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Abdominal Pain in Lower Quadrants

Lower abdominal pain is a common complaint that must be evaluated carefully and systematically to reach the appropriate diagnosis in timely manner. All diagnoses must be considered, with the most emergent etiologies rapidly ruled out, followed by a careful evaluation and treatment for the most common diagnoses, and followed, if necessary, by a search for less common etiologies.

Differential Diagnosis


Right lower quadrant

  • Appendicitis
  • Diverticulitis
  • Salpingitis/Pelvic inflammatory disease
  • Endometritis
  • Endometriosis
  • Ectopic pregnancy
  • Hemorrhage or rupture of ovarian cyst
  • Renal calculus
  • Intussusception
    Pelvic/hypogastric region
  • Cystitis
  • Salpingitis/Pelvic inflammatory disease
  • Ectopic pregnancy
  • Diverticulitis
  • Strangulated hernia
  • Endometriosis
  • Appendicitis
  • Ovarian cyst
  • Ovarian torsion
  • Testicular torsion
  • Bladder distension
  • Nephrolithiasis
  • Prostatitis
  • Malignancy
  • Abdominal aortic aneurysm
    Left lower quadrant
  • Diverticulitis
  • Intestinal obstruction
  • Colitis
  • Strangulated hernia
  • Inflammatory bowel disease
  • Gastroenteritis
  • Pyelonephritis
  • Nephrolithiasis
  • Mesenteric lymphadenitis or thrombosis
  • Aortic aneurysm
  • Volvulus
  • Salpingitis/Pelvic inflammatory disease

Workup and Diagnosis

  • Complete history and examination
    –Note progression of symptoms (duration, rapidity of onset, intensity), associated complaints (e.g., anorexia, diarrhea, fever), urinary complaints, exposure to illness and medication, and past medical history including prior episodes
    –Note body positioning that tends to relieve pain; signs of dehydration or fever
    –Vitals and full pulmonary, cardiac, abdominal, back, pelvic, and rectal examinations
    –Abdominal examination should include bowel sounds, distension, tympany, tenderness, palpation for masses and organomegaly, rebound tenderness, and guarding
  • Initial evaluation includes CBC with differential cell counts, electrolytes, BUN/creatinine, glucose, calcium, urinalysis, urine culture, and β-hCG level
  • Abdominal/pelvic ultrasound and/or CT, obstructive series, and KUB may be indicated
  • Consider endocervical gonorrhea/chlamydia cultures in sexually active females, laparoscopy, barium enema, intravenous pyelogram, stool cultures, and/or fecal fat

Treatment

  • Hemodynamically unstable patients require immediate resuscitation
    –Replace volume with normal saline and possibly a blood transfusion
    –Evidence of hemorrhage (e.g., ruptured AAA, ruptured ectopic pregnancy) or early sepsis (e.g., perforated diverticulitis, perforated bowel) may be a life-threatening emergency that requires urgent surgical intervention
  • Place nasogastric tube for obstruction or persistent vomiting
  • Administer broad-spectrum empiric antibiotics if a perforated viscus or intra-abdominal infection is suspected
  • Direct treatment toward the specific condition
  • Consider gynecology or surgery referral

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.

Other Book Chapters Related to Calf pain

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Medical Books Excerpts
  • BACK PAIN
  • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
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  • BREAST PAIN
  • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
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  • CHEST PAIN
  • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
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  • EYE PAIN
  • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
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  • FACE PAIN
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  • FLANK PAIN
  • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
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  • GIRDLE PAIN
  • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
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  • HEEL PAIN
  • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
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  • HIP PAIN
  • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
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  • JAW PAIN
  • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
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  • Back Pain
  • "In A Page: Pediatric Signs and Symptoms" (2007)
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  • Chest Pain
  • "In A Page: Pediatric Signs and Symptoms" (2007)
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  • Hip Pain
  • "In A Page: Pediatric Signs and Symptoms" (2007)
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  • Knee Pain
  • "In A Page: Pediatric Signs and Symptoms" (2007)
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  • LEG PAIN
  • "Differential Diagnosis in Primary Care" (2007)
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  • ARM PAIN
  • "Differential Diagnosis in Primary Care" (2007)
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  • EYE PAIN
  • "Differential Diagnosis in Primary Care" (2007)
  • [ read ]
  • HIP PAIN
  • "Differential Diagnosis in Primary Care" (2007)
  • [ read ]
  • Leg pain
  • "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)
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  • Throat pain
  • "Handbook of Signs & Symptoms (Third Edition)" (2006)
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  • Back Pain
  • "A Pocket Manual of Differential Diagnosis" (1999)
  • [ read ]
  • Chest Pain
  • "A Pocket Manual of Differential Diagnosis" (1999)
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  • Homans' sign
  • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
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  • Leg Pain
  • "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 ]
  • Rectal pain
  • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
  • [ read ]
  • Throat pain
  • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
  • [ read ]
  • Calf Pain
  • "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)
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  • 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 ]
  • Scrotal 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 ]
  • Eye Pain
  • "Field Guide to Bedside Diagnosis" (2007)
  • [ read ]
  • Hip Pain
  • "Field Guide to Bedside Diagnosis" (2007)
  • [ read ]
  • Homans' sign
  • "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 ]
  • Homans' sign
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
  • [ read ]
  • Leg pain
  • "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 ]
  • Throat pain
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
  • [ 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 ]
  • Leg pain
  • "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 ]
  • LEG PAIN
  • "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 ]
 

Copyright Details: In a Page: Signs and Symptoms, Copyright © 2008 Williams & Wilkins.

More About Causes of Calf pain



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 in Upper Quadrants (In a Page: Signs and Symptoms)

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