Buikpijn/misselijkheid/diarree

Linkerbovenkwadrant

• Splenomegalie (Pain or discomfort in LUQ, left shoulder pain, and/or early satiety. )

• Miltinfarct (Severe LUQ pain. )

• Miltabces (Associated with fever and LUQ tenderness. )

• Miltruptuur (May complain of LUQ, left chest wall, or left shoulder pain that is worse with inspiration. )

• Nierstenen

Rechterbovenkwadrant

Biliair

• Galsteenkoliek (Intense, dull discomfort located in the RUQ or epigastrium. Associated with nausea, vomiting, and diaphoresis. Generally lasts at least 30 minutes, plateauing within one hour. Benign abdominal examination.)

• Acute cholecystitis (Prolonged (>4 to 6 hours) RUQ or epigastric pain, fever. Patients will have abdominal guarding and Murphy's sign.)

• Acute cholangitis (Fever, jaundice, RUQ pain.)

• Sphincter van Oddi dysfunctie (RUQ pain similar to other biliary pain.)

Lever

• Acute hepatitis (RUQ pain with fatigue, malaise, nausea, vomiting, and anorexia. Patients may also have jaundice, dark urine, and light-colored stools. )

• Perihepatitis/Fitz-Hugh-Curtis (RUQ pain with a pleuritic component, pain is sometimes referred to the right shoulder. )

• Leverabces (Fever and abdominal pain are the most common symptoms.)

• Budd-Chiari (Symptoms include fever, abdominal pain, abdominal distention (from ascites), lower extremity edema, jaundice, gastrointestinal bleeding, and/or hepatic encephalopathy.)

• Portatrombose (Symptoms include abdominal pain, dyspepsia, or gastrointestinal bleeding.)

• Nierstenen

Onderbuikspijn

• Appendictis (vaak ROQ; Periumbilical pain initially that radiates to the right lower quadrant. Associated with anorexia, nausea, and vomiting.)

• Diverticulitis (vaak LOQ; vaker ROQ in Aziaten; Pain usually constant and present for several days prior to presentation. May have associated nausea and vomiting.)

• Nefrolithiasis (Pain most common symptom, varies from mild to severe. Generally flank pain, but may have back or abdominal pain.)

• Pyelonefritis (Associated with dysuria, frequency, urgency, hematuria, fever, chills, flank pain, and costovertebral angle tenderness. )

• Acute blaasretentie (suprapubisch; Present with lower abdominal pain and discomfort; inability to urinate)

• Cystitis (suprapubisch; Associated with dysuria, frequency, urgency, and hematuria.)

• Infectieuze colitis (Diarrhea as the predominant symptom, but may also have associated abdominal pain, which may be severe.)

• Ureterobstructie (Acute onset, manifests within hours. Pain is lateral, usually moderate to severe. Often radiates into the groin or costovertebral angle or flank )

• Beklemde navel-/buikwand-/liesbreuk

• Geruptureerd aneurysma aortae abdominale (AAAA)

Vrouwen

• EUG (Classically severe, sharp, lateral pelvic pain, but severity, location, and quality highly variable; Vaginal bleeding (often spotting or light, but can be absent)

• Geruptureerde ovariumcyste (Abrupt moderate to severe lateral pelvic pain.)

• Ovariumtorsie (Acute onset of moderate to severe lateral pain)

• Pelvic inflammatory disease (Without TOA, pain is usually bilateral; may manifest acutely within 48 hours, but PID may also be chronic)

• Ovariumvenetrombose (Pain localizes to the side of the affected vein (usually the right) but can be felt in the flank or back)

• Septische bekkentromboflebitis (Intermittent or mild abdominopelvic pain)

Pijn in epigastrio

• Acuut coronair syndroom (May be associated with shortness of breath and exertional symptoms. Also nausea and sweating.)

• Acute pancreatitis (Acute-onset, persistent upper abdominal pain radiating to the back.)

• Chronic pancreatitis (Epigastric pain radiating to the back.)

• Ulcuslijden (Epigastric pain or discomfort is the most prominent symptom.)

