Abdominal pain causes

Resident Survival Guide

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Abdominal pain Microchapters
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Causes Diffuse Abdominal Pain Left Upper Quadrant Left Flank Left Lower Quadrant Epigastric Quadrant Umbilical Region Pelvic Region Right Upper Quadrant Right Flank Right Lower Quadrant Intraperitoneal Extraperitoneal
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

The causes of abdominal pain vary with the distribution of the pain. The distribution can be determined by various methods, such as into either abdominal quadrants or nine sections.

Causes

Causes Based upon Location

Diffuse | Left Upper Quadrant | Left Flank | Left Lower Quadrant | Epigastric Region | Umbilical Region | Pelvic Region | Right Upper Quadrant | Right Flank | Right Lower Quadrant

Life Threatening Causes

Life-threatening causes include conditions that may result in death or permanent disability within the next 24 hours if left untreated.

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Causes by Organ System

Cardiovascular	Anaphylaxis, aortic aneurysm, cholesterol emboli syndrome, chronic necrotizing vasculitis
Chemical / poisoning	1,2-dibromo-3-chloropropane, 1,2-dibromoethane, 1,2-dichloroethane, 1,4-dioxane, 1-propanol, 2,4,6-trinitrotoluene, 2,4-dichlorophenol, 2-acetylamino-fluorene, 2-butoxyethanol, 2-hexanone, 2-methyl-4-chlorophenoxyacetic acid, 2-nitropropane, 4-aminopyridine, 4-dimethylaminoazobenzene, 8-hydroxyquinoline, Acetaminophen poisoning, Acetic acid, Acetonitrile, Acetylandromedol, Acetylene tetrabromide, Aconitum, Acrinathrin, Acrylamide, Acrylic acid, Acrylonitrile, Acute mercury inhalation, Adiponitrile, Alanycarb, Albitocin, Alcohol, Aldicarb, Aldoxycarb, Alicyclic hydrocarbons, Aliphatic amines, Aliphatic hydrocarbons, Aliphatic hydrogenated hydrocarbons, Allyl alcohol, Allyl chloride, Allylamines, Allyxycarb, Aloe poisoning, Alpha-cypermethrin, Aluminum phosphide, Amanita phalloides, Amanita polypyramis poisoning, Amaranth, Amidithion, Amines, Aminocarb, Amiton, Ammonium bifluoride, Ammonium nitrate, Amygdalin, Amyl acetate, Andromedotoxin, Anthraquinone, Antimony, Arachnidism, Aromatic amines, Aromatic halogenated hydrocarbons, Arsenic poisoning, Arsenic trioxide, Arsine, Asphalt, Athyl-gusathion, Azalea poisoning, Azinfosethyl, Azinfos-methyl, Azinphosmetile, Azothoate, Barium nitrate, Barium, Bendiocarb, Benoxafos, Benzene, Benzoate, Benzyl chloride, Beryllium, Beta-cyfluthrin, Bifenthrin, Bioallethrin, Bioresmethrin, Bipyridyl pesticides, Bismuth, Black locust poisoning, Black nightshade poisoning, Black widow spider bite, Borates, Boron hydrides, Box thorn poisoning, Bromide, Bromophos, Bufencarb, Butacarb, Butocarboxim, Buttercup poisoning, Cadmium, Cadusafos, Calcium hypochlorite, Calcium oxide, Camphor, Caper spruge poisoning, Captan, Carbamate insecticide poisoning, Carbofuran, Carbon disulfide, Carbon monoxide toxicity, Carbon tetrachloride, Carbophenothion, Carbosulfan, Carmine, Caspofungin, Chlorate salts, Chlordane, Chlorfenvinphos, Chlorinated benzenes, Chlorinated naphthalenes, Chlorobenzene, Chlorodiphenyl, Chloroform, Chloropicrin, Chloroprene, Chloropyrifos, Chokecherry seed poisoning, Christmas cherry poisoning, Chromium, Cicutoxin, Ciguatera poisoning, Clitocybe dealbata, Cloethocarb, Coastal leucothoe