Ectopic pregnancy differential diagnosis: Difference between revisions

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* [[Pelvic inflammatory disease]] ([[PID]])  
* [[Pelvic inflammatory disease]] ([[PID]])  
* [[Pyelonephritis]]
* [[Pyelonephritis]]
{| align="center"
|-
|
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
! colspan="2" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" | Classification of acute abdomen based on etiology
! colspan="1" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Presentation
! colspan="3" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" | Symptoms
! colspan="3" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" | Signs
! colspan="2" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" | Diagnosis
! colspan="1" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" | Comments
|-
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" | Fever
! align="center" style="background:#4479BA; color: #FFFFFF;" |Abdominal Pain
! align="center" style="background:#4479BA; color: #FFFFFF;" |Jaundice
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" | Guarding
! align="center" style="background:#4479BA; color: #FFFFFF;" |Rebound Tenderness
! align="center" style="background:#4479BA; color: #FFFFFF;" |Bowel sounds
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" | Lab Findings
! align="center" style="background:#4479BA; color: #FFFFFF;" |Imaging
|-
! colspan="1" rowspan="8" style="padding: 5px 5px; background: #DCDCDC;" align="center" | Common causes of Peritonitis
! colspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | Primary Peritonitis
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | [[Spontaneous bacterial peritonitis]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Diffuse
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hypoactive
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Ascitic fluid [[PMN]]>250 cells/mm<small>³</small>
* Culture: Positive for single organism
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound for evaluation of liver cirrhosis
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
|-
! colspan="1" rowspan="7" style="padding: 5px 5px; background: #DCDCDC;" align="center" | Secondary Peritonitis
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | Perforated [[Gastric ulcer|gastric]] and [[duodenal ulcer]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | Diffuse
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Ascitic fluid
** [[LDH]] > serum [[LDH]]
** Glucose < 50mg/dl
** Total protein > 1g/dl
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Air under [[diaphragm]] in upright [[CXR]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Upper GI [[endoscopy]] for diagnosis
|-
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | Acute cholangitis
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | [[RUQ]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Abnormal [[LFT]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound shows [[biliary]] dilatation
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Biliary drainage ([[Endoscopic retrograde cholangiopancreatography|ERCP]]) + IV antibiotics
|-
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | [[Acute cholecystitis|Acute cholecystitis]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | [[RUQ]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hypoactive
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Hyperbilirubinemia]]
* [[Leukocytosis]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound shows gallstone and evidence of inflammation
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Murphy's sign|Murphy’s sign]]
|-
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |  [[Acute pancreatitis]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | [[Epigastric]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | +/-
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Increased [[amylase]] / [[lipase]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound shows evidence of [[inflammation]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Pain radiation to back
|-
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | [[Acute appendicitis]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | RLQ
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hypoactive
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Leukocytosis]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound shows evidence of [[inflammation]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Nausea and vomiting|Nausea & vomiting]], [[decreased appetite]]
|-
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | [[Diverticulitis|Acute diverticulitis]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | LLQ
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | +/-
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hypoactive
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Leukocytosis]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |CT scan and ultrasound shows evidence of inflammation
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|-
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | [[Salpingitis|Acute salpingitis]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | LLQ/ RLQ
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | +/-
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | +/-
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Leukocytosis]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Pelvic ultrasound]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Vaginal discharge]]
|-
! colspan="2" rowspan="4" style="padding: 5px 5px; background: #DCDCDC;" align="center" | Hollow Viscous Obstruction
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Small intestine obstruction
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Diffuse
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | +/-
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hyperactive then absent
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Leukocytosis]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Abdominal X-ray|Abdominal X ray]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Nausea and vomiting|Nausea & vomiting]] associated with [[constipation]], [[Abdominal distension|abdominal distention]]
|-
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Volvulus]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Diffuse
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>+</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hypoactive
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Leukocytosis]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |CT scan and [[Abdominal x-ray|abdominal X ray]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Nausea and vomiting|Nausea & vomiting]] associated with [[constipation]], [[Abdominal distension|abdominal distention]]
|-
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Biliary colic]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |RUQ
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |+
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Increased [[bilirubin]] and [[alkaline phosphatase]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Nausea and vomiting|Nausea & vomiting]]
|-
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Renal colic]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Flank pain]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Hematuria]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |CT scan and ultrasound
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Colicky [[abdominal pain]] associated with [[Nausea and vomiting|nausea & vomiting]]
|-
! rowspan="4" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Vascular Disorders
! rowspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Ischemic causes
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Mesenteric ischemia]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>+/-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Periumbilical
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hyperactive
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Leukocytosis]] and [[lactic acidosis]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |CT scan
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Nausea and vomiting|Nausea & vomiting]], normal physical examination
|-
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Ischemic colitis|Acute ischemic colitis]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>+/-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Diffuse
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>+</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>+</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hyperactive then absent
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Leukocytosis]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |CT scan
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Nausea and vomiting|Nausea & vomiting]]
|-
! rowspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Hemorrhagic causes
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Ruptured abdominal aortic aneurysm]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Diffuse
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Normal
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |CT scan
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Unstable hemodynamics
|-
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |Intra-abdominal or [[retroperitoneal hemorrhage]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Diffuse
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Anemia]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |CT scan
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |History of [[trauma]]
|-
! rowspan="3" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Gynaecological Causes
! rowspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Ovarian cyst|Ovarian Cyst]] Complications
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |Torsion of the cyst
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |RLQ / LLQ
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>+/-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>+/-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Increased [[ESR]] and [[CRP]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Sudden onset sever pain with [[nausea and vomiting]]
|-
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |Cyst rupture
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |RLQ / LLQ
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>+/-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>+/-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Increased [[ESR]] and [[CRP]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Sudden onset sever pain with [[nausea and vomiting]]
|-
!style="padding: 5px 5px; background: #DCDCDC;" align="center" |Pregnancy
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |Ruptured [[ectopic pregnancy]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |RLQ / LLQ
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Positive [[pregnancy test]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |History of missed period and [[vaginal bleeding]]
|-
|}


