| Symptoms | General notes | Selected examples of diseases |
| Fever and chills | Although generally nonspecific, a fever suggests an infectious or inflammatory process. It can occur with an intra-abdominal process or with a systemic infection or inflammatory process that can also cause abdominal pain. | - Infectious mononucleosis – Most patients will have fever, while many will have splenic enlargement or mesenteric adenitis that can manifest as abdominal pain.
- Rocky Mountain spotted fever – In the early phase, most patients have nonspecific signs and symptoms such as fever and can have abdominal pain and nausea. The onset of abdominal pain prior to the rash can lead to a misdiagnosis such as appendicitis, cholecystitis, and even bowel obstruction.
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| Nausea and vomiting | Although these are nonspecific symptoms, the order of appearance and quality of emesis may provide a clue to the diagnosis. - Vomiting that starts after the onset of pain is more likely to have a surgical process.
- Bilious emesis suggests obstruction distal to the duodenum.
- Relatively benign etiologies tend to cause self-limited vomiting.
- Coffee-ground emesis suggests hematemesis.
| - Appendicitis
- Diverticulitis
- Bowel obstruction
- Gastroenteritis
- Gastritis
- Peptic ulcer disease
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| Fatigue, weight loss, anorexia | These constitutional symptoms are concerning for malignancy or systemic illnesses. | - Ovarian cancer – This can present with abdominal distension, dyspepsia, flatulence, anorexia, pelvic pressure, back pain, rectal fullness, or urinary symptoms.
- Colorectal cancer – This can present with abdominal pain associated with changes in bowel habits, weight loss, and rectal bleeding.
- Systemic lupus erythematosus – Up to 40% of patients will have gastrointestinal manifestations during their lifetime, which can include dysphagia, diarrhea, peptic ulcer disease, intestinal pseudo-obstruction, hepatitis, pancreatitis, mesenteric vasculitis with intestinal infarction, peritonitis, and ascites.
- Hypercalcemia – This can present with vague abdominal pain associated with anorexia, nausea, vomiting, and constipation.
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| Diarrhea | This is often associated with an infectious cause but can also occur with others. | - Gastroenteritis
- Diverticulitis
- Mesenteric ischemia (may be bloody)
- Bowel obstruction
- Inflammatory bowel disease (ie, Chron, ulcerative colitis)
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| Obstipation or constipation | Obstipation (ie, inability to pass flatus or stool), especially associated with increased belching and abdominal distension, is suggestive of a bowel obstruction. | - Bowel obstruction.
- Constipation – This is a common cause of abdominal pain but should be a diagnosis of exclusion in an emergency department patient.
- Irritable bowel syndrome – This often presents with swings between diarrhea and constipation. This should be a diagnosis of exclusion that is made in the outpatient setting (instead of the emergency department) since this requires persistent symptoms for 3 months to 1 year.
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| Dysuria, urinary urgency, urinary frequency, hematuria | These suggest a genitourinary cause of pain. | - Urinary tract infection – This often presents with suprapubic discomfort associated with urinary symptoms.
- Pyelonephritis – Fever (>38°C), flank pain, costovertebral angle tenderness, and nausea or vomiting suggest upper tract infection and warrant more aggressive diagnostic and therapeutic measures.
- Nephrolithiasis – This causes flank pain and hematuria but can also cause lower abdominal pain if the stone is in the ureterovesical junction.
- Prostatitis.
- Epididymitis.
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| Vaginal discharge, vaginal bleeding, abnormal uterine bleeding | These suggest a gynecologic etiology of abdominal pain. | - Ectopic pregnancy – This characteristically presents with pelvic pain, vaginal bleeding, and amenorrhea.
- Pelvic inflammatory disease – This commonly presents with bilateral lower abdominal pain that often starts during or shortly after menses. Pain that worsens during coitus or with jarring movement may be the only symptom. Can also cause abnormal uterine bleeding, new vaginal discharge, urethritis, and fever. This is rarely complicated by tubo-ovarian abscess or perihepatitis (Fitz-Hugh-Curtis syndrome).
- Endometriosis – This present with pelvic pain that is often chronic and worse during menses or ovulation, dysmenorrhea, and deep dyspareunia.
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| Scrotal pain | Scrotal pathology can cause lower abdominal pain that does not always localize to the scrotum. | - Testicular torsion – This characteristically presents with severe, sudden-onset pain following vigorous activity or testicular trauma.
- Inguinal hernia.
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