Table 2

 Common diagnoses and their common presentation

Non-specific abdominal painUsually vague history of symptoms with non-specific triggers. Little to find on examination. Usually self limiting. If pain continues/worsens consider other diagnoses.
GastroenteritisUsually history of eating possible contaminated food/contact with other cases. Diarrhoea and vomiting classical. Usually self limiting.
AppendicitisTypically initial central vague pain that becomes localised to the right iliac fossa. Often associated with vomiting and anorexia.
Leaking aneurysmIf acute rupture often sudden acute “tearing” pain or collapse. Pain radiates through to the back or groin, often with a palpable pulsating midline abdominal mass. May have history of known aneurysm.
Peptic ulcerUsually upper abdominal pain associated with eating. Perforation gives severe pain often through to back and peritonitis
Biliary colic and acute cholecystitisColicky right upper quadrant pain or epigastric pain often radiating to the back. In acute cholecystitis may be toxic and pyrexial with tenderness (Murphy’s sign).
Acute pancreatititisOften sudden onset of severe peritoneal pain in the upper abdomen, with signs of shock.
Acute intestinal obstructionClassically constipation and vomiting. In a more proximal obstruction vomiting is the main symptom. There may be significant fluid and electrolyte losses.
Renal colicUsually sudden onset severe colicky pain in the loin with radiation to groin. Voltarol PO or PR is an effective analgesic. Beware of this diagnosis in the elderly patient. Patients with AAA often have haematuria.
Small bowel infarctionAcute, severe abdominal pain in the elderly, out of proportion to clinical signs often around RIF. Rapidly become hypovolaemic and shocked. May have history of colicky post-prandial abdominal pain or of atrial fibrillation.