Diffuse abdominal pain - Revision history

Danbot: Strip excess bold

2026-03-22T09:29:41Z

Strip excess bold

← Older revision		Revision as of 09:29, 22 March 2026
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	===Must Not Miss===		===Must Not Miss===
	*~~'''~~[[Mesenteric ischemia]]~~'''~~: elderly, atrial fibrillation, pain out of proportion to exam		*[[Mesenteric ischemia]]: elderly, atrial fibrillation, pain out of proportion to exam
	*~~'''~~Perforated viscus~~'''~~: free air, peritonitis		*Perforated viscus: free air, peritonitis
	*~~'''~~[[Small bowel obstruction]]~~'''~~: vomiting, distension, prior surgery		*[[Small bowel obstruction]]: vomiting, distension, prior surgery
	*~~'''~~[[Ruptured AAA]]~~'''~~: elderly, hypotensive, pulsatile abdominal mass		*[[Ruptured AAA]]: elderly, hypotensive, pulsatile abdominal mass
	*~~'''~~[[Diabetic ketoacidosis]]~~'''~~: may present with severe abdominal pain as chief complaint		*[[Diabetic ketoacidosis]]: may present with severe abdominal pain as chief complaint

	==Evaluation==		==Evaluation==
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	*[[Urinalysis]]		*[[Urinalysis]]
	*Urine pregnancy test (females of reproductive age)		*Urine pregnancy test (females of reproductive age)
	*~~'''~~[[Lactate]]~~'''~~: elevated in mesenteric ischemia, sepsis, shock		*[[Lactate]]: elevated in mesenteric ischemia, sepsis, shock
	*[[ECG]]: rule out MI in older patients (can present as epigastric/diffuse abdominal pain)		*[[ECG]]: rule out MI in older patients (can present as epigastric/diffuse abdominal pain)
	*Blood gas: metabolic acidosis (ischemia, DKA, toxic ingestion)		*Blood gas: metabolic acidosis (ischemia, DKA, toxic ingestion)
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	===Imaging===		===Imaging===
	*~~'''~~[[CT abdomen pelvis]]~~'''~~ with IV contrast: most useful single test for diffuse abdominal pain (identifies obstruction, perforation, ischemia, abscess, appendicitis)		*[[CT abdomen pelvis]] with IV contrast: most useful single test for diffuse abdominal pain (identifies obstruction, perforation, ischemia, abscess, appendicitis)
	*~~'''~~Upright [[CXR]]~~'''~~ or abdominal X-ray: free air under diaphragm (perforation), air-fluid levels (obstruction)		*Upright [[CXR]] or abdominal X-ray: free air under diaphragm (perforation), air-fluid levels (obstruction)
	*~~'''~~[[POCUS]]~~'''~~: free fluid, AAA, hydronephrosis, gallbladder		*[[POCUS]]: free fluid, AAA, hydronephrosis, gallbladder
	*~~'''~~CT angiography~~'''~~: if mesenteric ischemia suspected		*CT angiography: if mesenteric ischemia suspected
	*~~'''~~KUB (abdominal X-ray)~~'''~~: obstruction pattern, foreign body		*KUB (abdominal X-ray): obstruction pattern, foreign body

	==Management==		==Management==
	*IV access, fluid resuscitation		*IV access, fluid resuscitation
	*~~'''~~Analgesia~~'''~~: appropriate pain control does NOT mask important findings and should not be withheld — opioids may actually improve physical exam by allowing patient to cooperate		*Analgesia: appropriate pain control does NOT mask important findings and should not be withheld — opioids may actually improve physical exam by allowing patient to cooperate
	*NPO if surgical abdomen suspected		*NPO if surgical abdomen suspected
	*NG tube for decompression in obstruction with vomiting		*NG tube for decompression in obstruction with vomiting
	*~~'''~~Emergent surgical consultation~~'''~~ for: peritonitis, free air, suspected mesenteric ischemia, ruptured AAA, SBO with signs of strangulation		*Emergent surgical consultation for: peritonitis, free air, suspected mesenteric ischemia, ruptured AAA, SBO with signs of strangulation
	*Broad-spectrum IV antibiotics if perforation, peritonitis, or intra-abdominal sepsis suspected		*Broad-spectrum IV antibiotics if perforation, peritonitis, or intra-abdominal sepsis suspected
	*Treat metabolic cause (DKA, adrenal crisis) if identified		*Treat metabolic cause (DKA, adrenal crisis) if identified

