Acute Generalized Abdominal Pain

Generalized = All OverxxxxPeriumbilical = Around the Umbilicus (belly-button)

Possible Causes of Acute Generalized / Periumbilical Abdominal Pain

xxxxCommon & Benign  

โ€ข Gastritis / Dyspepsia / GERD โ€ข Muscle Strain

x
x
x
x
xxxxRare & Catastrophic

โ€ข Bowel Obstruction
โ€ข Peritonitis / Ruptured Bowel
โ€ข Bowel Ischemia (loss of
xxcirculation)
โ€ข Aortic Aneurysm (ruptured)
โ€ข Strangulated Hernia
โ€ข Diabetic Ketoacidosis (DKA)  
xxxx  Keep In Mind  
โ€ข Early Appendicitis  


xxxShould NOT Diagnose
โ€ข
gastroenteritis

x
x

NOTE:  If Vomiting or Diarrhea are more significant than “pain”, refer to those symptom topics

FIRST — evaluate for Potentially Catastrophic Illness

1.  Send directly to ER if suspect Peritonitis or need for surgery:

  • Walks doubled-over in pain; Abdomen feels hard like a board when palpated
    • If it’s a Hernia, there’s a bulge is extremely tender to palpation
  • Fever
  • Nausea / Vomiting which began after the pain had already been going on
  • ER will do blood tests, images, maybe begin IV antibiotics, evaluate for surgery

2.  Also send to ER if suspect possible Aortic Aneurysm or Bowel Ischemia

  • Older patient with risks like hypertension, smoking, diabetes
  • Especially if pain began very abruptly
  • Pain seems much greater than when we palpate abdomen during exam
  • ER will do blood tests, images, evaluate for possible surgery

3.  Likely need extensive same-day work-up best done in ER

4. Diabetes with pain / vomiting needs rapid urinalysis to rule-out Ketoacidosis

  • If urine shows maximum level of “ketones” (not just a little), we send to ER by 911.

Then — If patient does not appear very ill, none of the above factors (the vast majority of patients will not appear ill)

a)  Maybe we do one or two simple tests  (which are usually normal)

b)  Trial of treatment for a Most Likely Diagnosis

c)  Warn to go to ER if pain increases, localizes in the RLQ, or nausea/vomiting develop

d)  Should NOT diagnose “gastroenteritis” if:

  • pain without vomiting / diarrhea
  • pain began first, before nausea / vomiting

See also Acute Generalized Abdominal Pain — Full Text for more in-depth explanations and discussions.

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