Acute Abdomen: Or something else? Differential Diagnosis

Congenital malformations, deformities, and chromosomal abnormalities (Q00-Q99).

  • Duodenal atresia (synonym: duodenojejunal atresia) – congenital developmental disorder in which the lumen of the duodenum is not patent [premature/newborn].
  • Ileum atresia – congenital developmental disorder in which the ileum (ileum), i.e., the lower portion of the small intestine, is occluded [premature/newborn]
  • Meckel’s diverticulum (Meckel’s diverticulum; diverticulum ilei) – protrusion of the jejunum (small intestine) or ileum (large intestine) that represents a remnant of the embryonic yolk duct (ductus omphaloentericus, the connection to the yolk sac) [infants/toddlers]

Certain conditions originating in the perinatal period (P00-P96).

  • Necrotizing enterocolitis (NEC or NEK) – inflammation of the small and large intestine that may occur as a complication of treatment in very small preterm infants with birth weights less than 1500 grams [preterm/newborn].

Respiratory System (J00-J99)

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

  • Hemolytic crisis* – acute hemoptysis in the context of anemia (anemia).
  • Hemophilia (hemophilia).
  • Schönlein-Henoch purpura (synonyms: Anaphylactoid purpura, acute infantile hemorrhagic edema, Schönlein-Henoch disease, Purpura anaphylactoides, Purpura anaphylactoides, Purpura Schönlein-Henoch (PSH), Seidlmayer cocard purpura, Schönlein-Henoch purpura, vasculitis allergica) – immunologically mediated vasculitis (inflammation of blood vessels) of capillaries as well as pre- and post-capillary vessels, usually without complications; As a multisystem disease, it affects preferentially skin, joints, intestines and kidneys (age group 2-12 years; thereby differential diagnosis among the 10 most common diagnoses) [infants / young children].

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

  • Addisonian crisis* – decompensation of insidious adrenocortical insufficiency (adrenal insufficiency).
  • Acute adrenal insufficiency
  • C1 esterase inhibitor deficiency (angioneurotic edema) – disease caused by the lack of an inhibitor of the complement system.
  • Diabetes mellitus (pseudoperitonitis diabetica).
  • Diabetic ketoacidosis* (DKA; synonym: ketoacidotic coma): severe metabolic derailment (ketoacidosis) in insulin deficiency – predominantly in diabetes mellitus type 1.
  • Familial Mediterranean fever (FMF; synonym: familial recurrent polyserositis) – autosomal recessive inherited disease clustered in inhabitants 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).
  • 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.
  • Hyperparathyroidism (parathyroid hyperfunction).
  • Food allergy
  • Food intolerance such as lactose intolerance, fructose intolerance.
  • 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 in the foreground, causing abdominal colic (acute abdomen), nausea (nausea), vomiting or constipation (constipation), as well as tachycardia (heartbeat too fast: > 100 beats per minute) and labile hypertension (high blood pressure).

Skin and subcutaneous (L00-L99).

  • Herpes zoster (shingles)

Cardiovascular system (I00-I99)

  • Aortic aneurysm (formation of a wall bulge in the aorta that can rupture (burst)) or. abdominal aortic aneurysm (AAA) – symptomatology: abdominal pain ranging from mild tightness to excruciating pain; it should be considered in patients >50 years of age who complain of abdominal pain or back pain, with concomitant “pulsatile abdominal tumor”; incidence (frequency of new onset) for asymptomatic abdominal aortic aneurysm ranges from 3.0 to 117 per 100,000 person-years
  • Aortic dissection (synonym: aneurysm dissecans aortae) – acute splitting (dissection) of the wall layers of the aorta (aorta), 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 terms of an aneurysm dissecans (pathological expansion of the artery).
  • 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.
  • Lymphadenitis mesenterialis (synonyms: lymphadenitis mesenterica, pseudoappendicitis, Maßhoff’s lymphadenitis; Maßhoff’s disease; Brennemann’s syndrome) – disease of childhood in which mesenteric lymph nodes of the ileocecal region (functional occlusion between the large and small intestines) swell as a concomitant of inflammation of the ileum (ileitis). [Infants/Toddlers]
  • Myocardial infarction* (heart attack).
  • Myocarditis (inflammation of the heart muscle)
  • Pericarditis (inflammation of the pericardium)
  • Pford vein thrombosis
  • Ruptured abdominal aortic aneurysm (BAA)

Infectious and parasitic diseases (A00-B99).

