Causes:
- RUQ: hepatitis, liver abscess, perihepatitis (Fitz-Hugh Curtis - gonococcal), cholecystitis, cholangitis, choledocholithiasis. Check for Charcot's triad and Reynold's pentad.
- RLQ: appendicitis, appendicular abscess, ovarian torsion, ruptured ovarian cyst, ovarian carcinoma.
- LUQ: splenic rupture, splenic infarct, splenic abscess, splenic flexure - colon obstruction.
- LLQ: diverticulitis, ischemic colitis, ovarian torsion, ruptured ovarian cyst, ovarian carcinoma.
- Epigastrium: MI, pericarditis, aortic dissection, AAA, pneumonia, pleurisy, subphrenic abscess, GERD, PUD, pancreatitis, pyelonephritis, renal colic.
- Hypogastrium: renal colic, psoas abscess, IBD, SBO, infectious gastroenteritis, ovarian torsion, ovarian cyst, ovarian carcinoma, ectopic pregnancy, salpingitis, endometriosis, cystitis, distended bladder
- Generalized abdominal pain: appendicitis, gastroenteritis, SBO, IBD, peritonitis, DKA, SCC, acute intermittent porphyria, acute adrenal insufficiency due to steroid withdrawal, mesenteric ischemia
- Major threat to life: perforated or ruptured viscus, ascending cholangitis, necrosis of viscus, AAA rupture - exsanguinating H'ge
**Abdominal pain in AIDS or immunosuppressed patient:
- Fever: take BC x 2
- Enteric inf: Cryptosporidium, Shigella, Salmonella, CMV, and Campylobacter enteritis.
- Even a Normal WBC count with slight left shift = poss. inf
- Neutopenic colitis (typhlitis) common.
- Drug induced pancreatitis from NRTIs
- Hepatic steatosis with lactic acidosis is rapidly fatal has ~50% mortality.
- HIV-infected Pts are at risk for non-Hodgkin's lymphoma in GI tract.
- Acalculous cholecystitis is common. Causes may include Cryptosporidium, CMV, or MAC inf.