Abdominal Pain: Or something else? Differential Diagnosis

Respiratory System (J00-J99)

Blood, blood-forming organs – immune system (D50-D90).

  • Hemochromatosis (iron storage disease) – genetic disease with autosomal recessive inheritance with increased deposition of iron as a result of increased iron concentration in the blood with tissue damage.
  • Hemolytic crisis* * * – acute blood loss in the context of anemia (anemia).
  • Hereditary angioedema (HAE; obsolete “hereditary angioneurotic edema”, HANE) – due to C1 esterase inhibitor (C1-INH) deficiency (blood protein deficiency); about 6% of cases:
    • Type 1 (85% of cases) – decreased activity and concentration of C1 inhibitor; autosomal dominant inheritance (new mutations about 25% of cases).
    • Type II (15% of cases) – decreased activity with normal or increased concentration of C1 inhibitor; expression of an abnormal C1-INH gene.

    Characterized by episodic skin and mucosal swelling, which may occur on the face and often on the extremities and gastrointestinal tract (gastrointestinal tract); furthermore, recurrent (recurrent) abdominal colic, acute ascites (abdominal dropsy) and edema (water retention), which occur up to twice a week and last for about 3-5 days if untreated.

Endocrine, nutritional and metabolic diseases (E00-E90).

  • Addisonian crisis* * * – decompensation of insidious adrenocortical insufficiency.
  • Acute adrenal insufficiency
  • C1 esterase inhibitor deficiency (angioneurotic edema or hereditary angioedema (HAE)) – disease caused by deficiency of an inhibitor of the complement system:
    • Low C1-INH and C4 concentrations indicate HAE type I.
    • Normal to elevated C1-INH concentrations with low C1-INH activity and low C4 levels indicate an HAE type II.

    Symptomatology: angioedema/swelling of the subcutaneous tissues, especially the lips (special form of Quincke’s edema) and colicky recurrent abdominal attacks (abdominal pain) for three to five days, often accompanied by nausea, diarrhea (diarrhea) and vomiting.

  • Diabetic ketoacidosis* * * (pseudoperitonitis diabetica) – form of metabolic acidosis, which occurs particularly frequently as a complication of diabetes mellitus with absolute insulin deficiency; causative is an excessive concentration of ketone bodies in the blood [OBS].
  • Diabetes mellitus
  • Familial Mediterranean fever (FMF; synonym: familial recurrent polyserositis) – autosomal recessive inherited disease clustered among residents of the eastern Mediterranean region; chronic disease characterized by sporadic episodes of fever with concomitant inflammation of the tunica serosa, resulting in abdominal pain (abdominal pain), thoracic pain, or arthralgia (joint pain).
  • Hyperproteinemia / hyperlipidemia (lipid metabolism disorder).
  • Hyperparathyroidism (parathyroid hyperfunction).
  • Gaucher disease – genetic disease with autosomal recessive inheritance; lipid storage disease due to the defect of the enzyme beta-glucocerebrosidase, which leads to storage of cerebrosides mainly in the spleen and marrow-containing bones; clinical picture: splenomegaly (splenomegaly), combined with anemia (anemia) and / or thrombocytopenia (pathological reduction of platelets / platelets).
  • Food allergy* *
  • Food intolerance such as lactose intolerance, fructose intolerance [chronic abdominal pain/infant].
  • Porphyria* * * or acute intermittent porphyria (AIP); genetic disease with autosomal dominant inheritance; patients with this disease have a 50 percent reduction in the activity of the enzyme porphobilinogen deaminase (PBG-D), which is sufficient for porphyrin synthesis. Triggers of a porphyria attack, which can last a few days but also months, are infections, drugs or alcohol.The clinical picture of these attacks presents as acute abdomen or neurological deficits, which can take a lethal course. The leading symptoms of acute porphyria are intermittent neurologic and psychiatric disturbances. Autonomic neuropathy is often prominent, causing abdominal colic (acute abdomen), nausea (nausea), vomiting, or constipation, as well as tachycardia (heartbeat too fast: > 100 beats per minute) and labile hypertension (high blood pressure). [OBS]

Skin and subcutaneous (L00-L99).

Cardiovascular system (I00-I99).

