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| <span style="font-size:85%"> '''Abbreviations:''' '''ACS:''' Acute coronary syndrome; '''AAA:''' Abdominal aortic aneurysm; '''RUQ:''' Right upper quadrant; '''RLQ:''' Right lower quadrant; '''LUQ:''' Left upper quadrant; '''LLQ:''' Left lower quadrant</span>
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| {{familytree/start |summary=Acute abdominal pain}}
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| {{familytree | | | | | | | | | | | | | | A01 | | | | | | | |A01=<div style="float: left; text-align: left; width: 20em; padding:1em;">'''Abdominal mass'''
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| <br>
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| '''Associated [[pain]]:'''<br>
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| :❑ Site (eg, a particular quadrant or diffuse, a change in location may reflect progression of the [[disease]]
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| :❑ Onset (eg, sudden, gradual)
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| :❑ Quality (eg, dull, sharp, colicky, waxing and waning)
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| :❑ Aggravating and relieving factors (e.g, Is the pain related to your meals?)
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| :❑ Intensity (scale of 0-10/ 0-5 with the maximum number; 10/5 being the worst pain of life)
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| :❑ Time course (eg, hours versus weeks, constant or intermittent)
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| :❑ Radiation (eg, to the shoulder, back, flank, groin, or chest)<br>
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| '''Associated [[symptoms]]'''<br>
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| :❑ [[Shortness of breath]]
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| :❑ [[Altered mental status]]
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| :❑ [[Nausea]] & [[vomiting]]
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| :❑ [[Diaphoresis]]
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| :❑ [[Fever]]
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| :❑ [[Hematuria]]
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| :❑ [[Anorexia]]
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| :❑ [[Bloody stool]]
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| :❑ [[Weight loss]]
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| :❑ [[Vaginal discharge]]
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| :❑ [[Penile discharge]]
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| :❑ [[Jaundice]]
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| :❑ [[Mal-digestion]]
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| :❑ [[Flatulence]]
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| :❑ [[Fatigue]]
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| :❑ Recent [[trauma]]
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| :❑ Symptoms suggestive of [[Sepsis history and symptoms|sepsis]]
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| '''Detailed history:'''<br>
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| :❑ Age (Patients above 50 years old are more likely to have severe diseases or cancers, such as ruptured [[abdominal aortic aneurysm]] or [[colon cancer]])
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| :❑ Past medical history
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| :❑ Past surgical history (for previous abdominal surgeries)
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| :❑ Menstrual and contraceptive history (pregnancy should be excluded in all women of childbearing age with abdominal mass)
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| :❑ Social history (alcohol abuse predispose to pancreatitis and hepatitis, smoking also predisposes to different types of cancers, eg. cancer bladder, which may cause abdominal pain)
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| :❑ Occupational history (exposure to chemicals or toxins)
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| :❑ Travel history
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| :❑ Medications (for over the counter drugs as</div>}}
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| {{familytree | | | | | | | | | | | | | | |!| | | | | | | | |}}
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| {{familytree | | | | | | | | | | | | | | A02 | | | | | | A02= <div style="float: left; text-align: left; width: 20em; padding:1em;"> '''Examine the patient:''' <br>
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| ❑ Vital signs<br>
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| :❑ [[Temperature]]<br>
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| :❑ [[Heart rate]] ([[tachycardia]]) <br>
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| :❑ [[Blood pressure]] ([[hypotension]])<br>
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| :❑ [[Respiratory rate]] ([[tachypnea]])<br>
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| ❑ Skin <br>
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| :❑ [[Diaphoresis]]
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| :❑ [[Pallor]]
