
Abdominal Pain
Rapid Review
- Differentials
- Gastrointestinal
- Pancreatitis
- Hepatitis
- Gastritis
- Peptic Ulcer Disease
- Cholecystitis
- Chiledocholithiasis
- Cholangitis
- Diverticulitis
- Crohn’s disease
- Ulcerative colitis
- Bowel obstruction
- Hernia
- Constipation
- Vascular
- Mesenteric ischemia
- Ischemic colitis
- Renal/Urinary
- Pyelonephritis
- Urinary tract infection
- Urologic
- Testicular torsion
- Epididymitis
- Gynecologic
- Pelvic inflammatory disease
- Ovarian torsion
- Ovarian cyst rupture
- Endometriosis
- Uterine fibroid
- Referred pain
- ACS
- Pulmonary embolism
- Pneumonia
- Gastrointestinal
- History
- Which region does the pain hurt most
- Differentials vary based on location
- Fever/chills
- Suggests infectious process
- Urinary symptoms
- Suggests pyelonephritis, cystitis, nephrolithiasis
- Melena/hematochezia
- Consider GI bleed
- Alcohol use
- Consider hepatitis or pancreatitis
- Exacerbated or relieved with foods
- Consider gastric or duodenal ulcers
- Hx of unprotected sex or recent STI
- Consider PID
- Which region does the pain hurt most
- Physical Exam
- Murphy’s sign
- Suggests biliary process
- Rigid abdomen
- Suggests peritonitis
- Rebound Tenderness/Rovsing’s/Obturator/Psoas Signs
- Suggests appendicitis
- CVA tenderness
- Suggests pyelonephritis or nephrolithiasis
- Murphy’s sign
- Work-Up
- Labs
- CBC, CMP, Lipase
- Lactate (if suspect mesenteric ischemia, sepsis, strangulated hernia)
- Imaging
- Abdominal X-ray
- RUQ ultrasound
- CT abdomen/pelvis
- Labs
Pearls

Constipation
Rapid Review
- Differentials
- Mechanical obstruction
- Stricture (colon, rectum, anus)
- Volvulus
- Hernia
- Neoplasm
- Functional/Idiopathic
- Irritable bowel syndrome
- Diverticular disease
- Megacolon
- Pelvic intussusception
- Metabolic/Endocrine
- Hypothyroidism
- Hypokalemia
- Hypomagnesemia
- Hypercalcemia
- Pregnancy
- Diabetes
- Medications
- Opiates
- Iron
- Calcium
- Anticholinergics
- Antipsychotics
- Mechanical obstruction
- History
- Time since last bowel movement
- Gauge severity of constipation
- Fever
- Consider infectious pathology
- Bloody stools
- Consider trauma, diverticular disease, or rectal foreign body
- Unintentional weight loss
- Consider colon cancer
- Time since last bowel movement
- Physical Exam
- Pale skin, cachexia
- Signs of anemia
- Guarding/rigidity
- May indicate peritonitis secondary to bowel perforation or obstruction
- Abnormal vitals (hypotension, tachycardia, fever)
- Concerning for serious pathology
- Absent bowel sounds/high-pitched
- Suggests complete or near-complete mechanical obstruction
- Blood on rectal exam
- Indicates active GI bleeding
- Pale skin, cachexia
- Work-up
- Labs
- CBC, BMP, Magnesium, TSH, Pregnancy test
- Imaging
- Abdominal X-Ray
- If uncomplicated
- Abdominal/Pelvic CT
- More sensitive for high risk pathologies
- Abdominal X-Ray
- Labs
Pearls

Diarrhea
Rapid Review
- Differentials
- Bacterial
- C. difficile
- Campylobacter
- Shigella
- Salmonella
- E. coli
- Viral
- HIV
- Enteroviruses
- Parasitic
- Entamoeba histolytica
- Giardia lamblia
- Other
- Inflammatory bowel disease
- Ulcerative colitis
- Diverticulitis
- Medications
- Alcoholism
- Bacterial
- History
- Frequency and volume of stools
- Watery, large volume stools likely viral
- Recent antibiotics
- Consider C. difficile
- Exposure to poultry, livestock, turtles
- Consider salmonella
- Travel to developing countries
- Consider bacterial/parasitic infections
- Consumption of raw, undercooked meats
- Consider bacterial organisms
- Frequency and volume of stools
- Physical Exam
- Dry mucous membranes
- Suspect dehydration
- Abdominal tenderness
- Suspect inflammatory process (pancreatitis, cholecystitis, appendicitis)
- Bloody stools
- Suggest bacterial/parasitic
- Dry mucous membranes
- Work-Up
- Labs
- CBC, BMP, hepatic panel
- C. diff PCR
- Hepatic panel
- Stool culture
- Stool ova/parasites
- Imaging
- CT Abdomen pelvis (if concern for acute abdomen)
- Labs
Pearls
Deep Dive

GI Bleeding
Rapid Review
- Differentials
- Upper GI bleeding
- Esophageal varices
- Boerhaave syndrome
- Aortoenteric fistula
- Mallory Weiss tear
- Gastritis
- Gastric cancer
- Peptic ulcer disease
- Lower GI bleeding
- Diverticular disease
- Malignancy
- Mesenteric ischemia
- Ulcerative Colitis
- Hemorrhoids
- Colitis
- Anorectal fissure
- Upper GI bleeding
- History
- Blood thinners (antiplatelets or anticoagulants)
- High-risk for life-threatening bleed
- Chronic NSAID use
- Risk factor for peptic ulcer disease
- Recent iron or bismuth use
- May turn stools black
- Chronic alcohol use or liver disease
- Consider varices
- Family Hx of colon cancer
- Consider malignancy
- Blood thinners (antiplatelets or anticoagulants)
- Physical Exam
- Jaundice
- Consider varices secondary to liver disease
- Abdominal Exam
- Look for signs of peritonitis
- Rectal Exam
- Evaluate for source of bleeding (anal fissures/hemorrhoids)
- Abnormal vitals (tachycardia, hypotension)
- Signs of hemorrhagic shock
- Jaundice
- Work-Up
- Labs
- CBC, BMP, coagulation studies, LFTs, Type and screen
- Procedures
- Anoscopy (if suspect internal hemorrhoids or fissures)
- Imaging
- Upright CXR/Abdominal films
- If concern for aspiration or to evaluate for free air
- Abdominal CT
- If concerned for perforation
- Upright CXR/Abdominal films
- Labs
Pearls
Deep Dive
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