  • Aortic dissection (synonym: aneurysm dissecans aortae) – acute splitting (dissection) of the wall layers of the aorta (main artery), with a tear of the inner layer of the vessel wall (intima) and hemorrhage between the intima and the muscular layer of the vessel wall (outer media), in the sense of aneurysm dissecans (pathological widening of the artery) [OBS].
  • Aneurysms of visceral arteries (AVA; arteries for the viscera in the abdomen, which have a widening of the vessel lumen); most commonly affected A. lienalis (30-60%)
  • Abdominal aortic aneurysm, ruptured [MBS]
  • Endocarditis (inflammation of the inner lining of the heart)
  • Heart failure (cardiac insufficiency)
  • Pulmonary embolism* * * – pulmonary infarction occurring due to acute occlusion of pulmonary vessels.
  • Myocardial infarction* * * (heart attack; acute posterior wall infarction).
  • Myocarditis (inflammation of the heart muscle)
  • Pericarditis (inflammation of the pericardium)

Infectious and parasitic diseases (A00-B99).

Liver, gallbladder, and bile ducts – Pancreas (pancreas) (K70-K77; K80-K87).

  • Autoimmune hepatitis (AIH; autoimmune hepatitis) – acute or chronic inflammatory autoimmune disease of the liver) [OBS].
  • Acute cholecystitis (gallbladder inflammation) [OBS]
  • Acute pancreatitis (inflammation of the pancreas) [OBS]
  • Biliary colic, usually triggered by gallstones (cholecystolithiasis) [OBS] (symptomatology: right-sided crampy upper abdominal pain, radiation to the right shoulder and back).
  • Hepatitis (liver inflammation) [OBS]
  • Liver capsular tension pain in decompensated heart failure (heart failure).

Mouth, esophagus (esophagus), stomach, and intestines (K00-K67; K90-K93).

