Differential diagnosis for acute abdominal pain
Common and important causes of acute abdominal pain for doctors and medical students
| Diagnosis | Evidence |
|---|---|
| Oesophagitis | Suggested by: retrosternal pain, heartburn. Confirmed by: OGD |
| Acute coronary syndrome (unstable angina or infarction) | Suggested by: chest tightness or pain on exertion. Confirmed by: exercise ECG ± coronary angiography if troponin normal. |
| Hiatus hernia | Suggested by: heartburn, worsens with stooping or lying, relieved by antacids. Confirmed by: OGD, barium meal. |
| Gastritis | Suggested by: epigastric pain, dull or burning discomfort, nocturnal pain. Confirmed by: OGD, barium meal and pH study. |
| Gallstone colic (with no acute inflammation or infection) | Suggested by: jaundice, biliary colic, pain in epigastrium or RUQ radiating to right lower scapula. No fever or increased WBC. Confirmed by: ultrasound of gallbladder and biliary ducts. |
| Acute cholecystitis | Suggested by: fever, guarding and positive Murphy’s sign (abrupt stopping of inspiration when the palpating hand meets the inflamed gallbladder descending with the liver from behind the subcostal margin on the right side - but not on the left side). Increased WBC and CRP. Confirmed by: ultrasound of gallbladder and biliary ducts. |
| Duodenal ulcer | Suggested by: epigastric pain, dull or burning discomfort, typically relieved by food, nocturnal pain. Confirmed by: OGD, barium meal and pH study (Helicobacter pylori often present in mucosa or by serology). |
| Gastric ulcer | Suggested by: epigastric pain, dull or burning discomfort, typically exacerbated by food, nocturnal pain. Confirmed by: OGD, barium meal and pH study. |
| Gastric carcinoma | Suggested by: marked anorexia, fullness, pain, Troisier’s sign (a Virchow’s node, i.e., large lymph node in the left supraclavicular fossa). Confirmed by: upper GI endoscopy with biopsy. |
| Pancreatitis | Suggested by: pain radiating straight through to the back, better on sitting up or leaning forward. Confirmed by: increased serum amylase, CT pancreas. |