]
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| ====Pelvic====
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| * [[Ovarian cyst]]
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| * Torsion or degeneration of fibroid
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| * [[Ectopic pregnancy]]
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| ===Hemoperitoneum===
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| * Ruptured hepatic neoplasm
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| * Spontaneous [[splenic]] rupture
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| * Ruptured mesentery
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| * Ruptured [[uterus]]
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| * Ruptured graafian follicle
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| * Ruptured [[ectopic pregnancy]]
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| * Ruptured [[aortic aneurysm|aortic]] or visceral aneurysm
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| ===Ischemic===
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| * [[Mesenteric]] [[thrombosis]]
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| * [[Hepatic]] [[infarction]] ([[toxemia]], [[purpura]])
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| * [[Splenic]] [[infarction]]
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| * Omental [[ischemia]]
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| * Strangulated [[hernia]]
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| ===Traumatic===
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| == '''Extraperitoneal Causes of Acute Abdominal Pain''' ==
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|
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| === Genitourinary ===
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| * [[Pyelonephritis]]
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| * Perinephric [[abscess]]
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| * [[Renal infarct]]
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| * [[Nephrolithiasis]]
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| * Ureteral obstruction ([[urolithiasis]], [[tumor]])
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| * Acute [[Cystitis|cystitis]]
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| * [[Prostatitis]]
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| * Seminal vesiculitis
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| * [[Orchitis]]/[[Epididymitis]]
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| * [[Testicular torsion]]
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| * [[Dysmenorrhea]]
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| * Threatened [[abortion]]
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| === Pulmonary ===
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| * [[Pneumonia]]
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| * [[Empyema]]
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| * [[Pulmonary embolism ]]([[infarction]])
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| * [[Pneumothorax]]
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| === Cardiac ===
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| * [[Myocardial ischemia]]/[[infarction]]
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| * [[Acute rheumatic fever]]
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| * [[Acute pericarditis]]
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| === Metabolic ===
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| * [[Acute intermittent porphyria]]
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| * [[Familial Mediterranean fever]]
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| * [[Hypolipoproteinemia]]
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| * [[Hemochromatosis]]
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| * Hereditary [[angioneurotic edema]]
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| * [[Uremia]]
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| === Endocrine ===
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| * [[Diabetic ketoacidosis]]
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| * [[Hyperparathyroidism]] ([[hypercalcemia]])
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| * Acute [[Adrenal insufficiency|adrenal insufficiency]] (Addisonian crisis)
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| * [[Hyperthyroidism]] or [[hypothyroidism]]
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| === Musculoskeletal ===
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| * [[Rectus sheath hematoma]]
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| * [[Arthritis]]/diskitis of thoracolumbar spine
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| === Neurogenic ===
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| * [[Herpes zoster]]
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| * [[Tabes dorsalis]]
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| * Nerve root compression
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| * [[Spinal cord]] [[tumor]]s
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| * [[Osteomyelitis]] of the spine
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| * [[Abdominal epilepsy]]
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| * [[migraine|Abdominal migraine]]
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| * [[Multiple sclerosis]]
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| === Inflammatory ===
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| * [[Henoch-Schönlein purpura]]
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| * [[Systemic lupus erythematosus]]
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| * [[Polyarteritis nodosa]]
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| * [[Dermatomyositis]]
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| * [[Scleroderma]]
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| === Infectious ===
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| * Bacterial
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| * Parasitic ([[malaria]])
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| * Viral ([[measles]], [[mumps]], [[infectious mononucleosis]])
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| * [[Rickettsia]]l ([[Rocky Mountain spotted fever]])
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| === Hematologic ===
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| * [[Acute leukemia]]