  • Abdominal migraine* – severe paraumbilical (occurring around the navel) abdominal pain attacks (accompanied by anorexia (loss of appetite), nausea (nausea), vomiting, cephalgia (headache), photophonia, or pallor) that may last from one hour to several days. The bowel movements are completely unremarkable. Physical or psychological stressful situations are typical trigger functions for this.
  • Acute mesenteric ischemia (AMI; intestinal infarction, mesenteric artery occlusion, mesenteric infarction, mesenteric occlusive disease, angina abdominalis) [MBS] symptomatology:
    • Initial stage with sudden onset of crampy abdominal pain (abdominal pain); distended abdomen, soft and doughy
    • Pain-free interval of circa six to twelve hours (due toZugrundegehen the intramural (“located in the organ wall”) pain receptors) with soft abdomen (rotten peace) to shock symptomatology.
    • Frequency: 1%; in over 70-year-olds: up to 10%.
  • Acute appendicitis (“appendicitis”) [UBS] Symptomatology: pain occurring mostly in the area of the right lower abdomen; typical pain points; mostly younger patients.
  • Acute gastritis (gastritis).
  • Anatomical malformations/deformities* * (e.g., malrotation, Meckel’s diverticulum, duplication).
  • Bride (adhesion strand (Bride), this pinches the intestine) [UBS].
  • Colitis indeterminata – disease that is a combination of ulcerative colitis and Crohn’s disease.
  • Ulcerative colitis – chronic inflammatory disease of the mucosa of the colon (large intestine) or rectum (rectum) [MBS].
  • Diversion colitis – disease occurring after surgical decommissioning of intestinal segments.
  • Diverticulitis – disease of the colon in which inflammation forms in protrusions of the mucosa (diverticula) [UBS].
  • Functional dyspepsia* (upper abdominal discomfort; irritable stomach) [OBS].
  • Functional abdominal pain*
  • Gastroesophageal reflux disease* * (Synonyms: GERD, gastroesophageal reflux disease; gastroesophageal reflux disease (GERD); gastroesophageal reflux disease (reflux disease); gastroesophageal reflux; reflux esophagitis; reflux disease; reflux esophagitis; peptic esophagitis) – inflammatory disease of the esophagus (esophagitis) caused by the abnormal reflux (reflux) of acid gastric juice and other gastric contents [OBS].
  • Gastroparesis – loss of tone of the stomach muscles.
  • Hollow organ perforation (symptomatology: initially “annihilation pain”, pain-free interval, then renewed increase in pain):
  • Ileus (intestinal obstruction) [MBS].
    • Mechanical: external (adhesions, brides, tumor) or internal (colon carcinoma, gallstone ileus fecal stones), with strangulation (e.g., incarcerated hernia, volvulus); symptomatology: hyperperistalsis with ringing bowel sounds, vomiting, retention of stool and wind (meteorism)
    • Paralytic (transit peritonitis!)
  • Infectious colitis – inflammation of the intestine by bacteria, viruses or parasites such as salmonella.
  • Incarcerated hernia – incarcerated soft tissue hernia [UBS].
  • Invagination – invagination of a portion of the intestine into the aborally following portion of the intestine (infants).
  • Ischemic colitis – inflammation of the intestine due to insufficient supply of nutrients and oxygen to the intestine.
  • Gastric/intestinal ulceration (ulcers)
  • Meckel’s diverticulitis – inflammation of an outpouching in the small intestine, which is a developmental remnant.
  • Meteorism (flatulence)
  • Microscopic colitis or microscopic colitis (synonyms: collagenous colitis; collagen colitis, collagen colitis) – chronic, somewhat atypical inflammation of the mucosa of the colon (large intestine), the cause of which is unclear and which is clinically accompanied by violent watery diarrhea (diarrhea)/4-5 times a day, even at night; some patients suffer from abdominal pain (abdominal pain) in addition; 75-80% are women/females > 50 years of age; correct diagnosis is only possible with colonoscopy (colonoscopy) and step biopsies (taking tissue samples in the individual sections of the colon), i.e. i.e. by a histological (fine tissue) examination to put.
  • Crohn’s diseasechronic inflammatory bowel disease; it usually progresses in relapses and can affect the entire digestive tract; characteristic is the segmental affection of the intestinal mucosa, that is, several intestinal sections may be affected, which are separated by healthy sections [MBS].
  • Whipple’s disease – rare systemic infectious disease; caused by the gram-positive rod bacterium Tropheryma whippelii (from the actinomycete group), which can affect various other organ systems in addition to the obligately affected intestinal system and is a chronic recurrent disease; symptoms: Fever, arthralgia (joint pain), brain dysfunction, weight loss, diarrhea (diarrhea), abdominal pain (abdominal pain), and more.
  • Lymphadenitis mesenterialis – bacterial infection leading to right-sided abdominal pain; affects abdominal lymph nodes.
  • Constipation* * (constipation)
  • Esophageal spasm – spasmodic narrowing of the esophagus.
  • Peptic ulcers* * (in Helicobacter pylori infection).
  • Perforation of hollow organs in the abdomen such as the stomach or intestine perforation.
  • Postenteritis syndrome* * – malabsorption syndrome in pediatrics that can develop after chronic gastroenteritis (gastrointestinal inflammation) with recurrent diarrhea.
  • Irritable bowel syndrome* (colon irritable) [MBS]
  • Rectal ulcer (rectal ulcer)
  • Giant diverticulum of the colon (diameter > 4 cm) [UBS].
  • Infant colic/infant colic (“three-month colic”) – 20% of infants suffer from intestinal colic in the first few months; symptomatology: excessive crying, painful facial expressions, flushing with legs tucked or hyperextended and fists clenched
  • (Sub-)Ileus due tocoprostasis (fecal accumulation in the colon; preferred in elderly patients).
  • Typhlitis – inflammation of the appendix (appendix) and ascending colon (colon), and sometimes the terminal ileum (end section of the scrotum or hip).
  • Radiation colitis – disease that can occur after radiation, especially in the context of cancer therapy.
  • Toxic megacolon – toxin-induced paralysis and massive dilatation of the colon (widening of the large intestine; > 6 cm), which is accompanied by acute abdomen (most severe abdominal pain), vomiting, clinical signs of shock and sepsis (blood poisoning); complication of ulcerative colitis; lethality (mortality rate) is about 30%.
  • Ulcus duodeni (duodenal ulcer) [OBS]
  • Ulcus ventriculi (gastric ulcer) [OBS]
  • Volvulus (rotation of a section of the digestive tract about its mesenteric axis) – symptoms: abdominal swelling that develops over two or three days
  • Celiac disease* * (gluten-induced enteropathy) – chronic disease of the mucosa of the small intestine (small intestinal mucosa) due to hypersensitivity to the cereal protein gluten.

Musculoskeletal system and connective tissue (M00-M99).

