Ectopic pregnancy differential diagnosis: Difference between revisions

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__NOTOC__
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{{Ectopic pregnancy}}
{{Ectopic pregnancy}}
{{CMG}};{{AE}}{{MehdiP}}
{{CMG}};{{AE}}{{MehdiP}}, [[User:MoisesRomo|Moises Romo, M.D]]


== Differentiating an Ectopic Pregnancy from other Conditions==  
== Overview ==


* Threatened or incomplete [[abortion]]
==Differentiating an Ectopic Pregnancy from other Conditions==
* Adnexal torsion
* [[Appendicitis]]
* Ruptured [[corpus luteum]] cyst
* [[Pancreatitis]]
* [[Pelvic inflammatory disease]] ([[PID]])
* [[Pyelonephritis]]


{| class="wikitable"
*Ectopic pregnancy must be differentiated from other diseases that cause abdominal pain, pelvic pain, vaginal bleeding, and/ or ammenorrhea, such as:
!
*Threatened or incomplete [[abortion]]
!Clinical Features
*[[Adnexal torsion]]
!Physical Examination
*[[Appendicitis]]
!Diagnostic Findings
*Ruptured [[corpus luteum]] cyst
|-
*[[Pancreatitis]]
|[[Endometriosis]]
*[[Pelvic inflammatory disease]] ([[PID]])
|
*[[Pyelonephritis]]
*[[Dysmenorrhea]]
*[[Dyspareunia]]
*[[Infertility]]
*Common in women between 25 to 35 years
|
*Nodules in the [[posterior fornix]]
*Adnexal masses
*Fixed retroverted [[uterus]]
*Lateral displacement of the [[cervix]]
|
*Increased [[CA-125|serum cancer antigen-125]] 
*Nodules of the [[Rectovaginal fascia|recto vaginal]] septum and hypoechoic, vascular mass on [[MRI]]
*Laproscopic visualization confirms the diagnosis
|-
|[[Adenomyosis]]<ref name="pmid16782099">{{cite journal| author=Parker JD, Leondires M, Sinaii N, Premkumar A, Nieman LK, Stratton P| title=Persistence of dysmenorrhea and nonmenstrual pain after optimal endometriosis surgery may indicate adenomyosis. | journal=Fertil Steril | year= 2006 | volume= 86 | issue= 3 | pages= 711-5 | pmid=16782099 | doi=10.1016/j.fertnstert.2006.01.030 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16782099  }}</ref>
|
*[[Abnormal uterine bleeding]]
*[[Dysmenorrhea]]
*Common in women aged 40 and 50 years
|
* Diffuse uterine enlargement always less than size corresponding to less than 12 weeks of [[gestation]]
|
*Asymmetric thickening of the [[myometrium]] on [[MRI]]
|-
|Submucous uterine [[Leiomyoma|leiomyomas]]<ref name="pmid26477496">{{cite journal| author=Donnez J, Donnez O, Matule D, Ahrendt HJ, Hudecek R, Zatik J et al.| title=Long-term medical management of uterine fibroids with ulipristal acetate. | journal=Fertil Steril | year= 2016 | volume= 105 | issue= 1 | pages= 165-173.e4 | pmid=26477496 | doi=10.1016/j.fertnstert.2015.09.032 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26477496  }}</ref>
|
*[[Menorrhagia]]
*Pelvic pressure and pain
*[[Infertility]]
*Peak age of onset 25 to 44 years of age
|
*Mobile [[uterus]] with an irregular contour
|
*[[Transvaginal ultrasound]] will demonstrate the presence of myomas
|-