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| * Acute hemolytic states
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| * Coagulopathies
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| * [[Pernicious anemia]]
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| * Other dyscrasias
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| === Vascular ===
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| * [[Vasculitis]]
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| * [[Periarteritis nodosa|Periarteritis]]
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| === Toxins ===
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| * Bacterial [[toxin]]s ([[tetanus]], [[staphylococcus]])
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| * [[Insect venom]] (black widow spider)
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| * [[venom|Animal venom]]
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| * Heavy metals ([[lead]], [[arsenic]], [[mercury]])
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| * Poisonous mushrooms
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| * Drugs
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| * [[Narcotic]]s withdrawal
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| === Retroperitoneal ===
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| * [[Retroperitoneal hemorrhage]] (spontaneous adrenal hemorrhage)
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| * [[Psoas]] [[abscess]]
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| === Psychogenic ===
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| * [[Hypochondriasis]]
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| * Somatization disorders
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| === Factitious===
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| * [[Munchausen syndrome]]
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| * Malingering
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| ==Differential Diagnosis of Underlying Etiology==
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| {|style="width:80%; height:100px" border="1"
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| |style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
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| |style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | • [[aortic aneurysm|Abdominal aortic aneurysm]] • [[Aortic aneurysm|Aortic aneurysms]] • [[Budd-Chiari syndrome]] ([[Budd-Chiari syndrome|hepatic vein obstruction]]) • [[Myocardial ischemia]] • [[Pericarditis]] •
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| |- | | |- |
| |-bgcolor="LightSteelBlue" | | | [[File:Siren.gif|30px|link=Abdominal pain resident survival guide]]|| <br> || <br> |
| | '''Chemical / poisoning'''
| | | [[Abdominal pain resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']] |
| |bgcolor="Beige"| • No underlying causes
| | |} |
| |-
| | {| class="infobox" style="float:right;" |
| |-bgcolor="LightSteelBlue"
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| | '''Dermatologic'''
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| |bgcolor="Beige"| • No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Drug Side Effect'''
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| |bgcolor="Beige"| • No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Ear Nose Throat'''
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| |bgcolor="Beige"| • No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Endocrine'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Environmental'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Gastroenterologic'''
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| |bgcolor="Beige"| • [[Cholecystitis]] • [[Cholecystolithiasis]] • [[Colon cancer]] • [[Hepatomegaly|Congested liver]] • [[Dyspepsia]] • [[Gastric cancer|Gastric tumors]] • [[Gastritis]] • [[Gastroesophageal reflux disease]] ([[GERD]]) • [[Giardiasis|Lamblia]] • [[Hepatocellular carcinoma|Hepatic tumors]] • [[Irritable stomach]] • [[Pancreatic cancer|Pancreatic tumors]] • [[Pancreatitis]] • [[Parasitosis of the liver]] • [[Peptic ulcer disease]] • [[Postcholecystectomy syndrome]] • [[pneumonia|Basal pneumonia]] • [[Splenic cancer]] • [[Splenic infarction]] • [[Splenic rupture]] • [[Stomach emptying disorder]] • [[Ulcerative colitis]] •
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Genetic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Hematologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Iatrogenic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Infectious Disease'''
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| |bgcolor="Beige"| No underlying causes
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| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Musculoskeletal / Ortho'''
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| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Neurologic'''
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| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Nutritional / Metabolic'''
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| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Obstetric/Gynecologic'''
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| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Oncologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Opthalmologic'''
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| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Overdose / Toxicity'''
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| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Psychiatric'''
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| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Pulmonary'''
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| |bgcolor="Beige"| • [[Empyema]] • [[Pleuritis]] • [[pneumonia|Basal pneumonia]] • [[Pulmonary embolism]] • [[Pulmonary infarction]] • [[Tuberculosis]] •
| |
| |- | |
| |-bgcolor="LightSteelBlue" | |
| | '''Renal / Electrolyte''' | |
| |bgcolor="Beige"| [[Kidney cancer]]
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Rheum / Immune / Allergy''' | |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Sexual'''
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| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Trauma'''
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| |bgcolor="Beige"| No underlying causes | |
| |-
| |
| |-bgcolor="LightSteelBlue" | |
| | '''Urologic'''
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| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Miscellaneous'''
