Differential of abdominal pain

The differential diagnosis of abdominal pain is extensive. We have already discussed the characteristics of intestinal colics and discussed how to differentiate the three major types of abdominal pain; visceral, referred and somatic.

There may on occasion be some confusion about whether the patient's pain is abdominal or not. Severe pain from aortic dissection or myocardial infarction may suggest an abdominal catastrophe. Pneumonia or pulmonary infarction may sometimes suggest a pain in the upper abdomen. The pain of neuritis is often puzzling until the cause such as Herpes Zoster is evident.

The clinician needs to consider the characteristics of the pain and other associated symptoms and signs which should point him/her in the right direction.

The following table only touches on the breath of diagnosis possible.

Table 6: Differential diagnosis of abdominal pain

Abdominal
	Other, Intestinal colic (gastroenteritis, poison)
	Pancreatitis
	Appendicitis
	Cholecystitis and Biliary colic
	Perforated hollow organ
	Pyelonephritis
	Mesenteric ischaemia (Venous, Arterial [Large vessel, Small vessel])
	Symptomatic or ruptured aneurysm (Aortic, Iliac, Other aneurysms)
	Torsion of appendix epiploicae
	Spontaneous retroperitoneal haemorrhage
	Rectus Sheath Hematoma
	Complicated ovarian cyst/tumor (Bleed or Torsion)
Non Abdominal
	Testicular Torsion
	Myocardial infarction
	Aortic dissection
	Pneumonia
	Pulmonary embolism
	Sickle cell disease
	Porphyria
	Tabes Dorsalis
	Shingles
	Diabetes