|[[PID|Pelvic Inflammatory disease]]<ref name="pmid24216035">{{cite journal| author=Ross J, Judlin P, Jensen J, International Union against sexually transmitted infections| title=2012 European guideline for the management of pelvic inflammatory disease. | journal=Int J STD AIDS | year= 2014 | volume= 25 | issue= 1 | pages= 1-7 | pmid=24216035 | doi=10.1177/0956462413498714 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24216035  }}</ref>
|
*Seen in patients with history of [[sexually transmitted disease]]
*History of multiple sexual partners 
*Common in women younger than 25 years of age
|
*[[Abdominal tenderness]] 
*Acute [[Cervical motion tenderness|cervical motion]], [[Uterus|uterine]], and adnexal tenderness
*Visualization of purulent endocervical discharge 
|
*Positive [[Nucleic acid test|Nucleic acid amplification tests]] for [[Chlamydia trachomatis]] and [[Neisseria gonorrhoeae|N. gonorrhoeae]]
*Gram negative [[diplococci]] on [[gram stain]]
|-
|Pelvic congestion Syndrome<ref name="pmid11133549">{{cite journal| author=Rozenblit AM, Ricci ZJ, Tuvia J, Amis ES| title=Incompetent and dilated ovarian veins: a common CT finding in asymptomatic parous women. | journal=AJR Am J Roentgenol | year= 2001 | volume= 176 | issue= 1 | pages= 119-22 | pmid=11133549 | doi=10.2214/ajr.176.1.1760119 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11133549  }}</ref>
|
*Shifting lower abdominal pain
*Deep [[dyspareunia]]
*Post-coital pain
*Exacerbation of pain after prolonged standing 
|
*Bimanual tenderness
*[[Cervical motion tenderness]]
|
*Pelvic [[varicosities]] on ultrasound with reduced blood flow
|}
Endometriosis should also be differentiated from conditions that present with [[lower abdominal pain]] in young women. The following is a list of diseases that present with acute onset severe lower abdominal pain:
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
|+
! style="background: #4479BA; width: 180px;" | {{fontcolor|#000|Disease}}
! style="background: #4479BA; width: 650px;" | {{fontcolor|#000|Findings}}
|-
| style="padding: 7px 7px; background: #DCDCDC;" | '''[[Ectopic pregnancy]]'''
| style="padding: 7px 7px; background: #F5F5F5;" | History of missed menses, positive [[pregnancy test]], [[ultrasound]] reveals an empty [[uterus]] and may show a mass in the [[fallopian tubes]].<ref name="pmid27720100">{{cite journal |vauthors=Morin L, Cargill YM, Glanc P |title=Ultrasound Evaluation of First Trimester Complications of Pregnancy |journal=J Obstet Gynaecol Can |volume=38 |issue=10 |pages=982–988 |year=2016 |pmid=27720100 |doi=10.1016/j.jogc.2016.06.001 |url=}}</ref>
|-
| style="padding: 7px 7px; background: #DCDCDC;" |'''[[Appendicitis]]'''
| style="padding: 7px 7px; background: #F5F5F5;" |Pain localized to the [[right iliac fossa]], [[vomiting]], [[Ultrasound|abdominal ultrasound]] [[Sensitivity (tests)|sensitivity]] for diagnosis of [[acute appendicitis]] is 75% to 90%.<ref name="pmid8259423">{{cite journal |vauthors=Balthazar EJ, Birnbaum BA, Yee J, Megibow AJ, Roshkow J, Gray C |title=Acute appendicitis: CT and US correlation in 100 patients |journal=Radiology |volume=190 |issue=1 |pages=31–5 |year=1994 |pmid=8259423 |doi=10.1148/radiology.190.1.8259423 |url=}}</ref>
|-
| style="padding: 7px 7px; background: #DCDCDC;" | '''Ruptured[[ ovarian cyst]]'''