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| |bgcolor="Beige"| No underlying causes
| |
| |- | | |- |
| | | [[File:Critical_Pathways.gif|88px|link=Abdominal pain critical pathways]]|| <br> || <br> |
| |} | | |} |
| | {{Abdominal pain}} |
|
| |
|
| ==Selected causes==
| | {{CMG}}; {{AE}} {{CZ}}; {{MUT}}; {{IQ}} {{ADS}} |
| *Parietal [[peritoneal]] [[inflammation]]
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| **Due to [[infection]]: inflamed or suppurative [[vermiform appendix|appendix]] in [[appendicitis]], [[pelvic inflammatory disease]]
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| **Due to chemical irritation: perforated [[gastric ulcer|gastric]] or [[peptic ulcer]]; [[pancreatitis]], ''[[Mittelschmerz]]'', ruptured [[ectopic pregnancy]]
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| **Miscellaneous ([[familial Mediterranean fever]])
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| *Inflammation of bowel wall [[Crohn's disease]], [[ulcerative colitis]], microscopic colitis, [[diverticulitis]], [[gastroenteritis]]
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| *[[Autoimmune]]: [[sarcoidosis]], [[vasculitis]]
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| *Mechanical obstruction of hollow viscera such as the [[small intestine]], the appendix associated with appendicitis, the [[large intestine]] (e.g. by [[intussusception]]), the [[biliary tree]] (e.g. by [[gallstone]]s), or the [[ureter]] (e.g. by urinary calculi)
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| *[[Blood vessel|vascular]] disturbances (leading to [[ischemia]]): [[embolism]], [[thrombosis]], vascular rupture, torsional occlusion ([[volvulus]]), [[sickle cell anemia]], left renal vein entrapment, superior mesenteric artery syndrome (nutcracker syndrome)
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| *[[Abdominal wall]] injury/disruption: mesenteric traction, muscle trauma, muscular infection, [[abdominal cutaneous nerve entrapment syndrome]] (ACNES), also known as intercostal neuralgia; [[diverticulosis]] (rare)
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| *[[Digestive]]: [[lactose intolerance]], [[Celiac sprue]]
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| *distention of visceral surfaces such as the [[hepatic]] or [[renal capsule]]
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| *[[Referred pain]] from the [[thorax]] ([[pneumonia]], [[myocardial infarction|coronary occlusion]]), the [[vertebral column|spine]] (radiculitis secondary to [[arthritis]]), [[genitals]] ([[testicular torsion]])
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| *Metabolic disturbance: [[lead poisoning]], Black widow spider bite, [[uremia]], [[diabetic ketoacidosis]], [[porphyria]], C1-esterase inhibitor deficiency, adrenal insufficiency
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| *Neurogenic pain: [[tabes dorsalis]], [[herpes zoster]], [[Lyme disease]] (Lyme radiculitis or Bannwarth syndrome)
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| *Functional pain, [[Irritable Bowel Syndrome]] (affecting up to 20% of the population, IBS is the most common cause of recurrent, intermittent abdominal pain)
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| *Reproductive organs (in women): [[mittelschmerz]], torsion of the ovary, ectopic pregnancy,
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| *[[Pelvic inflammatory disease]]
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| *[[Endometriosis]]
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| *Post-surgical [[Adhesion (medicine)|adhesions]]
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| *[[Diarrhea]]
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| *[[Meningitis]]
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| ==Acute Abdomen==
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| [[Acute abdomen]] can be defined as severe, persistent abdominal pain of sudden onset that is likely to require [[surgery|surgical intervention]] to treat its cause. The pain may frequently be associated with [[nausea]] and [[vomiting]], [[abdominal distention]], [[fever]] and signs of [[Shock (medical)|shock]].
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| ===Selected causes of acute abdomen===
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| *Traumatic : [[Blunt force trauma|blunt]] or perforating [[physical trauma|trauma]] to the [[stomach]], [[bowel]], [[spleen]], [[liver]], or [[kidney]]
| | {{SK}} Abdominal cramping; abdominal cramps; belly ache; abdominal discomfort; abdominal fullness |
| *Inflammatory :
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| ** Infections such as [[appendicitis]], [[cholecystitis]], [[pancreatitis]], [[pyelonephritis]], [[pelvic inflammatory disease]], [[hepatitis]], [[mesenteric adenitis]], or a subdiaphragmatic [[abscess]]
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| ** [[Gastrointestinal perforation|Perforation]] of a [[peptic ulcer]], a [[diverticulitis|diverticulum]], or the [[caecum]]
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| ** Complications of [[inflammatory bowel disease]] such as [[Crohn's disease]] or [[ulcerative colitis]]
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| *Mechanical :
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| **[[Small bowel]] [[bowel obstruction|obstruction]] secondary to adhesions caused by previous surgeries, [[intussusception]], [[hernia]]s, benign or malignant [[neoplasia|neoplasm]]s
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| **[[Large bowel]] [[bowel obstruction|obstruction]] caused by [[colorectal cancer]], [[inflammatory bowel disease]], [[volvulus]], [[fecal impaction]] or [[hernia]]
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| *Vascular : occlusive [[ischemic colitis|intestinal ischemia]], usually caused by [[thromboembolism]] of the [[superior mesenteric artery]]
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| ==Recurrent Abdominal Pain in Female Adolescents== | | ==[[Abdominal pain overview|Overview]]== |
| Recurrent abdominal pain (RAP) occurs in 5–15% of female children 6–19 years old. In a community-based study of middle and high school students, 13–17% had weekly abdominal pain. Using criteria for [[irritable bowel syndrome]] (IBS), 14% of high school students and 6% of middle school students fit the criteria for adult IBS. As with other difficult to diagnose chronic medical problems, patients with RAP [Recurrent Abdominal Pain] account for a very large number of office visits and medical resources in proportion to their actual numbers.
