embolus

Pulmonary: pneumonia, embolus Cardiac: ACS ;...=====---��-==::�

Periumbilical

I ntesti nal: early appendicitis, small bowel obstruction

vascular: AAA, aortic dissection, mesenteric ischemia

(

Right Lower Quadrant Suprapubic Left Lower Quadrant

Intesti nal: diverticulitis, colitis, IBD,

hernia

I Intestinal: appendicitis, col itis, I BD,

hernia

Intestinal: appendicitis, diverticul itis, colitis,

l BO, hernia

OB-GYN: ectopic pregnancy, PID, TOA,

ovarian torsion

OB-GYN: ectopic pregnancy, PID, TOA,

ovarian torsion

OB-GYN: ectopic pregnancy, PID, TOA,

ovarian torsion

1 GU: testicular torsion GU: testicular torsion GU: testicular torsion

l Renal: nephrolithiasis, pyelonephritis Renal: nephrolithiasis, pyelonephritis Renal: nephrolithiasis, pyelonephritis

Diffuse

Intestinal: bowel obstruction, early appendicitis, perforatio

vascular: aortic dissection, AAA, mesenteric ischemia

Peritonitis

Sickle cell crisis

Diabetic ketoacidosis

Black widow spider bite

AAA = abdominal aortic aneurysm; ACS = acute coronary syndrome; IBD = inflammatory bowel disease; PID = pelvic inflammatory

disease; PUD = peptic ulcer disease; TOA= tuba-ovarian abscess

Figure 26-1 . Causes of abdominal pain based on location.

grabbing the abdomen. Children can be asked to jump up

and down as an indirect means of inciting peritoneal irritation. In addition to signs of peritonitis, the physician

should examine for the presence of a pulsatile mass consistent with an aortic aneurysm.

A pelvic exam should be performed in women with

lower or undifferentiated abdominal pain to help separate a pelvic from abdominal source. Cervical motion

tenderness can be found with appendicitis, but the presence of a cervical mucopurulent discharge supports the

diagnosis of pelvic inflammatory disease. A genitourinary

exam (GU) in males should be performed to evaluate for

testicular disease, prostatitis, and hernias. Adolescents

with testicular torsion may only complain of abdominal

pain making a systematic GU exam paramount to timely

diagnosis.

DIAGNOSTIC STUDIES

...... Laboratory

Complete blood count. Although leukocytosis may alert

the physician that the patient is sicker than initially

perceived, the white blood cell count (WBC) must be used

with caution. A normal WBC does not exclude serious

infection, and an elevated WBC can be seen in many

benign conditions. Overall, the WBC is a poor predictor of

disease and should not replace clinical judgment.

Electrolytes and glucose. It is important to correct any

electrolyte derangement that can occur in the setting of

fluid losses from excessive vomiting or diarrhea. Conversely,