  • Coxarthrosis (osteoarthritis of the hip joint)
  • Behçet’s disease (synonym: Adamantiades-Behçet’s disease; Behçet’s disease; Behçet’s aphthae) – multisystem disease from the rheumatic form circle, which is associated with recurrent, chronic vasculitis (vascular inflammation) of the small and large arteries and mucosal inflammation; The triad (the occurrence of three symptoms) of aphthae (painful, erosive mucosal lesions) in the mouth and aphthous genital ulcers (ulcers in the genital region), as well as uveitis (inflammation of the middle eye skin, which consists of the choroid (choroid), the ray body (corpus ciliare) and the iris) is stated as typical for the disease; a defect in cellular immunity is suspected
  • Nucleus pulposus prolapse (herniated disc).
  • Psoas abscess (collection of pus in the psoas ligament) [UBS].
    • Primary psoas abscess: this results from hematogenous dissemination (seeding via the bloodstream) when the primary site is unclear and primarily affects younger patients and. (75-90% of cases Staphylococcus aureus).
    • Secondary psoas abscess: this arises from direct infection spread of adjacent organs (80% of cases gastrointestinal causes (appendicitis, diverticulitis, colon cancer, Crohn’s disease) before. Other causes include secondary spondylitis, tuberculous spondylitis, pyogenic sacroiliitis and infected hip joint endoprostheses.
  • Sacroiliitis – inflammation of the sacroiliac joint between the sacrum and the ilium.
  • Symphysis pain [SS]

Neoplasms – tumor diseases (C00-D48)

  • Familial adenomatous polyposis (FAP; synonym: Familial polyposis) – is an autosomal dominant inherited disorder. This leads to the occurrence of a large number (> 100 to thousands) of colorectal adenomas (polyps). The probability of malignant (malignant) degeneration is almost 100% (average from the age of 40).
  • Mastocytosis – two main forms: cutaneous mastocytosis (skin mastocytosis) and systemic mastocytosis (mastocytosis of the whole body); clinical picture of cutaneous mastocytosis: Yellowish-brown spots of varying size (urticaria pigmentosa); in systemic mastocytosis, there are also episodic gastrointestinal complaints (gastrointestinal complaints), (nausea (nausea), burning abdominal pain and diarrhea (diarrhea)), ulcer disease, and gastrointestinal bleeding (gastrointestinal bleeding) and malabsorption (disorder of food absorption); In systemic mastocytosis, there is an accumulation of mast cells (cell type that is involved in, among other things, allergic reactions). Among other things, involved in allergic reactions) in the bone marrow, where they are formed, as well as accumulation in the skin, bones, liver, spleen and gastrointestinal tract (GIT; gastrointestinal tract); mastocytosis is not curable; course usually benign (benign) and life expectancy normal; extremely rare degeneration mast cells (= mast cell leukemia (blood cancer)).
  • Leukemia (blood cancer)
  • Lymphoma – malignant disease originating in the lymphatic system.
  • Colon carcinoma (colon cancer)
  • Gastric carcinoma
  • Pancreatic carcinoma (cancer of the pancreas)
  • Tumors of any kind in the abdominal region.

Psyche – nervous system (F00-F99; G00-G99)

  • Abdominal migraine – Idiopathic, recurrent disorder that manifests before, especially in children, as episodic severe acute periumbilical pain lasting 1-72 hours. [MBS + OBS]
  • Chronic lower abdominal pain (“chronic pelvic pain”) in women [UBS]; affects approximately 15% of all women; risk factors include:
    • Alcohol and drug abuse
    • Physical or sexual abuse in childhood
    • Long duration of bleeding
    • Confirmed endometriosis
    • Anxiety, depression
    • Somatization disorders
    • “Pelvic inflammatory disease”, adhesions (adhesions).
    • Condition after caesarean section (cesarean section), abortion (miscarriage).
  • Epilepsy equivalent
  • Functional abdominal pain* * – see below for classification.
  • Neuralgia – pain in the area of spread of a sensitive nerve without a demonstrable cause.
  • Compression of the spinal cord/spinal nerves.
  • Somatoform disorders such as chronic lower abdominal pain syndrome or in high stress situations.
  • Radiculitis (nerve root inflammation).
  • Tabes dorsalis (neurolues) – late stage of syphilis in which there is demyelination of the spinal cord.

Pregnancy, childbirth, and puerperium (O00-O99) [SS] [UBS].