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| ==Chronic Functional Abdominal Pain== | | ==[[Abdominal pain classification|Classification]]== |
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| '''Chronic functional abdominal pain''' (CFAP) is the ongoing presence of [[abdominal pain]] for which there is no known medical explanation. It is quite similar to, but less common than, [[Irritable Bowel Syndrome]] (IBS), and many of the same treatments for IBS can also be of benefit to those with CFAP. The fundamental difference between IBS and CFAP is that in CFAP, unlike in IBS, there is no change in bowel habits such as [[constipation]] or [[diarrhea]]. Bowel dysfunction is a necessary diagnostic criteria of IBS.
| | ==[[Abdominal pain pathophysiology|Pathophysiology]]== |
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| CFAP is characterized by [[chronic pain]], with no physical explanation or findings (no structural, infectious, or mechanical causes can be found). It is theorized that CFAP is a disorder of the [[nervous system]] where normal nerve impulses are amplified "like a stereo system turned up too loud" resulting in [[Pain and nociception|pain]]. This visceral hypersensitivity may be a stand-alone cause of CFAP, or CFAP may result from the same type of brain-gut nervous system disorder that underlies IBS. As with IBS, low doses of [[antidepressants]] have been found useful in controlling the pain of CFAP.
| | ==[[Abdominal pain causes|Causes]]== |
| | [[Causes of diffuse abdominal pain|Diffuse]] |
| | | [[Causes of left upper quadrant abdominal pain|Left Upper Quadrant]] |
| | | [[Causes of left flank pain|Left Flank]] |
| | | [[Causes of left lower quadrant abdominal pain|Left Lower Quadrant]] |
| | | [[Causes of epigastric abdominal pain|Epigastric Region]] |
| | | [[Causes of umbilical region pain|Umbilical Region]] |
| | | [[Causes of pelvic pain|Pelvic Region]] |
| | | [[Causes of right upper quadrant abdominal pain|Right Upper Quadrant]] |
| | | [[Causes of right flank pain|Right Flank]] |
| | | [[Causes of right lower quadrant abdominal pain|Right Lower Quadrant]] |
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| Non-pharmaceutical approaches to CFAP also overlap with treatments for [[Irritable Bowel Syndrome]]. This includes enteric coated peppermint oil capsules, which act as anti-spasmodics to relax the gut and also have pain-killing properties due to the methyl salicylate that naturally occurs in peppermint. Gut-directed hypnotherapy or self-hypnosis can also mitigate the hyperreactive nervous system of CFAP, and help alleviate abdominal pain.
| | ==[[Abdominal pain differential diagnosis|Differentiating Abdominal pain from other Diseases]]== |
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| ===Etiology=== | | ==[[Abdominal pain epidemiology and demographics|Epidemiology and Demographics]]== |
| * Gynecologic Etiologies
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| ** [[Dysmenorrhea]]
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| ** [[Endometriosis]]
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| ** Müllerian abnormalities
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| ** [[Pelvic Inflammatory Disease]]
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| ** Ovarian Abnormalities
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| * Abdominal Etiologies
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| ==Medical Assessment== | | ==[[Abdominal pain risk factors|Risk Factors]]== |
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| When a physician assesses a patient to determine the etiology and subsequent treatment for abdominal pain the patients history of the presenting complaint and [[physical examination]] should derive a diagnosis in over 90% of cases.
| | ==[[Abdominal pain screening|Screening]]== |
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| It is important also for a physician to remember that abdominal pain can be caused by problems outside the abdomen, especially [[heart attack]]s and [[pneumonia]]s which can occasionally present as abdominal pain.
