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Abdominal Pain in Upper Quadrants

Contents
  1. Read book excerpt
  2. Restless Legs Syndrome: Introduction
  3. Restless Legs Syndrome Misdiagnosis
  4. Restless Legs Syndrome Causes
  5. Restless Legs Syndrome Complications
  6. Restless Legs Syndrome Treatments
  7. Clinical trials
  8. Diagnosis of Restless Legs Syndrome
  9. Restless Legs Syndrome Overview
  10. More book excerpts for Restless Legs Syndrome

Abdominal Pain in Upper Quadrants: Excerpt from In a Page: Signs and Symptoms

Upper abdominal pain is a common presenting symptom. A complete differential diagnosis should be developed based on the organs in the upper abdomen in addition to the associated history and physical examination. Gallbladder disease and gastritis are two of the most common causes of upper abdominal pain. Be sure to consider nonabdominal etiologies in the differential of abdominal pain (e.g., pulmonary embolus, pneumonia, myocardial ischemia)

Differential Diagnosis


Right upper quadrant pain

  • Cholecystitis
  • Fatty liver or NASH
  • Congested liver (e.g., secondary to heart failure)
  • Cholangitis
  • Hepatitis
  • Gastritis or pancreatitis (see below)
  • Pneumonia
  • Fitz-Hugh-Curtis syndrome (gonococcal perihepatitis secondary to pelvic inflammatory disease)

    • Epigastric pain
  • Gastritis
  • PUD
  • Pancreatitis
  • Gastroenteritis
  • Intestinal obstruction
  • Myocardial infarction
  • Aortic aneurysm
    Left upper quadrant pain
  • Peptic ulcer disease
  • Gastritis
  • GERD
  • Splenic infarct
  • Pulmonary embolism
  • Pancreatitis
  • Acute splenomegaly (e.g., mononucleosis)
  • Left lower lobe pneumonia
    Nonfocal pain
  • Herpes
  • Sickle cell crisis
  • Irritable bowel
  • Mesenteric ischemia
  • Peritonitis
  • Pleurisy
  • Uremia
  • Lead poisoning
  • Porphyria
  • Toxin ingestion

Workup and Diagnosis

  • History of associated symptoms; relation of pain to eating; anorexia; alcohol use; and location, quality, and intensity of pain
  • Physical exam should focus on heart, lungs, abdomen, and back examinations
  • Initial laboratory tests may include CBC with differential, electrolytes, urinalysis, BUN/creatinine, liver function tests, LDH, amylase/lipase, magnesium, and PT/PTT/INR
  • Chest and abdominal X-rays
  • Abdominal ultrasound and/or CT scan
  • Hepatitis viral serology
  • Percutaneous transhepatic cholangiography (PTCA) and/or ERCP
  • Upper GI endoscopy (EGD) or upper GI series with barium swallow
  • Cultures of blood, urine, and trachea/gastric aspirates
  • Evaluation of possible cardiac and pulmonary etiologies may require ECG (pulmonary embolus may show S in I, Q in III, inverted T in III), cardiac isoenzymes, pleural tap, echocardiogram, and stress test

Treatment

  • Rule out or treat serious causes of pain (e.g., bowel obstruction, cholangitis, MI, PE)
  • Urgent surgical intervention may be indicated for aortic aneurysm, splenic infarct, perforated viscus, and intestinal obstruction or infarct
    • Esophagitis, gastritis, PUD, and GERD are primarily treated with lifestyle changes (e.g., avoid causative foods or medications) and PPIs or H2 blockers
      –Rule out malignancies in older patients or those with suggestive histories
  • Pancreatitis: Aggressive IV hydration for lost fluids and third spacing; antibiotics; nasogastric tube insertion if vomiting; bowel rest; and narcotics for pain
  • Gastroenteritis: Rehydration, correct electrolytes
  • Intestinal obstruction: Bowel rest, surgery
  • Cardiac and pulmonary etiologies are treated per protocols (e.g., supplemental O2, aspirin, β-blocker, nitrates for MI; O2, heparin and/or thrombolytics for PE; O2, appropriate antibiotics for pneumonia)

Book Source Details

  • Book Title: In a Page: Signs and Symptoms
  • Author(s): Scott Kahan, Ellen G. Smith
  • Year of Publication: 2004
  • Copyright Details: In a Page: Signs and Symptoms, Copyright © 2004 Lippincott Williams & Wilkins.