  • Acute gastroenteritis (gastroenteritis).
  • Leptospirosis – infectious disease caused by leptospires and usually transmitted by animals or skin/mucous membrane contact.
  • Malaria
  • Mononucleosis (Pfeiffer’s glandular fever)
  • Parasite infection
  • Pleurodynia, epidemic (Bornholm disease) – pain that occurs due to irritation of the pleura.
  • Pseudomembranous enterocolitis / pseudomembranous colitis – colitis (inflammation of the mucous membrane of the intestine), which usually occurs after taking antibiotics; the cause is an overgrowth of the intestine with the bacterium Clostridium difficile.
  • Typhoid abdominalis – infectious disease caused by Salmonella typhi.
  • Tuberculosis (consumption)
  • Various other viral or bacterial infections.

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

  • Autoimmune hepatitis (AIH; acute or chronic inflammatory autoimmune disease of the liver).
  • Acute cholecystitis (gallbladder inflammation).
  • Acute pancreatitis (inflammation of the pancreas).
  • Alcohol hepatitis (inflammation of the liver)
  • Cholangitis (inflammation of the bile duct)
  • Biliary colic, usually triggered by gallstones (cholecystolithiasis); symptomatology: right-sided crampy upper abdominal pain, radiation in the right shoulder and back (gallstones: women three times more often).
  • Hepatitis (inflammation of the liver)
  • Liver rupture (liver rupture)
  • Pancreatitis (inflammation of the pancreas); symptomatology: acute abdominal pain (abdominal pain) most important symptom; typical is a strong, probing and persistent pain in the upper abdomen (epigastrium), which may also radiate to the back (girdle), chest, flanks or lower abdomen and improves in a sitting or crouching position

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

  • Acute appendicitis (“appendicitis”; symptomatology: pain occurring mostly in the area of the right lower abdomen; typical pain points; mostly younger patients/10-30 years).
  • Acute gastritis (gastritis).
  • Acute mesenteric ischemia (AMI; intestinal infarction, mesenteric artery occlusion, mesenteric infarction, mesenteric occlusive disease, angina abdominalis); symptomatology [MBS]:
    • Initial stage with sudden onset of cramping abdominal pain (abdominal pain); distended abdomen, soft and pasty
    • Pain-free interval of circa six to twelve hours (due toZugrundegehen the intramural pain receptors) with soft abdomen (rotten peace) to shock symptomatology
    • Frequency: 1%; in over 70-year-olds: up to 10%.
  • Abdominal wall hematomas, occur mainly during anticoagulant therapy
  • Bride (adhesion strand), this jams the intestine.
  • Colon obstruction (large bowel obstruction) wg.
    • Diverticulitis (see below).
    • Colonic volvulus; the most common type is colonic volvulus (75-80%).
    • Tumor diseases
  • Colitis indeterminata – disease that is a combination of ulcerative colitis and Crohn’s disease.
  • Diversion colitis – disease occurring after surgical immobilization of intestinal segments.
  • Diverticulitis – disease of the colon in which inflammation forms in protrusions of the mucosa (diverticula) (also consider younger patients, < 40 years).
  • Small bowel obstruction (small bowel obstruction) (older patients) wg.
    • Adhesions (adhesions) due to previous surgery (50-70%).
    • Hernia (hernia of the intestine) (15-30%)
  • Gastroparesis – loss of tone of the stomach muscles.
  • Hollow organ perforation (symptomatology: initially “annihilation pain”, pain-free interval, then renewed increase in pain):
  • Hypertrophic pyloric stenosis – hypertrophy of the gastric outlet in the first months of life, which manifests clinically usually in the 3rd-6th week of life [infants/toddlers].
  • Ileus (intestinal obstruction)
    • 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 (inguinal, umbilical, incisional).
  • Invagination – invagination of a portion of the intestine into the aborally following intestinal segment [infants/toddlers].
  • 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 disease – chronic inflammatory bowel disease; it usually runs in relapses and can affect the entire digestive tract; characteristic is the segmental affection of the intestinal mucosa (intestinal mucosa), that is, it may be affected several intestinal sections that are separated by healthy sections from each other
  • Whipple’s disease – a chronic recurrent disease caused by the gram-positive rod bacterium Tropheryma whippelii, which can affect the entire body (symptoms: Fever, joint pain, brain dysfunction, weight loss, diarrhea, abdominal pain and more).
  • Lymphadenitis mesenterialis – bacterial infection that leads to right-sided abdominal pain; affects the abdominal lymph nodes.
  • Constipation (constipation)/obstruction.
  • Omental infarction (infarction of the abdominal network) – mild gastrointestinal symptoms in association with unexplained abdominal pain
  • Esophageal spasm – spasmodic narrowing of the esophagus.
  • Perforation of hollow organs in the abdominal cavity such as the stomach or intestine perforation (violent and sudden onset of pain): e.g., perforated ulcus ventriculi or ulcus duodeni
  • Peritonitis (inflammation of the peritoneum).
  • Rectal ulcer (rectal ulcer)
  • Irritable bowel syndrome (colon irritable)
  • Sigmoid diverticulitis – inflammation around an infected diverticulum (protrusion of the intestinal wall).
  • Typhlitis – inflammation of the appendix (appendix) and ascending colon (colon), and sometimes the terminal ileum (end section of the scrotum or ileum).
  • 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 related to the total number of people suffering from the disease) is about 30%.
  • Volvulus – rotation of a section of the digestive tract about its mesenteric axis; symptoms: abdominal swelling that develops over two or three days; typical complications include mechanical ileus (intestinal obstruction) or intestinal gangrene (death of a section of the intestine due to insufficient oxygen supply)