| | ==[[Abdominal pain natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| ===Anamnesis=== | | ==Diagnosis== |
| * Note the following during a complete history and physical examination:
| | [[Abdominal pain history and symptoms|History and Symptoms]] | [[Abdominal pain physical examination|Physical Examination]] | [[Abdominal pain laboratory findings|Laboratory Findings]] | [[Abdominal pain electrocardiogram|Electrocardiogram]] | [[Abdominal pain x ray|X Ray]] | [[Abdominal pain other imaging findings|Other Imaging Findings]] | [[Abdominal pain other diagnostic studies|Other Diagnostic Studies]] |
| * Symptom progression
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| * Associated complaints
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| * Urinary complaints
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| * Exposure to medications and illness
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| * Past medical history (including previous episodes of discomfort)
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| ===Physical Examination and Diagnostic Tests=== | | ==Treatment== |
| | [[Abdominal pain medical therapy|Medical Therapy]] | [[Abdominal pain surgery|Surgery]] | [[Abdominal pain primary prevention|Primary Prevention]] | [[Abdominal pain secondary prevention|Secondary Prevention]] | [[Abdominal pain cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Abdominal pain future or investigational therapies|Future or Investigational Therapies]] |
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| *Inspection
| | ==Case Studies== |
| *:* Look for [[dehydration]], [[fever]]
| | [[Abdominal pain case study one|Case #1]] |
| *:* Vitals
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| *:* Patient's body position tends to relieve the pain
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| * [[Physical examination|Cardiac examination]]
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| * [[Physical examination|Pulmonary examination]]
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| * [[Abdominal examination]]
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| *:* [[Abdominal distention|Distention]]
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| *:* [[Physical examination|Bowel sounds]]
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| *:* [[Physical examination|Tympany]]
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| *:* [[Palpitation]] for masses and [[organomegaly]]
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| *:* [[Abdominal guarding|Guarding]]
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| *:* [[Tenderness]]
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| *:* [[Rebound tenderness]]
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| *Investigations that would aid diagnosis include
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| *:*[[Blood tests]] including [[Full blood count]], [[Electrolytes]], [[Urea]], [[Creatinine]], [[Liver function tests]], [[pregnancy test]] and [[lipase]].
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| *:*[[Urinalysis]]
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| *:*Imaging including erect [[Chest X-ray]] and plain films of the [[abdomen]]
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| *:*An [[electrocardiograph]] to rule out a [[heart attack]] which can occasionally present as abdominal pain
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| ===Other Tests=== | | ==Related Chapters== |
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| If diagnosis remains unclear after history, examination and basic investigations as above then more advanced investigations may reveal a diagnosis. These as such would include
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| *[[Computed Tomography]] of the [[Abdomen]] / [[Pelvis]]
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| *[[Abdominal]] or [[Pelvic ultrasound]]
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| *[[Endoscopy]] and [[Colonoscopy]] (not used for diagnosing acute pain)
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| *[[Mantoux test]]
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| *[[Barium enema]]
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| *[[Barium enema|Small bowel enema]]
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| *[[Bone scan]]
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| ==See also==
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| *[[Irritable Bowel Syndrome]] | | *[[Irritable Bowel Syndrome]] |
| *[[Bowelgina]] | | *[[Bowelgina]] |
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| ==References==
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| {{Reflist|2}}
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| ==Additional Reading==
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|
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| * Apley J, Naish N: Recurrent abdominal pains: A field survey of 1,000 school children. ''Arch Dis Child'' 1958;33:165 - 170.
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| * [http://www.health.am/gyneco/chronic-pelvic-pain/ Chronic Pelvic Pain and Recurrent Abdominal Pain in Female Adolescents]
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| * Boyle JT, Hamel-Lambert J: Biopsychosocial issues in functional abdominal pain. ''Pediatr Ann'' 2001;30:1.
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| *[http://www.suburbanchicagonews.com/beaconnews/lifestyles/438133,2_5_AU22_DUNCAN_S1.article] Stomach ache or abdominal pain can be misdiagnosed.Consult a Gastroenterologist rather than ER doctor if Pain persists more than a day.
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| ==External links==
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| * [http://www.nethealthbook.com/gastrointestinaldisease_abdominalpain.html Abdominal pain differential diagnosis according to pain location]
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| * [http://gut.bmj.com/cgi/reprint/45/suppl_2/II43.pdf Functional bowel disorders and functional abdominal pain ] - Article on diagnosis
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| * [http://www.aboutibs.org/Publications/CFAP.html Chronic Functional Abdominal Pain] - International Foundation for Functional Gastrointestinal Disorders, Inc.
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| * [http://www.helpforibs.com/ Help for Irritable Bowel Syndrome] - IBS and abdominal pain patient education, treatments, and community
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| * [http://www.uams.edu/acelab Laboratory of Elie D. Al-Chaer for the Study of Pain]
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