Acu t e Abdom in al Pain in Adu lt s In it ial Clin ical Diagn osis

ABBREVIATIONS:
Adult patient with acute
LLQ: left lower quadrant
(up to 7 days) abdominal pain
RLQ: right lower quadrant
RUQ: right upper quadrant

Does Is
patient have patient older,
unstable vital signs or No immunocompromised, No
peritoneal or pregnant?
signs?

Yes Yes

Urgent evaluation for: Urgent evaluation for:

- Peritonitis - Atypical presentation of
- Abdominal aortic infection
aneurysm - Pregnancy-related
- Perforated viscus complications
Migration of pain
- Ectopic pregnancy
from periumbilical Suggests acute appendicitis
region to RLQ

Note that abdominal pain Episodic

Evaluate pain location may be due to gnawing/burning
for potential organ or extra-abdominal causes pain that awakens Suggests peptic ulcer disease
structure involved such as myocardial patient at night, or acute gastritis
infarction or pneumonia relieved by
antacids

Epigast r iu m , Per iu m bilical Su pr apu bic An t er ior Nausea, Suggests acute gastritis or
RUQ Possibly midgut Possible hindgut abdom en or vomiting, peptic ulcer disease, possibly
Possible foregut structures such structures such gr oin epigastric pain acute pancreatitis
structure as small bowel, as bladder, distal Retroperitoneal
(stomach, proximal two-thirds of structure pain
pancreas, liver, one-third of colon, pelvic radiating from Epigastric pain
biliary, proximal colon, pelvic genitourinary aorta, kidneys radiating to
duodenum) genitourinary organs back with Suggests acute pancreatitis
organs nausea and
vomiting

Postprandial Suggests biliary Note:

Assess physical examination, Usually localizes Ascending
pain RUQ colic
looking for diagnostic clues to back or flank cholangitis
may present
with Charcot
RUQ pain triad of fever,
Suggests acute
with Murphy jaundice, RUQ
cholecystitis pain, or
Patient lying Pelvic or rectal sign
Patient Fever, Tachycardia, Reynolds
very still and exam revealing
unable to suggesting hypotension, or pentad (triad +
having tenderness,
lie still or infection orthostasis, shock and
rebound suggesting Severe loin Suggests mental status
preferring suggesting
tenderness, pelvic organ or to groin symptomatic change)
to stand, hypovolemia,
guarding, or adjacent pain nephrolithiasis
suggesting sepsis, or
rigidity, structure
renal colic perforated
suggesting involvement
viscus
peritonitis
Suprapubic
Suggests acute
pain/tenderness,
cystitis or
flank pain, urinary
pyelonephritis
symptoms
Evaluate for characteristic
clinical syndromes
Suggests
LLQ pain
diverticulitis

Abdominal
distension,
Suggests bowel obstruction
colicky pain,
constipation

Severe abdominal
pain out of Suggests acute mesenteric
proportion to ischemia or perforated viscus
tenderness

REFERENCES: Emerg Med Clin North Am. 2016 May;34(2):165?190 - Int JGen Med. 2012;5:789?797
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