| style="padding: 7px 7px; background: #F5F5F5;" |Usually spontaneous, can follow history of trauma, mild chronic lower abdominal discomfort may suddenly intensify, [[ultrasound]] is diagnostic.<ref name="pmid19299205">{{cite journal |vauthors=Bottomley C, Bourne T |title=Diagnosis and management of ovarian cyst accidents |journal=Best Pract Res Clin Obstet Gynaecol |volume=23 |issue=5 |pages=711–24 |year=2009 |pmid=19299205 |doi=10.1016/j.bpobgyn.2009.02.001 |url=}}</ref>
|-
| style="padding: 7px 7px; background: #DCDCDC;" | '''[[Ovarian cyst ]]torsion'''
| style="padding: 7px 7px; background: #F5F5F5;" |Presents with acute severe unilateral [[Lower abdominal pain|lower quadrant abdominal pain]], [[nausea and vomiting]], tender adnexal mass palpated in 90%, [[ultrasound]] is diagnostic.<ref name="pmid26760839">{{cite journal |vauthors=Bhavsar AK, Gelner EJ, Shorma T |title=Common Questions About the Evaluation of Acute Pelvic Pain |journal=Am Fam Physician |volume=93 |issue=1 |pages=41–8 |year=2016 |pmid=26760839 |doi= |url=}}</ref>
|-
| style="padding: 7px 7px; background: #DCDCDC;" | '''Hemorrhagic [[ovarian cyst]]'''
| style="padding: 7px 7px; background: #F5F5F5;" |Presents with [[Abdominal pain|localized abdominal pain]], [[nausea and vomiting]]. [[Hypovolemic shock]] may be present, [[abdominal tenderness]] and guarding are physical exam findings, [[ultrasound]] is diagnostic.<ref name="pmid26760839">{{cite journal |vauthors=Bhavsar AK, Gelner EJ, Shorma T |title=Common Questions About the Evaluation of Acute Pelvic Pain |journal=Am Fam Physician |volume=93 |issue=1 |pages=41–8 |year=2016 |pmid=26760839 |doi= |url=}}</ref>
|-
| style="padding: 7px 7px; background: #DCDCDC;" | '''[[Endometriosis]]'''
| style="padding: 7px 7px; background: #F5F5F5;" |Presents with cyclic pain that is exacerbated by onset of menses, [[dyspareunia]]. [[Laparoscopy|laparoscopic]] exploration is diagnostic.<ref name="pmid26760839">{{cite journal |vauthors=Bhavsar AK, Gelner EJ, Shorma T |title=Common Questions About the Evaluation of Acute Pelvic Pain |journal=Am Fam Physician |volume=93 |issue=1 |pages=41–8 |year=2016 |pmid=26760839 |doi= |url=}}</ref>
|-
| style="padding: 7px 7px; background: #DCDCDC;" | '''[[Acute cystitis]]'''
| style="padding: 7px 7px; background: #F5F5F5;" |Presents with features of increased urinary [[frequency]], [[urgency]], [[dysuria]], and suprapubic pain.<ref>{{Cite journal
<nowiki> </nowiki><nowiki>|</nowiki> author = [[W. E. Stamm]]
| title = Etiology and management of the acute urethral syndrome
| journal = [[Sexually transmitted diseases]]
| volume = 8
| issue = 3
| pages = 235–238
| year = 1981
| month = July-September
| pmid = 7292216
</ref><ref>{{Cite journal
<nowiki> </nowiki><nowiki>|</nowiki> author = [[W. E. Stamm]], [[K. F. Wagner]], [[R. Amsel]], [[E. R. Alexander]], [[M. Turck]], [[G. W. Counts]] & [[K. K. Holmes]]
| title = Causes of the acute urethral syndrome in women
| journal = [[The New England journal of medicine]]
| volume = 303
| issue = 8
| pages = 409–415
| year = 1980
| month = August
| doi = 10.1056/NEJM198008213030801
| pmid = 6993946</ref>
|}