More About Restless Legs Syndrome

More Medical Textbooks Online about Restless Legs Syndrome

Review other book chapters online related to Restless Legs Syndrome:

Medical Books Excerpts
  • BACK PAIN
  • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
  • [ read ]
  • BREAST PAIN
  • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
  • [ read ]
  • CHEST PAIN
  • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
  • [ read ]
  • EYE PAIN
  • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
  • [ read ]
  • FACE PAIN
  • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
  • [ read ]
  • FLANK PAIN
  • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
  • [ read ]
  • HEEL PAIN
  • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
  • [ read ]
  • HIP PAIN
  • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
  • [ read ]
  • JAW PAIN
  • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
  • [ read ]
  • JOINT PAIN
  • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
  • [ read ]
  • Back Pain
  • "In A Page: Pediatric Signs and Symptoms" (2007)
  • [ read ]
  • Chest Pain
  • "In A Page: Pediatric Signs and Symptoms" (2007)
  • [ read ]
  • Hip Pain
  • "In A Page: Pediatric Signs and Symptoms" (2007)
  • [ read ]
  • Knee Pain
  • "In A Page: Pediatric Signs and Symptoms" (2007)
  • [ read ]
  • Toeing Out
  • "In A Page: Pediatric Signs and Symptoms" (2007)
  • [ read ]
  • Toeing In
  • "In A Page: Pediatric Signs and Symptoms" (2007)
  • [ read ]
  • MYOCLONUS
  • "Differential Diagnosis in Primary Care" (2007)
  • [ read ]
  • ARM PAIN
  • "Differential Diagnosis in Primary Care" (2007)
  • [ read ]
  • EYE PAIN
  • "Differential Diagnosis in Primary Care" (2007)
  • [ read ]
  • HIP PAIN
  • "Differential Diagnosis in Primary Care" (2007)
  • [ read ]
  • Myoclonus
  • "Handbook of Signs & Symptoms (Third Edition)" (2006)
  • [ read ]
  • Arm pain
  • "Handbook of Signs & Symptoms (Third Edition)" (2006)
  • [ read ]
  • Back pain
  • "Handbook of Signs & Symptoms (Third Edition)" (2006)
  • [ read ]
  • Chest pain
  • "Handbook of Signs & Symptoms (Third Edition)" (2006)
  • [ read ]
  • Eye pain
  • "Handbook of Signs & Symptoms (Third Edition)" (2006)
  • [ read ]
  • Flank pain
  • "Handbook of Signs & Symptoms (Third Edition)" (2006)
  • [ read ]
  • Jaw pain
  • "Handbook of Signs & Symptoms (Third Edition)" (2006)
  • [ read ]
  • Neck pain
  • "Handbook of Signs & Symptoms (Third Edition)" (2006)
  • [ read ]
  • Rectal pain
  • "Handbook of Signs & Symptoms (Third Edition)" (2006)
  • [ read ]
  • Seizures
  • "A Pocket Manual of Differential Diagnosis" (1999)
  • [ read ]
  • Back Pain
  • "A Pocket Manual of Differential Diagnosis" (1999)
  • [ read ]
  • Chest Pain
  • "A Pocket Manual of Differential Diagnosis" (1999)
  • [ read ]
  • Myoclonus
  • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
  • [ read ]
  • Arm pain
  • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
  • [ read ]
  • Back pain
  • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
  • [ read ]
  • Chest pain
  • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
  • [ read ]
  • Facial pain
  • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
  • [ read ]
  • Flank pain
  • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
  • [ read ]
  • Jaw pain
  • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
  • [ read ]
  • Neck pain
  • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
  • [ read ]
  • Seizures
  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
  • [ read ]
  • Chest Pain, Atypical
  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
  • [ read ]
  • Low Back Pain
  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
  • [ read ]
  • Abdominal Pain
  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
  • [ read ]
  • Calf Pain
  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
  • [ read ]
  • Chronic Pelvic Pain