Danbot: Expanded with EM-focused content: must-not-miss diagnoses, red flags, evaluation strategy, pain management guidance, disposition

2026-03-20T23:43:18Z

Expanded with EM-focused content: must-not-miss diagnoses, red flags, evaluation strategy, pain management guidance, disposition

← Older revision		Revision as of 23:43, 20 March 2026
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	~~<languages/>~~
	~~<translate>~~

	==Background==		==Background==
			*Diffuse (generalized) abdominal pain suggests a process affecting multiple quadrants or a non-localizing etiology
	~~</translate>~~		*Key EM concern: diffuse pain with peritoneal signs suggests perforation, mesenteric ischemia, or diffuse peritonitis — all surgical emergencies
			*Diffuse pain may also represent early appendicitis (before localizing to RLQ), early small bowel obstruction, or extra-abdominal causes
			*Consider metabolic and extra-abdominal sources (DKA, uremia, adrenal crisis)
	{{Abdominal pain location}}		{{Abdominal pain location}}
	~~<translate>~~


	==Clinical Features==		==Clinical Features==
			===History===
			*Onset, character, duration, progression
			*Associated symptoms: nausea/vomiting, diarrhea/constipation, fever, last bowel movement/flatus
			*Prior abdominal surgeries (adhesive small bowel obstruction)
			*Medications: NSAIDs, anticoagulants, immunosuppressants
			*Medical history: diabetes (DKA), atrial fibrillation (mesenteric ischemia), vascular disease
			*Social history: alcohol use, recent travel

	*~~Diffuse abdominal pain~~		===Physical Exam===
			*Assess for peritoneal signs: rigidity, rebound tenderness, guarding, involuntary guarding
			*Abdominal distension (obstruction, ileus, ascites)
			*Bowel sounds: absent (ileus, late obstruction), high-pitched/tinkling (early obstruction)
			*Hernial orifices (incarcerated hernia)
			*Rectal exam: occult blood, rectal mass
			*Skin: jaundice, rash (vasculitis), livedo reticularis

			===Red Flags===
			*Hemodynamic instability
			*Rigid abdomen (peritonitis — surgical emergency)
			*Diffuse pain out of proportion to exam (mesenteric ischemia — "pain out of proportion")
			*Free air on imaging (perforation)
			*Metabolic acidosis with diffuse pain (ischemia, DKA, toxic ingestion)
			*Immunocompromised patient with abdominal pain (broad differential, atypical presentations)

	==Differential Diagnosis==		==Differential Diagnosis==

	~~</translate>~~
	{{Abdominal Pain DDX Diffuse}}		{{Abdominal Pain DDX Diffuse}}
	~~<translate>~~

	~~</translate>~~
	{{Extra-abdominal sources of abdominal pain DDX}}		{{Extra-abdominal sources of abdominal pain DDX}}
	~~<translate>~~

			===Must Not Miss===
			*'''[[Mesenteric ischemia]]''': elderly, atrial fibrillation, pain out of proportion to exam
			*'''Perforated viscus''': free air, peritonitis
			*'''[[Small bowel obstruction]]''': vomiting, distension, prior surgery
			*'''[[Ruptured AAA]]''': elderly, hypotensive, pulsatile abdominal mass
			*'''[[Diabetic ketoacidosis]]''': may present with severe abdominal pain as chief complaint

	==Evaluation==		==Evaluation==
			===Laboratory===
			*[[CBC]], [[BMP]]
			*[[LFTs]], lipase
			*[[Urinalysis]]
			*Urine pregnancy test (females of reproductive age)
			*'''[[Lactate]]''': elevated in mesenteric ischemia, sepsis, shock
			*[[ECG]]: rule out MI in older patients (can present as epigastric/diffuse abdominal pain)
			*Blood gas: metabolic acidosis (ischemia, DKA, toxic ingestion)
			*[[Lipase]]: pancreatitis
			*Blood cultures if febrile
			*Stool guaiac