• Reflux (Associated with heartburn, regurgitation, and dysphagia.)

• Gastritis/gastropathy (Abdominal discomfort/pain, heartburn, nausea, vomiting, and hematemesis.)

• Functional dyspepsia (The presence of one or more of the following: postprandial fullness, early satiation, epigastric pain, or burning.)

• Gastroparesis (Nausea, vomiting, abdominal pain, early satiety, postprandial fullness, and bloating.)

Diffuse buikpijn

• Darmobstructie/ileus/volvulus (Most common symptoms are nausea, vomiting, crampy abdominal pain, and obstipation. Distended, tympanic abdomen with high-pitched or absent bowel sounds.)

• Maag-/darmperforatie (Severe abdominal pain, particularly following procedures.)

• Acute darmischemie (Acute and severe onset of diffuse and persistent abdominal pain, often described as pain out of proportion to examination.)

• Chronische darmischemie (Abdominal pain after eating ("intestinal angina"), weight loss, nausea, vomiting, and diarrhea.)

• Inflammatory bowel disease (Associated with bloody diarrhea, urgency, tenesmus, bowel incontinence, weight loss, and fevers. )

• Virale gastroenteritis (Diarrhea accompanied by nausea, vomiting, and abdominal pain.)

• Spontane bacteriële peritonitis (Fever, abdominal pain, and/or altered mental status.)

• Dialyse-gerelateerde peritonitis (Abdominal pain and cloudy peritoneal effluent. Other symptoms and signs include fever, nausea, diarrhea, abdominal tenderness, and rebound tenderness.)

• Colorectaal carcinoom (Variable presentation, including obstruction and perforation.)

• Andere malignieiten (Vary depending on malignancy.)

• Coeliakie (Abdominal pain in addition to including diarrhea with bulky, foul-smelling, floating stools due to steatorrhea and flatulence.)

• Ketoacidose (Diffuse abdominal pain and nausea and vomiting.)

• Bijnierschorsinsufficiëntie (Diffuse abdominal pain and nausea and vomiting.)

• Voedselvergiftiging (Mixture of nausea, vomiting, fever, abdominal pain and diarrhea. )

• Prikkelbaredarmsyndroom (Chronic abdominal pain with altered bowel habits.)

• Obstipatie

• Diverticulose (May have symptoms of abdominal pain and constipation.)

• Lactoseintolerantie (Associated with abdominal pain, bloating, flatulence, and diarrhea. Abdominal pain may be cramping in nature.)

• Invaginatie

• FMF

• TRAPS

• Porphyria

• Loodintoxicatie

Diarree

• Definitie: abnormale vloeibare of ongevormde ontlasting in toegenomen freuentie (vaak >200 g/dag).

• Acuut (<2 weken), persisterend (2-4 weken) of chronisch (>4 weken).

• Onderscheid diarree van pseudodiarree (frequente kleine beetjes ontlasting zoals bv. bij IBS), fecale incontinentie en overloopdiarree.

• Anamnese: duur van klachten, frequentie, consistentie, hoeveelheid, bloed, slijm, buikpijn, koorts, recent antibioticagebruik, tekenen dehydratie, immuungecompromitteerd, invloed op dagelijkse activiteiten, nachtelijke diarree en/of diarree na >12 uur vasten, invloed voedsel op diarree, reisanamnese, gewichtsverlies

• Mogelijk ernstig indien: ≥6x ontlasting per 24h, tekenen dehydratie, koorts, hevige abdominale pijn, bloederige diarree (cave ischemie), hoge leeftijd, comorbiditeit (hartfalen, immuungecompromitteerd)

Acute diarree (<2 weken)

• Infectieus (~90%): bacterieel, viraal, parasitair, toxine

• Medicamenteus: chemotherapie, antibiotica, laxantia, anti-arritmica, antihypertensiva, NSAID, antidepressiva, antacida

• Intoxicatie: cholinerg syndroom

• Vasculair: darmischemie

• Overig: graft-versus-host disease, diverticulitis, anafylaxie, vroege presentatie van chronische diarree