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| :❑ [[Jaundice]]
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| :❑ [[Dehydration]]
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| ❑ Inspection <br>
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| :❑ If the patient is lying still in bed with knees bent, this is suggestive of organ rupture and resulting [[peritonitis]]<br>
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| :❑ Signs of previous surgery<br>
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| :❑ Abdominal pulsations<br>
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| :❑ Signs of systemic disease eg,<br>
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| ::❑ [[Pallor]], suggestive of bleeding<br>
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| ::❑ [[Spider angiomata]], suggestive of [[cirrhosis]]<br>
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| ❑ Auscultation <br>
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| :❑ Abdominal crepitations<br>
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| :❑ Reduced bowel sounds<br>
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| :❑ Increased bowel sounds<br>
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| :❑ Bruit, suggestive of [[abdominal aortic aneurysm]]<br>
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| ❑ Palpation<br>
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| :❑ Rigidity
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| :❑ [[Guarding]]
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| :❑ Abdominal tenderness
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| :❑ [[Distension]]
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| :❑ Detection of masses on palpating the abdomen
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| :❑ [[Carnett's sign]]
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| ❑ [[Psoas sign]] (suggestive of retrocecal appendix)<br>
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| ❑ [[Cullen's sign]]<br>
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| ❑ [[Grey-Turner's sign]]<br>
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| ❑ [[Digital rectal exam]] (tenderness may be present in retrocecal appendicitis)<br>
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| ❑ [[Pelvic exam]] in females<br>
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| ❑ [[Testicular examination]] in males<br>
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| ❑ Cardiovascular system<br>
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| ❑ Respiratory system<br>
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| ❑ Anorectal (bleeding)<br>
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| ❑ [[Signs of sepsis]]: [[tachycardia]], decreased urination, and [[hyperglycemia]], [[confusion]], [[metabolic acidosis]] with compensatory [[respiratory alkalosis]], [[low blood pressure]], decreased [[systemic vascular resistance]], higher [[cardiac output]], and [[coagulation]] dysfunctions<br>
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| </div>}}
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| {{familytree | | | | | | | | | | | | | | |!| | | | | | | }}
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| {{familytree | | | | | | | | | | | | | | C01 | | | | | | | |C01=<div style="float: left; text-align: left; width: 20em; padding:1em;">'''Consider extraabdominal differential diagnosis:'''<BR> ❑ aaaa</div>}}
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| {{familytree | | | | | | | | | | | | | | |!| | | | | | | }}
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| {{familytree | | | | | | | | | | | | | | E01 | | | | | | | | | |E01=❑ Assess hemodynamic stability }}
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| {{familytree | | | | | | | | | | | | | | |!| | | | | | | | | |}}
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| {{familytree | | | | | | | | | | | | | | Z02 | | | | | | | | |Z02=<div style="float: left; text-align: left; line-height: 150% ">'''If the patient is unstable,''' <br> '''Stabilize the patient:'''<br> ❑ Establish two large-bore intravenous peripheral lines<br> ❑ [[NPO]] until the patient is stable<br> ❑ Supportive care (fluids and electrolyes as required)<br> ❑ Place nasogastric tube if there is bleeding, obstruction, significant [[nausea]] or [[vomiting]]<br> ❑ Place [[foley catheter]] to monitor volume status<br> ❑ Cardiac monitoring<br> ❑ Supplemental oxygen as needed<br> ❑ Administer early antibiotics if indicated </div>}}
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| {{familytree | | | | | | | | | | | | | | |!| | | | | | | | | |}}
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| {{familytree | | | | | | | | | | | | | | Z01 | | | | | | | | | | |Z01 =<div style="float: left; text-align: left; line-height: 150% ">'''If the patient is stable,'''<br> '''Order laboratory tests:'''<br> ❑ [[Pregnancy test]] (required in women of child-bearing age) <br>❑ [[CBC]], [[Hematocrit]]<br> ❑ [[Urinalysis]]<br> ❑[[ESR]]<br>❑ [[ABG]]<br> ❑ [[D dimer]]<br>❑ [[Serum lactate]]<br> ❑ [[BMP]] ([[urea]], [[creatinine]], [[serum electrolytes]], [[BSL]]) <br> ❑ [[Amylase]] <br> ❑ [[Lipase]] <br> ❑ [[Triglyceride]] <br>❑[[Liver function tests]] (total [[bilirubin]], direct [[bilirubin]], [[albumin]], [[AST]], [[ALT]], [[Alkaline phosphatase]], [[GGT]])
