Generalized = All OverxxxxPeriumbilical = Around the Umbilicus (belly-button)
Possible Causes of Acute Generalized / Periumbilical Abdominal Pain
| xxxxCommon & Benign โข Gastritis / Dyspepsia / GERD โข Muscle Strain x x x x | xxxxRare & Catastrophic โข Bowel Obstruction โข Peritonitis / Ruptured Bowel โข Bowel Ischemia (loss of xxcirculation) โข Aortic Aneurysm (ruptured) โข Strangulated Hernia โข Diabetic Ketoacidosis (DKA) | xxxx Keep In Mind โข Early Appendicitis xxxShould NOT Diagnose โข “gastroenteritis“ x x |
NOTE:ย 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
- Immunocompromised (persons with weak immune systems)
- Severely mentally ill
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)
- Urinalysis — for Urinary Tract Infection, or new diagnosis of Diabetes (without ketoacidosis)
- X-Ray only if we wonder about possible early Bowel Obstruction (history of previous abdominal surgery or radiation treatment; vomiting began after pain; abnormal bowel sounds on our exam)
b) Trial of treatment for a Most Likely Diagnosis:
- Especially if also feels bloating โ Gastritis / Dyspepsia / GERD (all get helped by the same antacid medicines)
- If most tender to palpation when flexing abs (like doing a sit-up) โ Muscle Strain
c) Warn to go to ER if pain increases, localizes in the RLQ, or nausea/vomiting develop
- Could be Early Appendicitis
- If patient goes to ER, DO NOT EAT / DRINK anything on the way
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.