			===Imaging===
	===~~Workup~~===		*'''[[CT abdomen pelvis]]''' with IV contrast: most useful single test for diffuse abdominal pain (identifies obstruction, perforation, ischemia, abscess, appendicitis)
			*'''Upright [[CXR]]''' or abdominal X-ray: free air under diaphragm (perforation), air-fluid levels (obstruction)
	*CBC		*'''[[POCUS]]''': free fluid, AAA, hydronephrosis, gallbladder
	*Chem		*'''CT angiography''': if mesenteric ischemia suspected
	*[[~~Special:MyLanguage/LFTs\|LFTs~~]]		*'''KUB (abdominal X-ray)''': obstruction pattern, foreign body
	*Lipase
	*Coags
	*[[Special:~~MyLanguage/Urinalysis\|Urinalysis]]~~
	*Urine pregnancy (~~female~~)
	*[[~~Special:MyLanguage/ECG\|ECG~~]] (~~>40 yo~~)
	*~~Guaiac~~
	*?[[~~Special:MyLanguage/Lactate\|Lactate~~]]
	*?CT ~~abd/pelvis~~


	~~===Diagnosis===~~


	==Management==		==Management==
			*IV access, fluid resuscitation
	*~~Treat underlying disease process~~		*'''Analgesia''': appropriate pain control does NOT mask important findings and should not be withheld — opioids may actually improve physical exam by allowing patient to cooperate
	*~~[[Special~~:~~MyLanguage/Opioid\|Opioid]]~~ pain ~~medication (e.g. [[Special:MyLanguage/morphine\|morphine]])~~ may improve ~~localization of~~ physical exam		*NPO if surgical abdomen suspected
			*NG tube for decompression in obstruction with vomiting
			*'''Emergent surgical consultation''' for: peritonitis, free air, suspected mesenteric ischemia, ruptured AAA, SBO with signs of strangulation
			*Broad-spectrum IV antibiotics if perforation, peritonitis, or intra-abdominal sepsis suspected
			*Treat metabolic cause (DKA, adrenal crisis) if identified

	==Disposition==		==Disposition==
			*Admit: peritonitis, bowel obstruction, mesenteric ischemia, perforation, intra-abdominal abscess, pancreatitis requiring IV management, GI bleeding with hemodynamic changes
	*~~Disposition per underlying disease process~~		*Observation: undifferentiated abdominal pain with concerning features but negative initial workup — serial exams
			*Discharge: benign etiology identified, pain resolving, tolerating oral intake, reliable follow-up in 24-48 hours
			*Return precautions: worsening pain, vomiting, fever, inability to eat/drink, blood in stool

	==See Also==		==See Also==
			*[[Abdominal Pain]]
	*[[~~Special:MyLanguage/Abdominal Pain\|~~Abdominal Pain]]		*[[Abdominal Pain (Peds)]]
	*[[~~Special:MyLanguage/Abdominal Pain (Peds)\|~~Abdominal Pain (Peds)]]		*[[Mesenteric ischemia]]
			*[[Small bowel obstruction]]

	==External Links==		==External Links==


	==References==		==References==

	<references/>		<references/>

	[[Category:GI]]		[[Category:GI]]
	[[Category:Symptoms]]		[[Category:Symptoms]]
	~~</translate>~~

Ostermayer: Prepared the page for translation

2026-01-04T22:48:09Z

Prepared the page for translation

← Older revision		Revision as of 22:48, 4 January 2026
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			<languages/>
			<translate>

	==Background==		==Background==

			</translate>
	{{Abdominal pain location}}		{{Abdominal pain location}}
			<translate>


	==Clinical Features==		==Clinical Features==

	*Diffuse abdominal pain		*Diffuse abdominal pain


	==Differential Diagnosis==		==Differential Diagnosis==

			</translate>
	{{Abdominal Pain DDX Diffuse}}		{{Abdominal Pain DDX Diffuse}}
			<translate>

			</translate>
	{{Extra-abdominal sources of abdominal pain DDX}}		{{Extra-abdominal sources of abdominal pain DDX}}
			<translate>