poisoning, Cobalt, Cobra poisoning, Coffeeweed poisoning, Copper salts, Copper toxicity, Corsican hellebore poisoning, Coumaphos, Cresol, Cyanthoate, Cycad nut poisoning, Cycasin, Cyclochlorotine, Cyfluthrin, Cypermethrin, Cyphenothrin, Cypress spurge poisoning, Daffodil poisoning, Deadly nightshade (solanum dulcamara) poisoning, Deathcamas poisoning, Decarbofuran, Deltamethrin, Demeton, Demeton-methyl, Devil's snuff box poisoning, Dialifos, Dibromochloropropane, Dichlorvos, Dicresyl, Diethylene glycol, fluoride poisoning, grape seed extract, lead poisoning, oleander, parathion, pesticide, pyridine, snakebites, spider bite, tributyl phosphate
Dermatologic	Adnexal and skin appendage neoplasms, angioneurotic edema, Behcet's disease, Chiari-Frommel syndrome, chronic necrotizing vasculitis
Drug Side Effect	Acetylsalicylic acid, acarbose, acipimox, acyclovir, alosetron, allopurinolaminocaproic acid, amlodipine and benazepril, ambenonium, amodiaquine, amphetamine abuse, amphotericin, anesthetic agent, antiarrhythmics, anticoagulants, antifungals, antihypertensives, antineoplastic agents, antiviral medicationaspirin, ativan withdrawal, atomoxetine, atovaquone, atovaquone-Proguanil, auranofin, azithromycin, aztreonam, basiliximab, benzodiazepine, bethanechol chloride, bezafibrate, bicalutamide, bosutinib, busulfan, butyrophenone, carbarsone, carbarylcaspofungin, cefdinir, cefixime, cefuroxime, cidofovir, cladribine, clidinium, clindamycin, clofibrate, contraceptive patch, dactinomycin, danazol, daptomycin, deferasirox, deferiprone, desmopressin, didanosine, diflunisal, dimercaprol, donepezil, doxorubicin hydrochloride, drotrecogin alfa, dydrogesterone, ecallantide, enoxaparin, entacapone, Elosulfase alfa, erythromycin, ethcathinone, etodolac, etonogestrel, etoposide phosphate, febuxostat, fesoterodine, flucytosine, flurbiprofen, fluvastatin, ganirelix, glyburide and metformin, halofantrine, hydroxychloroquine, idarubicin, imiglucerase, indinavir, interferon beta- 1b, irinotecan hydrochloride, isoniazid, itraconazole, ivacaftor, ivermectin, ketorolac tromethamine, lactulose, lanreotide, lansoprazole, lanthanum carbonate, levonorgestrel, loperamide, lopinavir, loprazolam, loratadine, magnesium citrate, mebendazole, medroxyprogesterone, megestrol, mercaptopurine, mesna, methimazole, methotrexate, methylphenidate, metronidazole, mifepristone, miglitol, misoprostol, moxifloxacin, muscarine, nafcillin, naltrexone, naproxen sodium, naproxen and esomeprazole magnesium, natalizumab, neuromuscular-blocking drugs, niclosamide, nitazoxanide, norethindrone acetate and Ethinyl estradiol, norgestrel and ethinyl estradiol, octreotide injection, omeprazole, olsalazine, orlistat, oxcarbazepine, Pantoprazole, paromomycin sulfate, pasireotide, pazopanib hydrochloride, papaverine, piroxicam, pegaspargase, pentamidine Isethionate, pentavalent antimonial, pentostatin, perindopril, phenazocine, permethrin, pirfenidone, potassium iodide, polyethylene glycol-electrolyte solution (pEG-ES), potassium bicarbonate, potassium citrate, praziquantel, prazosin and polythiazide, primaquine phosphate, procainamide, procarbazine, progesterone, propylthiouracil, protirelin, rabeprazole, rasburicase, rifaximin, ritonavir, roxithromycin, sacrosidase, sargramostim, saquinavir mesylate, saxagliptin, secretin