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Differential diagnosis for acute abdominal pain

Common and important causes of acute abdominal pain for doctors and medical students

DiagnosisEvidence
OesophagitisSuggested 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 herniaSuggested by: heartburn, worsens with stooping or lying, relieved by antacids.
Confirmed by: OGD, barium meal.
GastritisSuggested 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 cholecystitisSuggested 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 ulcerSuggested 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 ulcerSuggested by: epigastric pain, dull or burning discomfort, typically exacerbated by food, nocturnal pain.
Confirmed by: OGD, barium meal and pH study.
Gastric carcinomaSuggested 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.
PancreatitisSuggested by: pain radiating straight through to the back, better on sitting up or leaning forward.
Confirmed by: increased serum amylase, CT pancreas.

Related page: Acute epigastric pain

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