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| ----
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| '''Order imaging studies:''' <br> ❑ Order urgent trans abdominal [[ultrasound]] (TAUSG)<br> ❑ [[Abdominal CT]]<br> ❑ [[ECG]]<br> ❑ [[MRCP]] <br> ❑ [[Abdominal x-ray]] <br> ❑ [[Angiography]]<br> ❑ Diagnostic [[paracentesis]]<br>
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| ----
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| '''''*Order the tests to rule in a suspected diagnosis<br> or to assess a case of unclear etiology'''''<br> '''''*In case of elderly patients, immunocompromised<br> or those unable to provide a comprehensive<br> history, order broader range of tests''''' </div>}}
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| {{familytree | | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | |}}
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| {{familytree | | | | | | | | | | | | | | A01 | | | | | |A01=<div style="float: left; text-align: left; line-height: 150% "> '''Signs of [[peritonitis]] or [[shock]]'''<br> ❑ [[Fever]]<br> ❑ Abdominal tenderness<br> ❑ Abdominal gaurding<br> ❑ Rebound tenderness ([[blumberg sign]])<br> ❑ Diffuse abdominal rigidity<br> ❑ [[Confusion]]<br> ❑ Weakness<br> ❑ Low blood pressure <br> ❑ Decreased urine output<br> ❑ Tachycardia<br> </div>}}
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| {{familytree | | | | | | | |,|-|-|-|-|-|-|^|-|-|-|-|-|-|.| }}
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| {{familytree | | | | | | | C01 |-|-|-|-|-|.| | | | | | C03 | | | | | | | |C01=No|C02=No|C03=Yes}}
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| {{familytree | | | | | | | |!| | | | | | |!| | | | | | |!| }}
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| {{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | }}
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| {{familytree/end}}
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| {| style="border: 2px solid #4479BA; align="left"
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| ! style="width: 100px; background: #4479BA;" | {{fontcolor|#FFF|Cause of abdominal mass}}
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| ! style="width: 300px; background: #4479BA;" | {{fontcolor|#FFF|CT scan finding}}
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| ! style="width: 300px; background: #4479BA;" | {{fontcolor|#FFF|Ultrasound finding}}
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| ! style="width: 300px; background: #4479BA;" | {{fontcolor|#FFF|MRI finding}}
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| |-
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| | style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Hepatic cyst]]
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| | style="padding: 0 5px; background: #F5F5F5; text-align: left;" | Reserved for more complicated cases.
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| For more information [[Hepatic cysts|click here]]
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| | style="padding: 0 5px; background: #F5F5F5; text-align: left;" | Most useful initial test.
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| Assess cyst size, type, location within the liver, type, and anatomic relations with surroundings.
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| | style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Hemangioma]]s
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| | style="padding: 0 5px; background: #F5F5F5; text-align: left;" | Asymmetric peripheral enhancement on IV contrast (diagnostic potential)
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| | style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Hepatic adenoma]]s
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| | style="padding: 0 5px; background: #F5F5F5; text-align: left;" | Well-circumscribed hypo-intense lesions.
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| | style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Hepatocellular carcinoma]]
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| | style="padding: 0 5px; background: #F5F5F5; text-align: left;" | Diffuse enhancement with arterial phase contrast, and then washout during delayed venous images.
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| | style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Focal nodular hyperplasia]]
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| | style="padding: 0 5px; background: #F5F5F5; text-align: left;" | Well-circumscribed mass with central stellate scar. With IV contrast hyperintense on
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| arterial phase and isodense on venous phase.
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| | style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Cholangiocarcinoma]]
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| | style="padding: 0 5px; background: #F5F5F5; text-align: left;" | he tumor tends to occur in the periphery of the liver
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| |}
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