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Surgical sieve
🩻 Abdominal pain
Where is it, does it radiate, and is the abdomen soft? Peritonism means surgeons now.
| Ruptured AAA Must exclude | Back/flank pain, pulsatile mass, hypotension. Frequently misdiagnosed as renal colic.If unstable — theatre. If stable — CT angiogram. |
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| Mesenteric ischaemia Must exclude | Pain out of all proportion to a soft abdomen. Raised lactate. AF is the classic risk factor.CT angiogram, urgent surgical referral. |
| Perforated viscus Must exclude | Sudden severe pain, rigid abdomen, absent bowel sounds. Free air under the diaphragm.Erect CXR / CT, NBM, IV antibiotics, surgeons. |
| Ruptured ectopic pregnancy Must exclude | Any woman of childbearing age with abdominal pain — until a pregnancy test says otherwise.βhCG in EVERY such patient. Urgent USS. |
| Ascending cholangitis Must exclude | Charcot's triad: RUQ pain, jaundice, fever. Add hypotension and confusion for Reynolds' pentad.Cultures, antibiotics, urgent ERCP. |
| Acute pancreatitis Time-sensitive | Epigastric pain radiating to back, relieved sitting forward. Amylase/lipase.Fluids, analgesia, modified Glasgow score, USS for gallstones. |
| Appendicitis Time-sensitive | Central pain migrating to RIF, anorexia, low-grade fever, tenderness at McBurney's point.Bloods, USS/CT, surgical review. |
| Bowel obstruction Time-sensitive | Colicky pain, vomiting, distension, absolute constipation. Previous surgery, hernias.AXR/CT, NBM, NG tube, IV fluids, surgeons. |
| Acute cholecystitis Time-sensitive | RUQ pain, Murphy's sign, fever — but not jaundiced (that suggests cholangitis).USS, antibiotics, surgical review. |
| Diverticulitis Time-sensitive | LIF pain, fever, altered bowel habit. Older patients.CT, antibiotics; watch for perforation or abscess. |
| Urinary retention Time-sensitive | Suprapubic pain and palpable bladder. Confusion may be the only sign in the frail.Bladder scan and catheterise. Always exclude cauda equina. |
| Renal colic Time-sensitive | Loin to groin, unable to lie still, haematuria.CT KUB. In over-50s always consider AAA first. |
| DKA Time-sensitive | Abdominal pain with vomiting can be the presenting feature of DKA.Glucose, ketones, VBG. |
| Constipation / faecal loading Common | Common in the elderly, on opioids, immobile. PR examination. |
| Gastroenteritis Common | Diarrhoea and vomiting, contacts affected, soft abdomen. |
| Inferior MI Consider | Inferior MI can present as epigastric pain and vomiting — do an ECG.ECG in every epigastric pain over 40. |
16 differentials · 14 open a full pathway in the app.