Upper Abdominal pain DDx

Upper Abdominal pain – Differential Diagnosis

Common causes

• Gastroenteritis
• GORD
• Hiatus Hernia
• Peptic ulcer disease
• Irritable bowel syndrome
• Gallstone disease
• Renal colic
• Constipation
• Diverticular disease
• Hernia
• Functional abdominal pain

Must Not Miss

• Vascular
  • AAA (Rupture or Dissection)
  • Myocardial Infarction
  • Mesenteric ischaemia
• Malignancy
  • Oesophageal cancer
  • Gastric Cancer
  • Pancreatic Cancer
  • Cholangiocarcinoma
  • Hepatocellular carcinoma
  • Ovarian cancer
• Infection
  • Cholecytitis/ Cholangitis
  • Pyelonephritis
  • Hepatitis
  • Pneumonia
• ‘Acute’ Abdomen
  • Acute Pancreatitis
  • Intestinal obstruction
  • Peritonitis
• Diabetic ketoacidosis

Easily missed

• Chronic Pancreatitis
• Crohn’s dis’/ Ulcerative colitis
• Coeliac disease
• Sickle cell crisis
• Addison’s disease
• Herpes Zoster

Red flags

• Acute severe pain
• Weight loss
• Systemic features (fever, night sweats, anorexia)
• New onset persistent Dyspepsia > 50 years old
• Dysphagia
• Persistent vomiting
• Haematemesis/Melaena
• Supraclavicular lymph nodes
• Abdominal swelling/mass
• Anaemia
• Raised inflammatory markers
• Known abdominal aortic aneurysm
• Past history of cancer
• Family history of cancer

Investigations to consider

• FBC, CRP/ESR
• U&Es, LFTs, Blood glucose, Bone profile
• Serum Amylase
• Coeliac screen
• Urinalysis/MSU
• Pregnancy test
• ECG
• AXR, KUB/ IVU, CXR
• USS
• OGD
• Barium swallow
• Small bowel enema
• CT
• Angiography