Musculoskeletal system and connective tissue (M00-M99).

  • Coxarthrosis (osteoarthritis of the hip joint)
  • Dermatomyositis – rare collagenosis that often occurs paraneoplastic.
  • 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 corpus ciliary (corpus ciliare) and the iris) is stated as typical for the disease; a defect in cellular immunity is suspected
  • Lupus erythematosus disseminatus – autoimmune disease that leads to various changes in the skin, joints and internal organs.
  • Nucleus pulposus prolapse (herniated disc).
  • Panarteriits nodosa – collagenosis leading to thickening of the vessel walls and thus to deficiency of blood flow.
  • Psoas abscess (accumulation of pus in the psoas lodge).
    • Primary psoas abscess: this arises 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.

Neoplasms – tumor diseases (C00-D48).

  • Familial adenomatous polyposis (FAP; synonym: familial polyposis) – autosomal-dominant inherited disease leading to the occurrence of a large number (> 100 to thousands) of colorectal adenomas (polyps); probability of malignant (malignant) degeneration is close to 100% (on average from the age of 40).
  • Leukemia (blood cancer)
  • Lymphoma – malignant disease originating in the lymphatic system.
  • Colon carcinoma (colon cancer)
  • Gastric carcinoma
  • Neuroblastoma [infants/toddlers]
  • Pancreatic carcinoma [pancreatic cancer)
  • Tumors of any kind in the abdominal region.

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

Pregnancy, childbirth and puerperium (O00-O99).

  • Extrauterine 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!)).
  • Premature placental abruption
  • Premature labor

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

  • Ischuria (urinary retention).
  • Uremia* (occurrence of urinary substances in the blood above normal values).

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

  • Adnexitis – inflammation of the fallopian tubes and ovary; symptomatology: general feeling of illness, fever, fluor genitalis (vaginal discharge), lower abdominal pain.
  • Endometriosis – appearance of endometrium (endometrium) outside the endometrial layer of the uterus.
  • Ureteral colic (symptomatology: contraction-like or cramping mid-abdominal and/or low back pain; radiation to the flank, groin, genitals).
  • Testicular torsion* (testicular torsion) – acute reduced blood flow to the testis caused by the sudden rotation of the testicle around its vascular pedicle.
  • Middle pain (intermenstrual pain) – lower abdominal pain occurring in the middle of the woman’s menstrual cycle, probably due to the follicular rupture.
  • Renal infarction
  • Renal colic, mainly caused by kidney stones
  • Ovarian cyst, pedunculated – 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.
  • Perforation of the urinary bladder (symptomatology: severe and sudden onset of pain).
  • Pyelonephritis (inflammation of the renal pelvis).
  • Uremia* (occurrence of urinary substances in the blood above normal values).
  • Urolithiasis (urinary stone disease) (age group: 30- to 60-year-olds; men to women is 2: 1).
  • Cystitis (inflammation of the bladder)

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

  • Alcohol intoxication (alcohol poisoning; alcohol).
  • Abdominal trauma / blunt abdominal trauma with the possible consequences of:
    • Hollow organ injuries (stomach, duodenum/duodenum, small intestine, large intestine, and rectum/foremast).
    • Splenic rupture [esp. common in children; conservative therapy when possible].
    • Kidney injury (40% of cases in children).
    • Pancreatic injuries (injuries to the pancreas; usually diagnosed secondarily).
    • Injuries to the liver and bile ducts
  • Foreign body in the gastrointestinal tract
  • Heat stroke
  • Nicotine poisoning

Medication

  • Quinine intoxication (antimalarial drug).
  • Drug withdrawal

Environmental pollution – intoxications (poisonings).

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

* Most important extraabdominal causes of abdominal pain.