Abdominal pain, fever and weight loss

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

	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
Disease	Clinical manifestations													Diagnosis		Comments
	Symptoms									Signs				Diagnosis
Peptic ulcer disease	Diffuse	±	−	+	−	−	−	+	Gastric ulcer- melena and hematemesis Duodenal ulcer- melena and hematochezia	Positive if perforated	Positive if perforated	Positive if perforated	N	Ascitic fluid LDH > serum LDH Glucose < 50mg/dl Total protein > 1g/dl	Air under diaphragm in upright CXR	Upper GI endoscopy for diagnosis
Gastritis	Epigastric	±	−	+	−	−	−	Positive in chronic gastritis	+	−	−	−	N	H.pylori infection diagnostic tests	Endoscopy	H.pylori gastritis guideline recommendation
Inflammatory bowel disease	Diffuse	±	−	−	±	−	+	+	+	−	−	−	Normal or hyperactive	Anti-neutrophil cytoplasmic antibody (P-ANCA) in Ulcerative colitis Anti saccharomyces cerevisiae antibodies (ASCA) in Crohn’s disease	String sign on abdominal x-ray in Crohn’s disease	Extra intestinal findings: Uveitis Arthritis
Whipple’s disease	Diffuse	±	−	−	±	−	+	+	−	±	−	−	N	Thrombocytopenia Hypoalbuminemia Small intestinal biopsy for Tropheryma whipplei	Endoscopy is used to confirm diagnosis. Images used to find complications Chest and joint x-ray CT MRI Echocardiography	Extra intestinal findings: Uveitis Endocarditis Encephalitis Dementia Hepatosplenomegaly Arthritis Ascites
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
Tropical sprue	Diffuse	+	−	−	−	−	+	+	−	−	−	−	N	Fat soluble vitamin deficiency Hypoalbuminemia Fecal stool test	Barium studies: Dilation and edema of mucosal folds	Steatorrhea– 10-40 g/day (Normal=5 g/day)
Viral hepatitis	RUQ	+	−	+	+	−	Positive in Hep A and E	+	−	Positive in fulminant hepatitis	Positive in acute	+	N	Abnormal LFTs Viral serology	US	Hep A and E have fecal-oral route of transmission Hep B and C transmits via blood transfusion and sexual contact.
Liver abscess	RUQ	+	+	+	+	−	±	+	−	+	+	±	Normal or hypoactive	CBC Blood cultures Abnormal liver function tests	US CT
Hepatocellular carcinoma/Metastasis	RUQ	+	−	−	+	−	−	+	−	−	−	−	Normal Hyperactive if obstruction present	High levels of AFP in serum Abnormal liver function tests	US CT Liver biopsy	Other symptoms: Splenomegaly Variceal bleeding Ascites Spider nevi Asterixis
Small bowel obstruction	Diffuse	+	−	+	−	+	−	+	−	+	+	±	Hyperactive then absent	Leukocytosis with left shift indicates complications	Abdominal X ray Dilated loops of bowel with air fluid levels Gasless abdomen	“Target sign”– , indicative of intussusception Venous cut-off sign” – suggests thrombosis
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
Mesenteric ischemia	Periumbilical	Positive if bowel becomes gangrenous	−	+	−	−	+	+	+	Positive if bowel becomes gangrenous	Positive if bowel becomes gangrenous	−	Hyperactive to absent	Leukocytosis and lactic acidosis Amylase levels D-dimer	CT angiography SMA or SMV thrombosis	Also known as abdominal angina that worsens with eating
Acute ischemic colitis	Diffuse	+	±	+	−	−	+	+	+	+	+	+	Hyperactive then absent	Leukocytosis	Abdominal x-ray Distension and pneumatosis CT scan Double halo appearance, thumbprinting Thickening of bowel	May lead to shock
Ruptured abdominal aortic aneurysm	Diffuse	±	−	+	−	−	−	+	+	+	−	−	N	Fibrinogen D-dimer	Focused Assessment with Sonography in Trauma (FAST)	Unstable hemodynamics
Pleural empyema	RUQ/Epigastric	+	±	−	−	−	−	+	−	−	−	−	N	Thoracentesis	Chest X-ray Pleural opacity Localization of effusion	Physical examination Crackles Egophony Increased tactile fremitus

Abdominal pain, fever and weight loss

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