Abdominal Pain Differential

Associated GI symptoms

Nausea/vomiting, diarrhea/constipation, hematemesis, melena, hematochezia, jaundice, dark urine, gray stools, fevers, weight change.

Parietal (somatic) pain

Sharp, constant, well‑localized; due to parietal peritoneum irritation.

Visceral pain

Dull, crampy, poorly localized; follows embryologic origin of organ.

Referred pain

Pain perceived at dermatome sharing spinal pathway with visceral organ. Poorly localized

Foregut visceral pain location

Epigastric (esophagus, stomach, duodenum, pancreas, liver, gallbladder).

Midgut visceral pain location

Periumbilical (jejunum, ileum, appendix, cecum, proximal colon).

Hindgut visceral pain location

Lower abdomen/LLQ (distal colon, sigmoid, rectum).

Epigastric pain differential

GERD, gastric ulcer, duodenal ulcer, dyspepsia, gastroparesis, biliary disease, pancreas disease.

RUQ pain differential

Biliary colic, acute cholecystitis, ascending cholangitis, hepatic abscess, hepatitis.

LUQ pain differential

Splenic rupture, splenic abscess, pancreatitis, pancreatic cancer.

Periumbilical pain differential

Small bowel obstruction, small bowel ischemia, small bowel infarction.

RLQ pain differential

Appendicitis, Crohn’s disease.

LLQ pain differential

Diverticulitis, Ulcerative colitis, infectious colitis, ischemic colitis, colon cancer.

Suprapubic pain differential

Cystitis(inflammation of bladder), prostatitis, Pelvic inflammatory disease.

Classic appendicitis progression

Poorly localized epigastric/periumbilical pain → nausea → RLQ pain → fever, leukocytosis.

Pain worsened by eating

GERD, gastric ulcer, dyspepsia, partial SBO, biliary colic, pancreatitis, mesenteric ischemia.

Pain relieved by eating

Duodenal ulcer.

Abdominal pain + blood loss differential

GERD, PUD, cancer, IBD, invasive infection, ischemic gut, ischemic colitis, AMI.

Abdominal pain + fever differential

Gastroenteritis, IBD, cholecystitis, cholangitis, hepatic abscess, pancreatitis, appendicitis, diverticulitis.

Abdominal pain + jaundice differential

Ascending Cholangitis, hepatic abscess, acute hepatitis, cholangiocarcinoma, pancreatic cancer.

Abdominal pain + weight loss differential

Cancer, chronic mesenteric ischemia, chronic pancreatitis.

Non‑GI causes of abdominal pain

MI, pneumonia, PE, AAA, rectus sheath hematoma, shingles, kidney stones, UTI, PID, ectopic pregnancy.

Imaging modality preference

Alarm symptoms

Weight loss, blood loss, hematemesis, melena, hematochezia, iron‑deficiency anemia, dysphagia, nocturnal symptoms, new symptoms after age 50, jaundice.