Hx
     Location
     Quality
     Intensity
     Duration
     Radiation
     Timing (relation to meals)
     Associated sx
          Constitutional
          GI
          Cardiac
          Pulmonary
          Renal
          Pelvic
          Other
     Exacerbating and alleviating factors
     Prior hx of similar symptoms
     Medications
     Alcohol and drug use
     Domestic violence
PMHx
     Abdominal surgeries
     Gallstones
     Renal stones
     Atherosclerotic vascular disease

PE
     Vital signs
     CV exams
     Abdominal exam (incl. guarding, rebound, Murphy's sign, CVA palpation)
     Rectal exam
     Pelvic exam in women

Ddx
     Gastrointestinal
          GERD
          Mallory-Weiss tear
          Food poisoning
          Gastroenteritis
          Gastritis
          Gastric cancer
          Functional/nonulcer dyspepsia/indigestion    
          Peptic ulcer disease
          Peptic ulcer perforation
          Acute hepatitis
          Alcoholic hepatitis
          Sclerosing cholangitis
          Biliary disease
               Cholelithiasis
               Ascending cholangitis (Charcot's triad)
                    Suppurative cholangitis (Reynold's pentad)
               Acute cholecystitis
                    Acute calculous cholecystitis
                    Emphysematous cholecystitis
          Acute pancreatitis
          Chronic pancreatitis
          Pancreatic cancer
          Ileus
          Intestinal obstruction
          Volvulus
          Appendicitis
          Diverticulitis
          Crohn's disease
          Ulcerative colitis
          Small bowel or colon cancer
          Irritable bowel syndrome
     Renal
          Renal cell carcinoma
          Nephrolithiasis
          Pyelonephritis
     Gynecologic
          Abortion
          Septic abortion
          Ectopic pregnancy
          Endometriosis
          Pelvic inflammatory disease
          Ovarian torsion
          Ruptured ectopic pregnancy
          Ruptured ovarian cyst
          Fitz-Hugh-Curtis syndrome
     Vascular
          Abdominal aortic aneurysm
          Mesenteric ischemia     
          Splenic rupture
     Other
          Intraabdominal abscess
          Hernia

Workup (general)
     Rectal exam, stool for occult blood
          Elicits pain on the right side of the abdomen in acute appendicitis, though not very specific
     Pelvic exam
          Look for cervical motion tenderness, discharge, uterine size, adnexal masses or tenderness
     AST/ALT/bilirubin/ALP, lipase
          To look for evidence of hepatocellular injury, biliary obstruction, or pancreatitis
     U/S-abdomen
          May show gallstones, pericholecystic fluid, thickened gallbladder wall, sonographic Murphy's sign
     Upper endoscopy
          May identify lesions of: peptic ulcer, gastritis, and/or gastric cancer. Bx is required for gastric cancer dx and sometimes for H.pylori dx.
     HIDA scan
          Can document obstruction of the cystic duct in acute cholecystitis; a positive scan shows absence of filling of the gallbladder. Usually ordered after U/S if it does not establish dx of acute cholecystitis.
     H. pylori serologies
          Adequate for diagnosis but not to document cure.
     Urease breath test
          Useful to confirm H. pylori eradication in PUD
     Urine hCG
          Positive in pregnancy
          Urine and serum are equally sensistive, but obtaining quantitative levels via serum can help dx ectopic pregnancy
     Cervical cx
          N. gonorrhoeae and C. trachomatic, the main causes of PID are detected via PCR
     UA
          To rule out UTI
     CBC
          Nonspecific, but leukocytosis can suggest infection or appendicitis
     US-abdomen/pelvis
          Can help dx appendiceal or ovarian pathology.
          Transvaginal u/s can identify an intrauterine gestational sac when the time elapsed since the LMP is 35 days (this corresponds to a beta-hCG of about 1500)
          Fluid in the cul-de-sac is nonspecific and may suggest ectopic pregnancy or a ruptured ovarian cyst
     CT-abdomen/pelvis
          Can detect presence of appendiceal inflammation, abscess in appendicitis, or signs of other GI or gynecologic pathology
     Laparoscopy
          Can dx ectopic pregnancy (gold standard), ruptured ovarian cyst, ovarian torsion, PID, tubo-ovarian abscess, appendicitis, etc.

Content on this page has not been checked for accuracy. The author's credentials have not been confirmed. Always use multiple peer-reviewed scholarly sources and good clinical judgement in your decision making.

The Compendium platform was created by David Kwinter, MD, CCFP(EM).

Dr. Kwinter is a Cayman Family Doctor. He runs a Family Medicine Clinic at Cayman Medical in George Town, Grand Cayman, Cayman Islands.