MyEClinic
MyEClinic
Health Dictionary Find a Doctor

Abdominal pain and fever

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, US = Ultrasound

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
Acute suppurative cholangitis RUQ + + + + βˆ’ βˆ’ βˆ’ βˆ’ + + + N
  • Abnormal LFT
  • WBC >10,000
  • Ultrasound shows biliary dilatation/stents/tumor
  • Septic shock occurs with features of SIRS
Acute cholangitis RUQ + βˆ’ βˆ’ + βˆ’ βˆ’ βˆ’ βˆ’ βˆ’ βˆ’ βˆ’ N
  • Ultrasound shows biliary dilatation/stents/tumor
  • Biliary drainage (ERCP) + IV antibiotics
Acute cholecystitis RUQ + βˆ’ + + βˆ’ βˆ’ βˆ’ βˆ’ βˆ’ βˆ’ βˆ’ Hypoactive Ultrasound shows:
  • Gallstone
  • Inflammation
Acute pancreatitis Epigastric + βˆ’ + Β± βˆ’ βˆ’ βˆ’ βˆ’ Β± βˆ’ βˆ’ N
  • Ultrasound shows evidence of inflammation
  • CT scan shows severity of pancreatitis
  • Pain radiation to back
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
Primary sclerosing cholangitis RUQ + βˆ’ βˆ’ + βˆ’ βˆ’ βˆ’ βˆ’ βˆ’ βˆ’ βˆ’ N ERCP and MRCP shows
  • Multiple segmentalΒ strictures
  • Mural irregularities
  • BiliaryΒ dilatation and diverticula
  • Distortion of biliary tree
  • The risk ofΒ cholangiocarcinomaΒ in patients with primary sclerosing cholangitis is 400 times higher than the risk in the general population.
Cholelithiasis RUQ/Epigastric Β± βˆ’ Β± Β± βˆ’ βˆ’ βˆ’ βˆ’ βˆ’ βˆ’ βˆ’ Normal to hyperactive for dislodged stone
  • Fatty food intolerance
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
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
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 appendicitis Starts in epigastrium, migrates to RLQ + Positive in pyogenic appendicitis + βˆ’ βˆ’ Β± βˆ’ βˆ’ Positive in perforated appendicitis + + Hypoactive
  • Ct scan
  • Ultrasound
  • Positive Rovsing sign
  • Positive Obturator sign
  • Positive Iliopsoas sign
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:

Whipple’s disease Diffuse Β± βˆ’ βˆ’ Β± βˆ’ + + βˆ’ Β± βˆ’ βˆ’ N Endoscopy is used to confirm diagnosis.

Images used to find complications

Extra intestinal findings:
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
Toxic megacolon Diffuse + βˆ’ βˆ’ βˆ’ βˆ’ + βˆ’ βˆ’ + Β± + Hypoactive CT and Ultrasound shows:
  • Loss of colonic haustration
  • Hypoechoic and thickened bowel walls with irregular internal margins in the sigmoid and descending colon
  • Prominent dilation of the transverse colon (>6 cm)
  • Insignificant dilation of ileal bowel loops (diameter >18 mm) with increased intraluminal gas and fluid
Tropical sprue Diffuse + βˆ’ βˆ’ βˆ’ βˆ’ + + βˆ’ βˆ’ βˆ’ βˆ’ N Barium studies:
  • Dilation and edema of mucosal folds
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
Viral hepatitis RUQ + βˆ’ + + βˆ’ Positive in Hep A and E + βˆ’ 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 + + + + βˆ’ Β± + βˆ’ + + Β± Normal or hypoactive
  • US
  • CT
Hepatocellular carcinoma/Metastasis RUQ + βˆ’ βˆ’ + βˆ’ βˆ’ + βˆ’ βˆ’ βˆ’ βˆ’
  • Normal
  • Hyperactive if obstruction present
  • US
  • CT
  • Liver biopsy

Other symptoms:

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:
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
Spontaneous bacterial peritonitis Diffuse + βˆ’ βˆ’ Positive in cirrhotic patients βˆ’ + βˆ’ βˆ’ Β± + + Hypoactive
  • Ascitic fluid PMN>250 cells/mmΒ³
  • Culture: Positive for single organism
  • Ultrasound for evaluation of liver cirrhosis
Pyelonephritis Unilateral + Β± + βˆ’ βˆ’ βˆ’ βˆ’ βˆ’ + βˆ’ βˆ’ Hypoactive
  • Urinalysis
  • Urine culture
  • Blood culture
  • CT
  • MRI
  • CVA tenderness
Small bowel obstruction Diffuse + βˆ’ + βˆ’ + βˆ’ + βˆ’ + + Β± Hyperactive then absent 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 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
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
Acute salpingitis RLQ / LLQ + Β± βˆ’ βˆ’ βˆ’ βˆ’ βˆ’ βˆ’ βˆ’ Β± Β± N
Pleural empyema RUQ/Epigastric + Β± βˆ’ βˆ’ βˆ’ βˆ’ + βˆ’ βˆ’ βˆ’ βˆ’ N Chest X-ray
  • Pleural opacity
  • Localization of effusion
 Physical examination
Pulmonary embolism RUQ/LUQ Β± βˆ’ βˆ’ βˆ’ βˆ’ βˆ’ βˆ’ βˆ’ Β± βˆ’ βˆ’ N
  • ABGs
  • D-dimer
  • Dyspnea
  • Tachycardia
  • Pleuretic chest pain
Pneumonia RUQ/LUQ + + + βˆ’ βˆ’ Β± βˆ’ βˆ’ + βˆ’ βˆ’ Normal or hypoactive
  • ABGs
  • Leukocytosis
  • Pancytopenia
  • CXR
  • CT chest
  • Bronchoscopy
  • Shortness of breath
  • Cough
Myocardial Infarction Epigastric Β± βˆ’ + βˆ’ βˆ’ βˆ’ βˆ’ βˆ’ Positive in cardiogenic shock βˆ’ βˆ’ N ECG

Echocardiogram

  • Wall motion abnormality
  • Wall rupture
  • Septal rupture
  • Chest pain, tightness, diaphoresis

Complications:

Looking for the patient version?

Back to the patient-friendly article

Imprint

Privacy Policy

Terms and Conditions

Β© 2026 MyEClinic – IFTM Institut fΓΌr Telematik in der Medizin GmbH