Clinical features
Comment(s)
Epigastric pain
Acute myocardial infarction
May be associated with shortness of breath and exertional symptoms
Elderly patient with risk factors for coronary artery disease. EKG may be consistent for ST elevation myocardial infarction
Acute pancreatitis
Acute onset, severe epigastric pain radiating to the back
Associated with elevated lipase acutely
Chronic pancreatitis
Epigastric pain radiating to the back. Calcifications and atrophy may be seen on imaging
Associated with pancreatic insufficiency. Some may have diabetes. Lipase may not be elevated in cases of chronic pancreatitis
Peptic ulcer disease
Persistent, sharp stabbing pain. Usually associated with food intake
Associated with NSAID use, H. pylori infection
Gastroesophageal reflux disease
Heartburn, usually associated with food intake
Gastritis/gastropathy
Abdominal discomfort/pain, heartburn, nausea, vomiting, and hematemesis
Variety of etiologies including alcohol, NSAIDs, H. pylori
Gastroparesis
Nausea, vomiting, abdominal pain, early satiety, postprandial fullness, and bloating
Most causes are idiopathic, due to diabetes, hypothyroidism, or postsurgical in nature. Also seen in Parkinson’s disease
Left upper quadrant pain
Splenomegaly
Pain may radiate to left shoulder. May have palpable spleen on examination
Multiple etiologies
Splenic infarct
Severe LUQ pain. Splenomegaly
Associated with hypercoagulable states and embolism
Splenic abscess
Associated with fever and LUQ tenderness
Common complication after splenic infarction
Splenic rupture
May complain of LUQ, left chest wall, or left shoulder pain that is worse with inspiration
Most often associated with trauma
Right upper quadrant pain
Biliary colic
Intermittent, intense, dull discomfort
Associated with gall bladder or biliary disease
Acute cholecystitis
Intense pain and sometimes with fever. May have a (+) Murphy’s sign
May see pericholecystic fluid and gallstones on ultrasound
Acute cholangitis
Fever, jaundice, RUQ pain
Associated with biliary duct infection or obstruction. Patients are typically very ill
Sphincter of Oddi dysfunction
Intermittent biliary-type pain. May occasionally have elevated lipase and amylase
Biliary-type pain without other apparent causes
Acute hepatitis
RUQ pain with fatigue, malaise, nausea, vomiting, and anorexia. Patients may also have jaundice
Variety of etiologies include hepatitis A, alcohol, and drug induced
Perihepatitis (Fitz-Hugh-Curtis syndrome)
Pain associated with coughing or breathing. Referred pain to the right shoulder
Usually in women with gonorrhea or chlamydia infection
Liver abscess
Fever and abdominal pain. Transaminitis is common
Risk factors include diabetes, underlying hepatobiliary or pancreatic disease, or liver transplant
Budd-Chiari syndrome
Associated with signs of portal hypertension, without cirrhosis. Hepatosplenomegaly
From occlusion of the hepatic vein
Portal vein thrombosis
Associated with signs of portal hypertension
Most commonly associated with cirrhosis
Lower abdominal pain
Appendicitis
Severe, mostly localized RLQ pain. Associated with leukocytosis, anorexia, vomiting
Emergent surgical evaluation is necessary
Diverticulitis
Constant pain, common in the LLQ (sigmoid colon)
Inflammation of a diverticulum
Epiploic appendagitis
Acute or subacute abdominal pain
Benign and self-limited condition of epiploic appendages
Nephrolithiasis
Severe flank pain, but may have back, flank, or abdominal pain
Causes symptoms as stone passes from renal pelvis to ureter. Pain may shift from flank to groin
Pyelonephritis
Associated with dysuria, frequency, urgency, hematuria, fever, chills, flank pain, and costovertebral angle tenderness
Associated with pyuria. Computed tomography may show inflammatory stranding around the affected kidney
Acute urinary retention
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