Abdominal pain differentials

• Severe sudden onset epigastric pain:

  • Leaking AAA
  • Aortic dissection
  • MI (inferior)
  • Perforated gastric/duodenal ulcer
  • Oesophageal rupture
  • Acute pancreatitis
• Epigastric pain:

  • Gastritis
  • Peptic ulcer
  • GORD/oesophagitis
  • Pancreatitis
  • Malignancy (gastric, pancreatic)
  • Boerhaave syndrome (oesophageal rupture)
  • Dyspepsia
  • Pain from nearby RUQ, central abdomen
  • MI
  • Basal pneumonia
• RUQ pain:

  • Gall bladder - colic, cholecystitis, cholangitis
  • Liver - hepatitis, hepatomegaly, haemorrhage or trauma, abscess, pre-eclampsia
  • Appendicitis with high appendix e.g. pregnancy
  • Perforated duodenal ulcer
  • Pain from nearby abdomen e.g. epigastric
  • Right basal pneumonia
  • Pyelonephritis
• Left hypochondrium pain:

  • Basal pneumonia
  • Ruptured spleen
• Flank pain:

  • Pyelonephritis
  • Renal/ureteric colic
  • Renal infarct
• Umbilical pain:

  • AAA
  • Acute pancreatitis
  • Gastroenteritis
  • Bowel obstruction
  • Ischaemia bowel
  • Testicular torsion
  • Early appendicitis
• RIF:

  • Appendicitis (late)
  • Mesenteric adenitis
  • Terminal ileitis (e.g. crohn's)
  • Perforated caeal carcinoma
  • Renal/ureteric colic
  • Ovarian cyst rupture/haemorrhage/torsion
  • Ectopic pregnancy
  • Salpingitis (inflammation of fallopian tubes)
  • Testicular torsion
• Suprapubic:

  • Cystitis/UTI
  • Urinary retention
  • Uterine fibroid
• LIF:

  • Diverticulitis
  • Constipation
  • Renal/ureteric colic
  • Sigmoid volvulus
  • Colitis (ischaemic, infective, ulcerative)
  • Ovarian cyst rupture/haemorrhage/torsion
  • Ectopic pregnancy
  • Salpingitis
  • Testicular torsion