{| align="center"
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| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
! colspan="2" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" | Classification of acute abdomen based on etiology
! colspan="2" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Classification of acute abdomen based  
on etiology
! colspan="1" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Presentation
! colspan="1" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Presentation
! colspan="3" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" | Symptoms
! colspan="8" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" |Clinical findings
! colspan="3" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" | Signs
! colspan="2" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" |Diagnosis
! colspan="2" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" | Diagnosis
! colspan="1" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Comments
! colspan="1" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" | Comments
|-
|-
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" | Fever  
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" |Fever
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" |Rigors and Chills
! align="center" style="background:#4479BA; color: #FFFFFF;" |Abdominal Pain
! align="center" style="background:#4479BA; color: #FFFFFF;" |Abdominal Pain
! align="center" style="background:#4479BA; color: #FFFFFF;" |Jaundice  
! align="center" style="background:#4479BA; color: #FFFFFF;" |Jaundice
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" | Guarding
! align="center" style="background:#4479BA; color: #FFFFFF;" |Hypotension
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" |Guarding
! align="center" style="background:#4479BA; color: #FFFFFF;" |Rebound Tenderness
! align="center" style="background:#4479BA; color: #FFFFFF;" |Rebound Tenderness
! align="center" style="background:#4479BA; color: #FFFFFF;" |Bowel sounds
! align="center" style="background:#4479BA; color: #FFFFFF;" |Bowel sounds
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" | Lab Findings
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" |Lab Findings
! align="center" style="background:#4479BA; color: #FFFFFF;" |Imaging
! align="center" style="background:#4479BA; color: #FFFFFF;" |Imaging
|-
|-
! colspan="1" rowspan="8" style="padding: 5px 5px; background: #DCDCDC;" align="center" | Common causes of Peritonitis
| colspan="2" rowspan="8" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Common causes of  
! colspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | Primary Peritonitis
Peritonitis
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | [[Spontaneous bacterial peritonitis]]
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Spontaneous bacterial peritonitis]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Diffuse
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Diffuse
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
|−
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hypoactive
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Ascitic fluid [[PMN]]>250 cells/mm<small>³</small>
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hypoactive
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*Ascitic fluid [[PMN]]>250 cells/mm<small>³</small>


