Abdominal pain has numerous differential diagnoses. For the purpose of simplicity, this clinical mind map is based upon anatomy or the specific location of pain. The list of probable diagnoses is made based upon information such as demographics and the description of the presenting complaint. The top differential diagnosis for a 7-year old with onset of pain a few hours ago should evoke differentials such as appendicitis, and gastroenteritis, whereas chronic recurrent post prandial pain in a 46-year old female should lead a clinician to think of diagnoses more common in this demographic, such as cholecystitis. In the absence of such helpful information which can provide clues to narrow the list of differentials, a clinician can start with the broad and full list of differentials and assume that all diagnoses are possible in any given patient.
In order to address urgent/emergent situations, a clinician must review vital signs and the patient’s appearance. Several pathologies, if left untreated, can give rise to urgent/emergent situations, such as appendicitis, severe cholecystitis, ascending cholangitis, ischemic colitis, splenic infarction or rupture. Additionally, peptic ulcer perforation, gastric malignancy (late stages if obstruction or significant metastasis have occurred), and several other pathologies can potentially become life threatening. Several factors must be considered for weighing, such as the demographics of the patient, risk factors for certain diseases and the answers to high yield questions and medium yield questions. Certain pathologies are more common in certain age groups, such as cholecystitis in adults and appendicitis in children. However, patient presentation can be very atypical, so in order to avoid anchor bias, a clinician must review unlikely causes as well. High yield questions in the abdominal pain mind map are based on location and duration, as these questions can help narrow differential diagnoses quickly so that a clinician can then focus on the medium yield questions to gather data and arrive at one or a few working diagnoses.
A helpful mnemonic to remember causes of generalized abdominal pain is DIG – CIMIC. Additional causes can be memorized by correlating organ related conditions with corresponding quadrants of the abdomen.