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Differential Diagnosis of Abdominal pain and Flank Pain

Abdominal pain or flank pain due to urological disorders:

• Ureteral stone
• Pyelonephritis
• Renal abscess
• Retroperitoneal bleeding or hematoma
• Kidney infarction
• Renal vein thrombosis
• Urinary retention
• Acute prostatitis
• Testicular torsion
• Congenital disorders of the upper urinary tract

Abdominal pain due to liver disease:

• Cholelithiasis
• Cholecystitis
• Cholangitis
• Hepatitis

Abdominal pain due to intestinal diseases:

• Gastric ulcer or duodenal ulcer
• Appendicitis
• Ileus
• Diverticulitis
• Mesenteric infarction
• Crohn disease

Pancreatic diseases:

• Pancreatitis

Spleen diseases:

• Splenic infarction
• Spontaneous splenic rupture

Abdominal pain or flank pain due to diseases of the great arteries:

• Aortic aneurysm
• Renal artery aneurysm
• Mesenteric artery occlusion/stenosis

Abdominal pain due to gynecological diseases:

• Pelvic inflammatory disease
• Ectopic pregnancy
• Ovarian torsion
• (Ruptured) ovarian cyst
• Mittelschmerz

Diseases of the abdominal wall:

• Incarcerated hernia
• Rectus sheath or abdominal wall hematoma

Abdominal pain or flank pain due to thoracic diseases:

• Pneumonia
• Pulmonary embolism
• Pleurisy
• Myocardial ischemia
• Esophageal rupture
• Esophageal spasm
• Gastro-esophageal reflux disease (GERD)

Abdominal pain due to metabolic diseases:

• Porphyria
• Ketoacidosis in diabetes mellitus
• Hemochromatosis
• Hyperparathyroidism
• Acute hemolysis
• Uremia

Abdominal pain or flank pain due to diseases of the nervous system:

• Back pain
• Herpes zoster
• Herniated disc
• Neuralgia

Diagnostic Workup of sudden Abdominal Pain or Flank Pain

• Medical history and physical examination
• Urine sediment
• Laboratory tests: blood count, GOT, GPT, gamma-GT, CK, CRP, electrolytes, creatinine, urea, lipase
• ECG
• Imaging: depending on the symptoms and severity: Ultrasound imaging, abdominal X-ray, chest X-ray and/or abdominal CT scan (with or without contrast medium)
• Diagnostic laparoscopy or laparotomy if acute intestinal or vascular disease is suspected
• Gastroscopy if melena or blood vomiting is present

References

  Deutsche Version: Differentialdiagnose von Bauchschmerzen und Flankenschmerzen

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