human, siltuximab, simvastatin, sorafenib, sucralfate, sulfasalazine, sunitinib, thiotepa, tianeptine, tigecycline, tolmetin, topiramate, topotecan, trametinib dimethyl sulfoxide, trastuzumab, tretinoin, triclofos, valacyclovir, vancomycin, vardenafil,vandetanib, vigabatrin, vinblastine, voriconazole, zafirlukast Cefdinir, Cefixime, Cefuroxime, Cephalosporin, Chloramphenicol, Chloroquine, Cidofovir, Cimetidine, Ciprofloxacin, Cisapride, Cladribine, Clidinium, Clindamycin, Clofibrate, Codeine withdrawal, Colchicine, Cyclopropane, Cycloserine, Cytarabine, Dactinomycin, Danazol, Dantrolene, Daptomycin, Darvocet overdose, Deferiprone, Depo-provera, Desmopressin, Dexedrine overdose, Didanosine, Diflunisal,
Ear Nose Throat	No underlying causes
Endocrine	Addison's disease, adrenal crisis, adrenal disorders, adrenal gland hypofunction, adrenal hemorrhage, adrenal hyperplasia, adrenal insufficiency, Chiari-Frommel syndrome, congenital adrenal hyperplasia, cushing syndrome, diabetes mellitus type 2, diabetic gastroparesis, diabetic ketoacidosis, multiple endocrine neoplasia type 1
Environmental	No underlying causes
Gastroenterologic	Abdominal cramps, abdominal cutaneous nerve entrapment syndrome, abdominal mass, accessory pancreas, acute pancreatitis, appendicitis, autoimmune hepatitis, autoimmune pancreatitis, bacterial gastroenteritis, bowel obstruction, caecitis, carcinoid syndrome, celiac disease, Charcot's triad, cholangiocarcinoma, cholangitis, cholecystitis, choledochal cysts, chronic pancreatitis, cirrhosis, clostridial necrotizing enteritis, colitis, colonic polyps, colorectal cancer, constipation, Crohn's disease, diverticulitis, duodenitis, dyspepsia, enteritis, epiploic appendagitis, gastric outlet obstruction, gastritis, gastroenteritis, gastrointestinal perforation, gastrointestinal stromal tumor, hemosuccus pancreaticus, ileitis, ileus, intestinal malrotation, intestinal pseudoobstruction, intussusception, irritable bowel syndrome, ischemic colitis, König's syndrome, Krukenberg tumor, malabsorption, Meckel's diverticulum, mesenteric ischemia, ogilvie syndrome, pancreatic cancer, pancreatitis, peptic ulcer, peritonitis, porcelain gallbladder, proctitis, pseudomembranous colitis, pseudomyxoma peritonei, toxic megacolon, ulcerative colitis, volvulus, Whipple's disease
Genetic	Gilbert's syndrome, Marfan syndrome, periodic fever syndrome, pyruvate carboxylase deficiency, Slone's disease
Hematologic	Capillary leak syndrome, cholesterol emboli syndrome, mastocytosis, porphyria
Iatrogenic	Adjustable gastric band, postcholecystectomy syndrome, short bowel syndrome, transfusion-associated graft versus host disease
Infectious Disease	African horse sickness, Anisakis, Ascaris infection, Astroviridae, Bacillus cereus, blastocystosis, Brachylaima, campylobacteriosis, cat scratch fever, Cestoda, Clostridium difficile, Colorado tick fever, Cryptosporidium parvum, Dengue fever, Ebola, Entamoeba histolytica, familial Mediterranean fever, fasciolopsiasis, fasciolosis, fungemia, Fusarium, Giardia lamblia, Hantavirus pulmonary syndrome, Helicobacter pylori infection, Henipavirus, hookworm, Hymenolepis infection, isosporiasis, leptospirosis, Mycobacterium avium complex, Norovirus, Opisthorchis infection, Paragonimus infection, Q fever, rheumatic fever, Rocky Mountain spotted fever, salmonellosis, scarlet fever, schistosomiasis, scombrotoxic fish poisoning, shigellosis, strongyloidiasis, toxocariasis, trichomoniasis, typhoid fever, Vibrio vulnificus, viral hepatitis , whipworm infection, yellow fever, yersiniosis
