Abdominal pain, nausea,vomiting 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
Chronic pancreatitis	Epigastric	−	−	±	±	−	+	+	−	−	−	−	N	Increased amylase / lipase Increased stool fat content Pancreatic function test	CT scan Calcification Pseudocyst Dilation of main pancreatic duct	Predisposes to pancreatic cancer
Pancreatic carcinoma	Epigastric	−	−	+	+	−	+	+	−	−	−	−	N	↑ Alkaline phosphatase ↑ serum bilirubin ↑ gamma-glutamyl transpeptidase ↑ CA 19-9	MDCT with PET/CT MRI	Skin manifestations may include: Bullous pemphigoid Cicatricial pemphigoid Migratory superficial thrombophlebitis (classic Trousseau’s syndrome) Pancreatic panniculitis
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
Gastric outlet obstruction	Epigastric	−	−	±	−	−	−	+	−	−	−	−	Hyperactive	Complete blood count Basic metabolic panel	Abdominal x-ray– air fluid level Barium upper GI studies- narrowed pylorus	Succussion splash
Gastroparesis	Epigastric	−	−	+	−	−	−	+	−	±	−	−	Hyperactive/hypoactive	Hemoglobin Fasting plasma glucose Serum total protein, albumin, thyrotropin (TSH), and an antinuclear antibody (ANA) titer HbA1c	Scintigraphic gastric emptying	Succussion splash Single photon emission computed tomography (SPECT) Full thickness gastric and small intestinal biopsy
Dumping syndrome	Lower and then diffuse	−	−	+	−	−	+	+	−	+	−	−	Hyperactive	Glucose challenge test Hydrogen breath test	Upper GI series Gastric emptying study	Postgastrectomy
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
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
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
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

Abdominal pain, nausea,vomiting and weight loss

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