Chronic Abdominal Pain Causes - Differential Diagnosis Framework Many patients with chronic abdominal pain have had prior evaluations that did not yield a diagnosis after history, physical and testing. • Could potentially be an acute exacerbation of a chronic problem. • Process: Accelerating vs plateaued? Long-standing vs intermittent Chronic Abdominal Pain Red Flags: • Fever • Anorexia, weight loss • Pain that awakens the patient • Blood in stool • Jaundice • Edema • Abdominal mass/organomegaly • Vomiting, diarrhea • Back pain • Skin changes • Urinary symptoms • Family history of IBD Chronic abdominal pain > 3 months • Recurrent: Consider tumor • Upper quadrant/Epigastric: Consider cardiac causes • Lower quadrant: Consider genitourinary causes RUQ: • Biliary colic/Chronic cholecystitis • Functional biliary pain • Sphincter of Oddi dysfunction • PSC • Budd-Chiari syndrome • Chronic portal vein thrombosis • Hepatocellular carcinoma Epigastric/LUQ Pain: • Cardiopulmonary disease/AMI • PUD • Gastric malignancy • Esophageal malignancy • GERD/Dyspepsia • Gastritis: H. pylori/NSAIDs • Chronic pancreatitis • Splenomegaly/Abscess • Splenic vein thrombus • Splenic infarction • Lymphoma/Leukemia Lower Abdominal Pain: • Pregnancy • Diverticulitis • IBD • Intestinal obstruction • Colorectal CA • Urinary retention • Pyelonephritis • Nephrolithiasis • Femoral/Inguinal hernia • Epididymitis • Endometriosis • Fibroids • Ovulatory pain • Ectopic pregnancy • Ovarian CA Diffuse Pain: • Constipation • Irritable bowel syndrome • Celiac disease • Inflammatory bowel disease • Chronic mesenteric ischemia • GI malignancy • Lactase malabsorption/intolerance • SIBO Focal Pain: • Abdominal wall pain • Abdominal cutaneous nerve entrapment • Abdominal hernia • Rib fracture • Shingles Poorly Localized Pain: • Abdominal aortic aneurysms • Acute intermittent porphyria • Hypercalcemia • Hypothyroidism • Lead poisoning • Celiac artery compression syndrome • Mesenteric ischemia • Chronic intestinal pseudoobstruction • Eosinophilic gastroenteritis • Epiploic appendages • FMF • Adult Still's disease • Necrotic bowel disease • Somatization #Abdominal #Pain #Chronic #Causes #Differential #Diagnosis #gastroenterology