  • Abortion (miscarriage in the 1st trimester/third trimester of pregnancy).
  • Extrauterine pregnancy (heterotropic pregnancy) – pregnancy outside the uterus; extrauterine pregnancy is present in approximately 1 to 2% of all pregnancies: Tubalgravidity (ectopic pregnancy), Ovariangravidity (pregnancy in the ovary), Peritonealgravidity or Abdominalgravidity (pregnancy in the abdominal cavity), Cervicalgravidity (pregnancy in the cervix); Symptomatology:
    • Lower abdominal pain, colicky, side-dependent (may be very mild initially!).
    • Nausea, especially in the morning
    • Secondary amenorrhea (absence of menstruation).
    • Mild vaginal spotting
    • Collapse/shock in the context of an acute abdomen (e.g., tubal rupture and ovarian pregnancy (rupture occurs quite early in this case!)).

    Note: An inconspicuous sonographic finding does not exclude a heterotopic pregnancy! (insb. after assisted reproduction always remember).

  • HELLP syndrome (H = hemolysis/dissolution of erythrocytes (red blood cells) in the blood), EL = elevated liver enzymes, LP = low platelets (thrombocytopenia/decrease in platelets) [SS].
  • Premature placental abruption
  • Premature labor
  • Uterine rupture

Symptoms and abnormal clinical and laboratory findings not elsewhere classified (R00-R99).

  • Uremia* * * (occurrence of urinary substances in the blood above normal levels).

Genitourinary system (kidneys, urinary tract – reproductive organs) (N00-N99).

  • Adenomyosis (adenomyosis uteri) – endometrial islets (endometrial islets) within the myometrium/uterine muscles (endometriosis uteri) [UBS].
  • Adnexitis – inflammation of the fallopian tubes and ovary; symptomatology: general feeling of illness, fever, fluor genitalis (vaginal discharge), lower abdominal pain) [UBS].
  • Dysmenorrhea (menstrual pain) [UBS].
  • Endometriosis – appearance of endometrium (lining of the uterus) outside the endometrial layer of the uterus [UBS].
  • Urinary tract diseases* *
  • Testicular torsion* * * (twisting of the testicles)
  • Interstitial cystitis (interstitial cystitis, IC; synonym: Hunner’s cystitis) – cystitis (bladder inflammation) of unclear etiology occurring predominantly in women with fibrosis of the urinary bladder muscles, urge incontinence (irritable bladder or overactive (hyperactive) bladder) and development of a shrinking bladder; confirm diagnosis by: Urethrocystoscopy (urethral and bladder endoscopy) and biopsy (tissue sampling) for histology (fine tissue examination) and molecular diagnostics of specific cell proteins [chronic UBS of women].
  • Mid-cycle pain (intermenstrual pain) – lower abdominal pain occurring in the middle of a woman’s menstrual cycle, probably due to follicular rupture [UBS].
  • Myoma necrosis (myoma = benign muscular growth of the uterus; necrosis = death of cells/cell death) [UBS] [SS].
  • Renal colic, mainly caused by kidney stones.
  • Ovarian cyst, pedunculated (ovarian torsion) – water-filled tumor in the region of the ovary, whose supplying vessels were pinched off; symptomatology: pain and defensive tension in the lower abdomen, shock [UBS].
  • Perforation of the urinary bladder (symptomatology: severe and sudden onset of pain).
  • Pyelonephritis* * (inflammation of the renal pelvis).
  • Strangulated rotation of the adnexa (appendages of the uterus, i.e. the ovary (ovary) and the uterine tube (fallopian tube)).
  • Urolithiasis (urinary stone disease).
  • Cystitis* * (cystitis)

Injuries, poisonings, and other consequences of external causes (S00-T98).

Medication

Operations

  • Zust. n. operations (e.g. adhesions / adhesions).

Environmental pollution – Intoxications (poisoning).

  • Arsenic intoxication (arsenic)
  • Lead intoxication (lead)* * *
  • Intoxications (poisonings) – by various toxins (spiders, snakes, insects).

Further

  • Drug withdrawal
  • Rectus sheath hematoma (RSH; hematoma within the anterior and posterior fascial leaflets of the rectus sheath/tendon plate of the muscles of the anterior abdominal wall) [SS].

* Functional gastrointestinal conditions that are common causes of abdominal pain in childhood. * * Typical diseases that are the cause of chronic abdominal pain in childhood. * * * Most important extraabdominal causes of abdominal pain.

Below, the most common abdominal pains are marked with their localization as follows:

  • [OBS] = upper abdominal pain
  • [MBS] = mid-abdominal pain
  • [UBS] = lower abdominal pain