Musculoskeletal / Ortho	No underlying causes
Neurologic	Autonomic neuropathy
Nutritional / Metabolic	Diabetic ketoacidosis, food allergy, food intolerance, lactic acidosis, metabolic acidosis, pantothenic acid, Zieve's syndrome
Obstetric / Gynecologic	Cervical cancer, ectopic pregnancy, endometrial cancer, endometriosis, menstruation, ovarian cancer, ovarian cyst, ovarian hyperstimulation syndrome, ovarian torsion, pelvic inflammatory disease, placental abruption, pregnancy, Salpingitis, uterine fibroids, uterine rupture, uterine sarcoma
Oncologic	Desmoplastic small round cell tumor, liposarcoma, liver tumor, mesothelioma, sacrococcygeal teratoma
Ophthalmologic	No underlying causes
Overdose / Toxicity	4-Nitrophenol, cicutoxin, cinchonism, clitocybe dealbata, colchicine, hebeloma crustuliniforme, hypervitaminosis A, sorbitol, statins, tegaserod, tetrodotoxin
Psychiatric	Bulimia nervosa, childhood-onset bipolar disorder, depression
Pulmonary	Allergies, alveolar hydatid disease, anaphylaxis, acquired angioedema, angioneurotic edema, aspiration pneumonia, basal pneumonia, Chilaiditi syndrome, Churg-Strauss syndrome, congenital bronchogenic cyst, decompression sickness, empyema, pleuritis, pulmonary embolism, pulmonary infarction, tuberculosis
Renal / Electrolyte	Bright's disease, Burnett's milk drinker's syndrome, chronic renal insufficiency, clear cell renal cell carcinoma, collecting duct carcinoma, congenital lactic acidosis, congenital megalo-ureter, continuous ambulatory peritoneal dialysis, Cope's syndrome, cystitis, hydronephrosis, hypercalcemia, hyperkalemia, hypocalcemia, nutcracker syndrome, polycystic kidney disease, pyelonephritis, ureterocele,urinary tract infection
Rheum / Immune / Allergy	Allergies, alpha heavy chain disease, anaphylaxis, acquired angioedema, angiofollicular ganglionic hyperplasia, angioneurotic edema, autoimmune oophoritis, autoimmune pancreatitis, autoimmune thyroid disease, Behcet's disease, celiac disease, chronic fatigue syndrome, chronic necrotizing vasculitis, Churg-Strauss syndrome, citric acid intolerance, collagenous celiac disease, diffuse systemic sclerosis, systemic lupus erythematosus, polyarteritis nodosa
Sexual	No underlying causes
Trauma	No underlying causes
Urologic	Prostate cancer, prostatitis
Miscellaneous	Alcoholic hepatitis, chronic fatigue syndrome, chronic functional abdominal pain, foreign body, ruptured spleen, side stitch, Situs inversus, Zollinger-Ellison syndrome

Causes in Alphabetical Order

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Acute Abdomen

Common causes of acute abdomen include:

• Acute appendicitis
• Acute cholecystitis
• Acute diverticulitis
• Acute intestinal ischemia
• Acute pancreatitis
• Acute peptic ulcer and its complications
• Acute peritonitis
• Acute ureteral colic
• Bowel perforation with free air or bowel contents in the abdominal cavity
• Bowel volvulus
• Diabetic ketoacidosis
• Ectopic pregnancy with tubal rupture

Chronic Functional Abdominal Pain

Common causes of CFAP stem from:

• Abdominal etiologies
• Gynecologic etiologies
  • Dysmenorrhea
  • Endometriosis
  • Müllerian abnormalities
  • Ovarian abnormalities
  • Pelvic inflammatory disease

References

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