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Abdominal pain, fever and GI bleeding

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Amandeep Singh M.D.[2],Iqra Qamar M.D.[3]

Abbreviations: RUQ= Right upper quadrant of the abdomen, LUQ= Left upper quadrant, LLQ= Left lower quadrant, RLQ= Right lower quadrant, LFT= Liver function test, SIRS= Systemic inflammatory response syndrome, ERCP= Endoscopic retrograde cholangiopancreatography, IV= Intravenous, N= Normal, AMA= Anti mitochondrial antibodies, LDH= Lactate dehydrogenase, GI= Gastrointestinal, CXR= Chest X ray, IgA= Immunoglobulin A, IgG= Immunoglobulin G, IgM= Immunoglobulin M, CT= Computed tomography, PMN= Polymorphonuclear cells, ESR= Erythrocyte sedimentation rate, CRP= C-reactive protein, TS= Transferrin saturation, SF= Serum Ferritin, SMA= Superior mesenteric artery, SMV= Superior mesenteric vein, ECG= Electrocardiogram

Disease Clinical manifestations Diagnosis Comments
Symptoms Signs
Abdominal Pain Fever Rigors and chills Nausea or vomiting Jaundice Constipation Diarrhea Weight loss GI bleeding Hypo-

tension

Guarding Rebound Tenderness Bowel sounds Lab Findings Imaging
Peptic ulcer disease Diffuse Β± βˆ’ + βˆ’ βˆ’ βˆ’ + Positive if perforated Positive if perforated Positive if perforated N
  • Ascitic fluid
    • LDH > serum LDH
    • Glucose < 50mg/dl
    • Total protein > 1g/dl
Gastritis Epigastric Β± βˆ’ + βˆ’ βˆ’ βˆ’ Positive in chronic gastritis + βˆ’ βˆ’ βˆ’ N
Gastrointestinal perforation Diffuse + Β± – Β± βˆ’ βˆ’ βˆ’ + + + Β± Hyperactive/hypoactive
  • WBC> 10,000
Acute diverticulitis LLQ + Β± + βˆ’ + Β± βˆ’ + Positive in perforated diverticulitis + + Hypoactive
  • CT scan
  • Ultrasound
Inflammatory bowel disease Diffuse Β± βˆ’ βˆ’ Β± βˆ’ + + + βˆ’ βˆ’ βˆ’ Normal or hyperactive

Extra intestinal findings:

Infective colitis Diffuse + βˆ’ Β± βˆ’ βˆ’ + βˆ’ + Positive in fulminant colitis Β± Β± Hyperactive CT scan
  • Bowel wall thickening
  • Edema
Disease Abdominal Pain Fever Rigors and chills Nausea or vomiting Jaundice Constipation Diarrhea Weight loss GI bleeding Hypo-

tension

Guarding Rebound Tenderness Bowel sounds Lab Findings Imaging Comments
Budd-Chiari syndrome RUQ Β± βˆ’ βˆ’ Β± βˆ’ βˆ’ βˆ’ Positive in liver failure leading to varices βˆ’ βˆ’ βˆ’ N
Findings on CT scan suggestive of Budd-Chiari syndrome include:
Ascitic fluid examination shows:
Mesenteric ischemia Periumbilical Positive if bowel becomes gangrenous βˆ’ + βˆ’ βˆ’ + + + Positive if bowel becomes gangrenous Positive if bowel becomes gangrenous βˆ’ Hyperactive to absent CT angiography
  • SMA or SMV thrombosis
  • Also known as abdominal angina that worsens with eating
Acute ischemic colitis Diffuse + Β± + βˆ’ βˆ’ + + + + + + Hyperactive then absent Abdominal x-ray
  • Distension and pneumatosis

CT scan

  • Double halo appearance, thumbprinting
  • Thickening of bowel
  • May lead to shock
Ruptured abdominal aortic aneurysm Diffuse Β± βˆ’ + βˆ’ βˆ’ βˆ’ + + + βˆ’ βˆ’ N
  • Focused Assessment with Sonography in Trauma (FAST)Β 
  • Unstable hemodynamics
Intra-abdominal or retroperitoneal hemorrhage Diffuse Β± βˆ’ Β± βˆ’ βˆ’ βˆ’ βˆ’ + + βˆ’ βˆ’ N
  • ↓ Hb
  • ↓ Hct
  • CT scan

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