Abdominal pain

Abdominal pain is a common presentation in emergency and non-emergency settings. GI tract and related organs account for most of the cases, followed by kidneys, ureters, and reproductive organs (especially in females). Characteristics of pain like site, duration, radiation and shifting, and associated symptoms like vomiting, fever, diarhea or constipation help in establishing probable diagnosis.

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• Cholecystitis: Steady pain at right hypochondrium or epigastrium, radiating to right side of back or tip of shoulder. May be associated with fatty food dyspepsia. Murphy's sign may be positive.
• Pancreatitis: Constant pain, usually at epigastric region, relieved by sitting or bending forward and aggravated by lying down, movement and coughing. Usually radiates to the back. Culin and Grey-turner signs may be present. History of alcohol intake or gall stones.
• Peptic Ulcer: Dull, gnawing pain at epigastric region. In case of perforation, abdomen might be rigid and tender (peritonitis).
• Appendicitis: Migratory pain (from umbilicus to right iliac fossa) , anorexia , nausea/vomiting and raised temperature. Alvarado score is useful for clinical diagnosis. Pointing, Rowsing and Psoas signs may be positive.
• Peritonitis: Trauma, surgery, spreading inflammation from an abdominal organ or perforation of an abdominal viscera can all lead to peritonitis. Abdomen shows board like rigidity and patient prefers to lie still.
• Intestinal Obstruction: Periumbilical colicky pain, vomiting , abdominal distension and constipation are the cardinal symtoms.
• Infections: Acute gastroenteritis, Typhoid fever, Amoebiasis, Giardiasis etc.
• Other causes: Diverticulitis, Liver cyst, IBS, IBD
• Vascular: Superior mesenteric artery occlusion, ruptured aortic aneurysm, sickle cell disease.
• Referred Pain: Inferior MI, Basal Pneumonia, Testicular torsion.
• In Female: Mittelschmerz pain, Ectopic pregnancy, ovarian cyst (torsion or rupture), PID.
• Metabolic: Diabetic ketoacidosis, Porphyria, Uremia, Lead Poisoning.