	==Evaluation==		==Evaluation==


	===Workup===		===Workup===

	*CBC		*CBC
	*Chem		*Chem
	*[[LFTs]]		*[[Special:MyLanguage/LFTs\|LFTs]]
	*Lipase		*Lipase
	*Coags		*Coags
	*[[Urinalysis]]		*[[Special:MyLanguage/Urinalysis\|Urinalysis]]
	*Urine pregnancy (female)		*Urine pregnancy (female)
	*[[ECG]] (>40 yo)		*[[Special:MyLanguage/ECG\|ECG]] (>40 yo)
	*Guaiac		*Guaiac
	*?[[Lactate]]		*?[[Special:MyLanguage/Lactate\|Lactate]]
	*?CT abd/pelvis		*?CT abd/pelvis


	===Diagnosis===		===Diagnosis===


	==Management==		==Management==

	*Treat underlying disease process		*Treat underlying disease process
	*[[Opioid]] pain medication (e.g. [[morphine]]) may improve localization of physical exam		*[[Special:MyLanguage/Opioid\|Opioid]] pain medication (e.g. [[Special:MyLanguage/morphine\|morphine]]) may improve localization of physical exam


	==Disposition==		==Disposition==

	*Disposition per underlying disease process		*Disposition per underlying disease process


	==See Also==		==See Also==
	*[[Abdominal Pain]]
	*[[Abdominal Pain (Peds)]]		*[[Special:MyLanguage/Abdominal Pain\|Abdominal Pain]]
			*[[Special:MyLanguage/Abdominal Pain (Peds)\|Abdominal Pain (Peds)]]


	==External Links==		==External Links==


	==References==		==References==

	<references/>		<references/>

	[[Category:GI]]		[[Category:GI]]
	[[Category:Symptoms]]		[[Category:Symptoms]]
			</translate>

Rossdonaldson1: /* Diagnosis */

2024-02-01T00:41:31Z

Diagnosis

← Older revision		Revision as of 00:41, 1 February 2024
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	*?CT abd/pelvis		*?CT abd/pelvis

	==Diagnosis==		===Diagnosis===

	==Management==		==Management==

Rossdonaldson1: /* Evaluation */

2024-02-01T00:41:19Z

Evaluation

← Older revision		Revision as of 00:41, 1 February 2024
Line 24:		Line 24:
	*?[[Lactate]]		*?[[Lactate]]
	*?CT abd/pelvis		*?CT abd/pelvis

			==Diagnosis==

	==Management==		==Management==

Rossdonaldson1: /* Clinical Features */

2024-02-01T00:41:03Z

Clinical Features

← Older revision		Revision as of 00:41, 1 February 2024
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	==Clinical Features==		==Clinical Features==
			*Diffuse abdominal pain

	==Differential Diagnosis==		==Differential Diagnosis==

Rossdonaldson1: /* Background */

2024-02-01T00:40:52Z

Background

← Older revision		Revision as of 00:40, 1 February 2024
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	==Background==		==Background==

			{{Abdominal pain location}}

	==Clinical Features==		==Clinical Features==

ClaireLewis: /* Evaluation */

2019-09-29T20:20:56Z

Evaluation

← Older revision		Revision as of 20:20, 29 September 2019
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	*CBC		*CBC
	*Chem		*Chem
	*LFTs		*[[LFTs]]
	*Lipase		*Lipase
	*Coags		*Coags
Line 19:		Line 19:
	*[[ECG]] (>40 yo)		*[[ECG]] (>40 yo)
	*Guaiac		*Guaiac
	*?Lactate		*?[[Lactate]]
	*?CT abd/pelvis		*?CT abd/pelvis

Rossdonaldson1 at 17:12, 27 June 2017

2017-06-27T17:12:58Z

← Older revision		Revision as of 17:12, 27 June 2017
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	{{Extra-abdominal sources of abdominal pain DDX}}		{{Extra-abdominal sources of abdominal pain DDX}}

	==Workup==		==Evaluation==
			===Workup===
	*CBC		*CBC
	*Chem		*Chem

ClaireLewis: /* References */

2016-10-29T17:04:07Z

References

← Older revision		Revision as of 17:04, 29 October 2016
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	[[Category:GI]]		[[Category:GI]]
			[[Category:Symptoms]]