* Culture: Positive for single organism  
*Culture: Positive for single organism
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound for evaluation of liver cirrhosis
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound for evaluation of liver cirrhosis
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
|-
|-
! colspan="1" rowspan="7" style="padding: 5px 5px; background: #DCDCDC;" align="center" | Secondary Peritonitis
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Perforated [[Gastric ulcer|gastric]] and [[duodenal ulcer]]
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | Perforated [[Gastric ulcer|gastric]] and [[duodenal ulcer]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | Diffuse
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Diffuse
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
* Ascitic fluid
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
** [[LDH]] > serum [[LDH]]
*Ascitic fluid
 
**[[LDH]] > serum [[LDH]]
** Glucose < 50mg/dl
**Glucose < 50mg/dl
 
**Total protein > 1g/dl
** Total protein > 1g/dl  


|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Air under [[diaphragm]] in upright [[CXR]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Air under [[diaphragm]] in upright [[CXR]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Upper GI [[endoscopy]] for diagnosis
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Upper GI [[endoscopy]] for diagnosis
|-
|-
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | Acute cholangitis  
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Acute suppurative cholangitis
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | [[RUQ]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[RUQ]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Abnormal [[LFT]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound shows [[biliary]] dilatation
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |±
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Biliary drainage ([[Endoscopic retrograde cholangiopancreatography|ERCP]]) + IV antibiotics
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|-
|-
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | [[Acute cholecystitis|Acute cholecystitis]]
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Acute cholangitis
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | [[RUQ]]
|−
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[RUQ]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
|−
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hypoactive
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Hyperbilirubinemia]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
* [[Leukocytosis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Abnormal [[LFT]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound shows gallstone and evidence of inflammation
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound shows [[biliary]] dilatation
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Murphy's sign|Murphy’s sign]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Biliary drainage ([[Endoscopic retrograde cholangiopancreatography|ERCP]]) + IV antibiotics
|-
|-
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | [[Acute pancreatitis]]
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Acute Cholecystitis|Acute cholecystitis]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | [[Epigastric]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | +/-
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[RUQ]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Increased [[amylase]] / [[lipase]]  
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound shows evidence of [[inflammation]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hypoactive
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Pain radiation to back
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Hyperbilirubinemia]]
*[[Leukocytosis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound shows gallstone and evidence of inflammation
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Murphy's sign|Murphy’s sign]]
|-
|-
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | [[Acute appendicitis]]
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Acute pancreatitis]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | RLQ
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Epigastric]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |±
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hypoactive
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Leukocytosis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |−
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound shows evidence of [[inflammation]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Nausea and vomiting|Nausea & vomiting]], [[decreased appetite]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Increased [[amylase]] / [[lipase]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound shows evidence of [[inflammation]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Pain radiation to back
|-
|-
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | [[Diverticulitis|Acute diverticulitis]]
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Acute appendicitis]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | LLQ
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | +/-
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |RLQ
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |−
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hypoactive
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Leukocytosis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |CT scan and ultrasound shows evidence of inflammation
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hypoactive
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Leukocytosis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound shows evidence of [[inflammation]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Nausea and vomiting|Nausea & vomiting]], [[decreased appetite]]
|-
|-
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | [[Salpingitis|Acute salpingitis]]
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Diverticulitis|Acute diverticulitis]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | LLQ/ RLQ
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |LLQ
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | +/-
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |±
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | +/-
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Leukocytosis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Pelvic ultrasound]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hypoactive
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Vaginal discharge]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Leukocytosis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |CT scan and ultrasound shows evidence of inflammation
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|-
|-
! colspan="2" rowspan="4" style="padding: 5px 5px; background: #DCDCDC;" align="center" | Hollow Viscous Obstruction  
| colspan="2" rowspan="5" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Hollow Viscous Obstruction
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Small intestine obstruction
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Small intestine obstruction
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Diffuse
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Diffuse
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | +/-
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hyperactive then absent
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Leukocytosis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |±
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Abdominal X-ray|Abdominal X ray]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hyperactive then absent
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Nausea and vomiting|Nausea & vomiting]] associated with [[constipation]], [[Abdominal distension|abdominal distention]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Leukocytosis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Abdominal X-ray|Abdominal X ray]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Nausea and vomiting|Nausea & vomiting]] associated with [[constipation]], [[Abdominal distension|abdominal distention]]
|-
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Gall stone disease|Gall stone '''disease''']]/'''Cholelithiasis'''
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |±
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |−
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Volvulus]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Diffuse
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>+</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hypoactive
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Leukocytosis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |CT scan and [[Abdominal x-ray|abdominal X ray]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Nausea and vomiting|Nausea & vomiting]] associated with [[constipation]], [[Abdominal distension|abdominal distention]]
|-
|-
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Volvulus]]
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Biliary colic]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Diffuse
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |RUQ
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>+</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hypoactive
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Leukocytosis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |CT scan and [[Abdominal x-ray|abdominal X ray]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Nausea and vomiting|Nausea & vomiting]] associated with [[constipation]], [[Abdominal distension|abdominal distention]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Increased [[bilirubin]] and [[alkaline phosphatase]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Nausea and vomiting|Nausea & vomiting]]