  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
  • [ read ]
  • Hip Pain
  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
  • [ read ]
  • Knee Pain
  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
  • [ read ]
  • Neck Pain
  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
  • [ read ]
  • Pleuritic Pain
  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
  • [ read ]
  • Shoulder Pain
  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
  • [ read ]
  • Scrotal Pain
  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
  • [ read ]
  • Seizures
  • "Field Guide to Bedside Diagnosis" (2007)
  • [ read ]
  • Eye Pain
  • "Field Guide to Bedside Diagnosis" (2007)
  • [ read ]
  • Hip Pain
  • "Field Guide to Bedside Diagnosis" (2007)
  • [ read ]
  • Myoclonus
  • "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
  • [ read ]
  • Abdominal pain
  • "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
  • [ read ]
  • Back pain
  • "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
  • [ read ]
  • Chest pain
  • "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
  • [ read ]
  • Eye pain
  • "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
  • [ read ]
  • Flank pain
  • "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
  • [ read ]
  • Jaw pain
  • "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
  • [ read ]
  • Neck pain
  • "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
  • [ read ]
  • Myoclonus
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
  • [ read ]
  • Arm pain
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
  • [ read ]
  • Back pain
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
  • [ read ]
  • Breast pain
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
  • [ read ]
  • Chest pain
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
  • [ read ]
  • Eye pain
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
  • [ read ]
  • Facial pain
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
  • [ read ]
  • Flank pain
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
  • [ read ]
  • Jaw pain
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
  • [ read ]
  • Neck pain
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
  • [ read ]
  • Rectal pain
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
  • [ read ]
  • Seizures
  • "The Diagnostic Approach to Symptoms and Signs in Pediatrics" (2006)
  • [ read ]
  • Abdominal Pain
  • "The Diagnostic Approach to Symptoms and Signs in Pediatrics" (2006)
  • [ read ]
  • Back Pain
  • "The Diagnostic Approach to Symptoms and Signs in Pediatrics" (2006)
  • [ read ]
  • Chest Pain
  • "The Diagnostic Approach to Symptoms and Signs in Pediatrics" (2006)
  • [ read ]
  • Myoclonus
  • "Nursing: Interpreting Signs and Symptoms" (2007)
  • [ read ]
  • Arm pain
  • "Nursing: Interpreting Signs and Symptoms" (2007)
  • [ read ]
  • Back pain
  • "Nursing: Interpreting Signs and Symptoms" (2007)
  • [ read ]
  • Chest pain
  • "Nursing: Interpreting Signs and Symptoms" (2007)
  • [ read ]
  • Flank pain
  • "Nursing: Interpreting Signs and Symptoms" (2007)
  • [ read ]
  • Jaw pain
  • "Nursing: Interpreting Signs and Symptoms" (2007)
  • [ read ]
  • Neck pain
  • "Nursing: Interpreting Signs and Symptoms" (2007)
  • [ read ]
  • ARM PAIN
  • "Differential Diagnosis in Primary Care" (2007)
  • [ read ]
  • EYE PAIN
  • "Differential Diagnosis in Primary Care" (2007)
  • [ read ]
  • HIP PAIN
  • "Differential Diagnosis in Primary Care" (2007)
  • [ read ]
 

Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.



More About This Book:
Title: In a Page: Signs and Symptoms
Authors: Scott Kahan, Ellen G. Smith
Publisher: Lippincott Williams & Wilkins
Copyright: 2004
ISBN: 1-4051-0368-X

 » Next page: Abdominal Pain with Rebound Tenderness (In a Page: Signs and Symptoms)

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