COVID-19 associated abdominal pain differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Javaria Anwer M.D.[2]

Overview

Abdominal pain is a vast entity and a challenge to clinicians. It may be associated with other symptoms such as anorexia, nausea and fever. Abdominal pain associated with COVID-19 must be differentiated from other diseases such as hepatitis, Ulcerative colitis, Crohn's disease and Cinfectious diarrhea.

COVID-19 associated abdominal pain must be differentiated from other diseases that also cause abdominal pain such as:^[1]^[2]


Disease	Differentiating features
Hepatitis	Acute hepatitis especially autoimmune hepatitis shared common symptoms such as fatigue, abdominal pain, nausea, vomiting, diarrhea, skin rash. Some hepatic infections may involve pleuritis and pleural effusion thus chest pain.
Crohn's disease	Crohn's disease may have a history of remissions and relapses Present with symptoms shared by COVID-19 infection as well especially during a relapse. Other symptoms of Crohn's disease include abdominal pain, diarrhea that may or may not be bloody, fever and rash. History of Crohn's disease can help on deciding on the differential diagnosis but it is equally important to access possible COVID-19 infection. Patients should be counseled about the similarities in two diseases.
Ulcerative colitis	A relapse can have symptoms similar to COVID-19 such as: abdominal pain ,diarrhea, rash. A history of ulcerative colitis is important it is equally important to access for possible COVID-19 infection. Patients should be counseled about the similarities in two diseases.
Infectious diarrhea	Abdominal pain associated with bloody diarrhea are features of infections such as C.difficile, shigellosis and diverticulitis. A careful history, physical exam and stool RT-PCR for coronavirus can help in diagnosis. High suspicion is required and the patient should be tested for COVID-19 infection if required. COVID-19-associated diarrhea may be accompanied by abdominal pain.

↑ Occhipinti V, Pastorelli L (May 2020). "Challenges in the Care of IBD Patients During the CoViD-19 Pandemic: Report From a "Red Zone" Area in Northern Italy". Inflamm. Bowel Dis. 26 (6): 793–796. doi:10.1093/ibd/izaa084. PMC 7188155 Check |pmc= value (help). PMID 32314792 Check |pmid= value (help).
↑ Ponnurangam Nagarajan V, Palaniyadi A, Sathyamoorthi M, Sasitharan R, Shuba S, Padur Sivaraman R, Scott JX (2012). "Pleural effusion - An unusual cause". Australas Med J. 5 (7): 369–72. doi:10.4066/AMJ.2012.1024. PMC 3413004. PMID 22905065.