|-
|-
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Biliary colic]]
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Renal colic]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |RUQ
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |+
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Flank pain]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Increased [[bilirubin]] and [[alkaline phosphatase]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Nausea and vomiting|Nausea & vomiting]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Hematuria]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |CT scan and ultrasound
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Colicky [[abdominal pain]] associated with [[Nausea and vomiting|nausea & vomiting]]
|-
|-
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Renal colic]]
| rowspan="4" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Vascular Disorders
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
| rowspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Ischemic causes
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Flank pain]]
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Mesenteric ischemia]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |±
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Periumbilical
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Hematuria]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |CT scan and ultrasound
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Colicky [[abdominal pain]] associated with [[Nausea and vomiting|nausea & vomiting]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hyperactive
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Leukocytosis]] and [[lactic acidosis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |CT scan
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Nausea and vomiting|Nausea & vomiting]], normal physical examination
|-
|-
! rowspan="4" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Vascular Disorders
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Ischemic colitis|Acute ischemic colitis]]
! rowspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Ischemic causes
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |±
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Mesenteric ischemia]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>+/-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Diffuse
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Periumbilical
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>+</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>+</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hyperactive
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hyperactive then absent
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Leukocytosis]] and [[lactic acidosis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Leukocytosis]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |CT scan
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |CT scan
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Nausea and vomiting|Nausea & vomiting]], normal physical examination
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Nausea and vomiting|Nausea & vomiting]]
|-
|-
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Ischemic colitis|Acute ischemic colitis]]
| rowspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Hemorrhagic causes
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>+/-</nowiki>
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Ruptured abdominal aortic aneurysm]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Diffuse
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>+</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Diffuse
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>+</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hyperactive then absent
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Leukocytosis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |CT scan
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Nausea and vomiting|Nausea & vomiting]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Normal
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |CT scan
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Unstable hemodynamics
|-
|-
! rowspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Hemorrhagic causes
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |Intra-abdominal or [[retroperitoneal hemorrhage]]
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Ruptured abdominal aortic aneurysm]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Diffuse
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Diffuse
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Normal
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |CT scan  
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Anemia]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Unstable hemodynamics
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |CT scan
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |History of [[trauma]]
|-
|-
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |Intra-abdominal or [[retroperitoneal hemorrhage]]
| rowspan="5" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Gynaecological Causes
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |Fallopian tube
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Diffuse
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Salpingitis|Acute salpingitis]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |LLQ/ RLQ
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Anemia]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |CT scan
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |±
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |History of [[trauma]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |±
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Leukocytosis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Pelvic ultrasound]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Vaginal discharge]]
|-
|-
! rowspan="3" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Gynaecological Causes
| rowspan="3" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Ovarian cyst]] complications and endometrial disease
! rowspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Ovarian cyst|Ovarian Cyst]] Complications
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |Torsion of the cyst
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |Torsion of the cyst
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |RLQ / LLQ
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |RLQ / LLQ
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>+/-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>+/-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |±
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |±
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Increased [[ESR]] and [[CRP]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Increased [[ESR]] and [[CRP]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Sudden onset sever pain with [[nausea and vomiting]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Sudden onset severe pain with [[nausea and vomiting]]
|-
|-
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |Cyst rupture
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |Endometriosis
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
| -
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |RLQ / LLQ
|
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
|RLQ/LLQ
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>+/-</nowiki>
| -
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>+/-</nowiki>
|
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
| +/-
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Increased [[ESR]] and [[CRP]]
| +/-
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound
|N
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Sudden onset sever pain with [[nausea and vomiting]]
|Normal
|Laproscopy
|Menstrual-associated symptoms, pelvic
symptoms
|-
|-
!style="padding: 5px 5px; background: #DCDCDC;" align="center" |Pregnancy
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |Cyst rupture
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |Ruptured [[ectopic pregnancy]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |RLQ / LLQ
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |RLQ / LLQ
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>+/-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>+/-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Positive [[pregnancy test]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Increased [[ESR]] and [[CRP]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |History of missed period and [[vaginal bleeding]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Sudden onset severe pain with [[nausea and vomiting]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |Pregnancy
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |Ruptured [[ectopic pregnancy]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |RLQ / LLQ
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Positive [[pregnancy test]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |History of missed period and [[vaginal bleeding]]
|-
| rowspan="4" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Functional
| colspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Irritable Bowel Syndrome
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Diffuse
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
| align="left" style="padding: 5px 5px; background: #F5F5F5;" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
[[Diagnosis|Clinical diagnosis]]
 
