Cause | Diagnostic clue |
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Appendicitis Acute Appendicitis | Common. Laboratory parameters indicating acute inflammation usually increased, but not necessarily yet in the initial phase. A prolonged history of the condition is often associated with a periappendicular abscess. |
Intestinal obstruction | Surgical scars, hernias, possible malignancy. Initially undulating pain; development of strangulation: a suspicion of this is an indication for surgery. |
Perforated peptic ulcer | Acute onset, peritonism. Often the first symptom of peptic ulcer disease. Pain starts in the upper abdomen. |
Acute cholecystitis Cholelithiasis | Colicky pain in the right costal arch, clear tenderness on palpation, clinical manifestations of an infection. Ultrasonography. Pain becomes constant as the cholecystitis progresses. Often the first symptom of gallstone disease. |
Acute pancreatitis Acute Pancreatitis | History of alcohol consumption. Consider gallstones as possible aetiology. Urine and serum amylase may be normal in chronic or recurrent cases. |
Mesenterial thrombosis | May be difficult to diagnose on the basis of clinical manifestations; often resembles strangulation. Clear peritonitis is initially absent but the patient is obviously ill. The patient usually has atrial fibrillation or some other cardiovascular disease. |
Complicated diverticulitis of the colon Diverticulitis and Diverticulosis | The most common site is the sigmoid colon. Peritonitis or abscess, clear local tenderness, low-grade fever and increased inflammation parameters. Ileus and intestinal bleeding are possible. |
Volvulus | Sigma is the most common site. Symptoms of intestinal obstruction (risk for perforation!). Plain abdominal X-ray is diagnostic. Volvulus of the caecum develops more slowly. |
Testis torsion | The testis is tender on palpation. Often pain and tenderness in lower abdomen. Doppler ultrasonography. In an unclear case, explorative surgery should be readily performed. |
Cause | Diagnostic clues/examples |
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Ectopic pregnancy Ectopic Pregnancy | Pain; referred pain in shoulder. Urine pregnancy test may be negative, sensitive serum test is usually positive. |
Ovarian origin | Ovulation pain, oophoritis, ruptured cyst, torsion of a cyst. The aetiology of acute lower abdominal pain in a young woman is often revealed on laparoscopy. |
Myoma | Torsion; necrosis; bleeding into the abdominal cavity, infection |
Endometriosis Endometriosis | Menstrual pain |
Cause | Example |
---|---|
Metabolic disorders | Diabetic ketoacidosis Diabetic Ketoacidosis Porphyria Porphyrias Hypertriglyceridaemia (pancreatitis) Hyperparathyroidism (pancreatitis) Hypercalcaemia and Hyperparathyroidism Uraemia Pain conditions associated with haematological diseases Haemochromatosis Haemochromatosis Addisonian crisis Mushroom and heavy metal poisonings |
Infectious causes | Gastroenteritis Diverticulitis Diverticulitis and Diverticulosis Inflammatory bowel disease (IBD; Crohn's Disease Ulcerative Colitis Hepatitis Viral Hepatitis Perihepatitis Mononucleosis Mononucleosis Herpes zoster Shingles (Herpes Zoster) Pyelonephritis Prostatitis, epididymitis, orchitis Sepsis Sepsis |
Referred pain | Myocardial infarction Acute Coronary Syndrome and Myocardial Infarction Pericarditis Pneumonia Pneumonia Pleuritis Pulmonary infarction or embolism Pulmonary Embolism Spontaneous pneumothorax Pneumothorax Heart failure (hepatic stasis) Acute Heart Failure and Pulmonary Oedema Renal calculi Urinary Calculi Haematoma of the rectus abdominis muscle |
Immunological disorder | Angioneurotic oedema Hereditary Angioedema (HAE) and ACE Inhibitor-Induced Angioedema Polyarteritis nodosa Vasculitides Henoch-Schönlein purpura Henoch-Schönlein Purpura Hypersensitivity reaction Eosinophilic gastroenteritis, enteritis, colitis |