*ROME III/IV criteria
*[[Pharmacological|Pharmacologic]] studies based criteria
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*High [[dietary fiber]]
 
*[[Osmotic]] [[laxatives]]
*[[Antispasmodic]]<nowiki/>drugs
|-
|-
|}
|}
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{{WH}}
{{WS}}
{{WS}}
[[Category:Needs overview]]
[[Category:Needs overview]]
[[Category:Disease]]
[[Category:Disease]]
[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
[[Category:Obstetrics]]
[[Category:Obstetrics]]
[[Category:primary care]]
|}

Latest revision as of 15:32, 18 February 2021

Ectopic pregnancy Microchapters

Home

Patient Information

Overview

Pathophysiology

Causes

Differentiating an Ectopic Pregnancy from other Conditions

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

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Case #1

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Risk calculators and risk factors for Ectopic pregnancy differential diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2], Moises Romo, M.D

Overview

Differentiating an Ectopic Pregnancy from other Conditions


Classification of acute abdomen based

on etiology

Presentation Clinical findings Diagnosis Comments
Fever Rigors and Chills Abdominal Pain Jaundice Hypotension Guarding Rebound Tenderness Bowel sounds Lab Findings Imaging
Common causes of

Peritonitis

Spontaneous bacterial peritonitis + Diffuse Hypoactive
  • Ascitic fluid PMN>250 cells/mm³
  • Culture: Positive for single organism
Ultrasound for evaluation of liver cirrhosis -
Perforated gastric and duodenal ulcer + Diffuse + + + N
  • Ascitic fluid
    • LDH > serum LDH
    • Glucose < 50mg/dl
    • Total protein > 1g/dl
Air under diaphragm in upright CXR Upper GI endoscopy for diagnosis
Acute suppurative cholangitis + + RUQ + + + + ±
Acute cholangitis + RUQ + N Abnormal LFT Ultrasound shows biliary dilatation Biliary drainage (ERCP) + IV antibiotics
Acute cholecystitis + RUQ + Hypoactive Ultrasound shows gallstone and evidence of inflammation Murphy’s sign
Acute pancreatitis + Epigastric ± N Increased amylase / lipase Ultrasound shows evidence of inflammation Pain radiation to back
Acute appendicitis + RLQ + + Hypoactive Leukocytosis Ultrasound shows evidence of inflammation Nausea & vomiting, decreased appetite
Acute diverticulitis + LLQ ± + Hypoactive Leukocytosis CT scan and ultrasound shows evidence of inflammation
Hollow Viscous Obstruction Small intestine obstruction Diffuse + ± Hyperactive then absent Leukocytosis Abdominal X ray Nausea & vomiting associated with constipation, abdominal distention
Gall stone disease/Cholelithiasis ±
Volvulus - Diffuse - + - Hypoactive Leukocytosis CT scan and abdominal X ray Nausea & vomiting associated with constipation, abdominal distention
Biliary colic - RUQ + - - N Increased bilirubin and alkaline phosphatase Ultrasound Nausea & vomiting
Renal colic - Flank pain - - - N Hematuria CT scan and ultrasound Colicky abdominal pain associated with nausea & vomiting
Vascular Disorders Ischemic causes Mesenteric ischemia ± Periumbilical - - - Hyperactive Leukocytosis and lactic acidosis CT scan Nausea & vomiting, normal physical examination
Acute ischemic colitis ± Diffuse - + + Hyperactive then absent Leukocytosis CT scan Nausea & vomiting
Hemorrhagic causes Ruptured abdominal aortic aneurysm - Diffuse - - - N Normal CT scan Unstable hemodynamics
Intra-abdominal or retroperitoneal hemorrhage - Diffuse - - - N Anemia CT scan History of trauma
Gynaecological Causes Fallopian tube Acute salpingitis + LLQ/ RLQ ± ± N Leukocytosis Pelvic ultrasound Vaginal discharge
Ovarian cyst complications and endometrial disease Torsion of the cyst - RLQ / LLQ - ± ± N Increased ESR and CRP Ultrasound Sudden onset severe pain with nausea and vomiting
Endometriosis - RLQ/LLQ - +/- +/- N Normal Laproscopy Menstrual-associated symptoms, pelvic

symptoms

Cyst rupture - RLQ / LLQ - +/- +/- N Increased ESR and CRP Ultrasound Sudden onset severe pain with nausea and vomiting
Pregnancy Ruptured ectopic pregnancy - RLQ / LLQ - - - N Positive pregnancy test Ultrasound History of missed period and vaginal bleeding
Functional Irritable Bowel Syndrome - Diffuse - - - - N

Clinical diagnosis

-

References

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