==References==
==References==

Revision as of 18:29, 8 May 2017

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Differentiating an Ectopic Pregnancy from other Conditions


Classification of acute abdomen based on etiology Presentation Symptoms Signs Diagnosis Comments
Fever Abdominal Pain Jaundice Guarding Rebound Tenderness Bowel sounds Lab Findings Imaging
Common causes of Peritonitis Primary Peritonitis Spontaneous bacterial peritonitis + Diffuse - - - Hypoactive
  • Ascitic fluid PMN>250 cells/mm³
  • Culture: Positive for single organism
Ultrasound for evaluation of liver cirrhosis -
Secondary Peritonitis Perforated gastric and duodenal ulcer + Diffuse - + + N
    • Glucose < 50mg/dl
    • Total protein > 1g/dl
Air under diaphragm in upright CXR Upper GI endoscopy for diagnosis
Acute cholangitis + RUQ + - - N Abnormal LFT Ultrasound shows biliary dilatation Biliary drainage (ERCP) + IV antibiotics
Acute cholecystitis + RUQ + - - Hypoactive Ultrasound shows gallstone and evidence of inflammation Murphy’s sign
Acute pancreatitis + Epigastric +/- - - N Increased amylase / lipase Ultrasound shows evidence of inflammation Pain radiation to back
Acute appendicitis + RLQ - + + Hypoactive Leukocytosis Ultrasound shows evidence of inflammation Nausea & vomiting, decreased appetite
Acute diverticulitis + LLQ +/- + - Hypoactive Leukocytosis CT scan and ultrasound shows evidence of inflammation
Acute salpingitis + LLQ/ RLQ - +/- +/- N Leukocytosis Pelvic ultrasound Vaginal discharge
Hollow Viscous Obstruction Small intestine obstruction - Diffuse - + +/- Hyperactive then absent Leukocytosis Abdominal X ray Nausea & vomiting associated with constipation, abdominal distention
Volvulus - Diffuse - + - Hypoactive Leukocytosis CT scan and abdominal X ray Nausea & vomiting associated with constipation, abdominal distention
Biliary colic - RUQ + - - N Increased bilirubin and alkaline phosphatase Ultrasound Nausea & vomiting
Renal colic - Flank pain - - - N Hematuria CT scan and ultrasound Colicky abdominal pain associated with nausea & vomiting
Vascular Disorders Ischemic causes Mesenteric ischemia +/- Periumbilical - - - Hyperactive Leukocytosis and lactic acidosis CT scan Nausea & vomiting, normal physical examination
Acute ischemic colitis +/- Diffuse - + + Hyperactive then absent Leukocytosis CT scan Nausea & vomiting
Hemorrhagic causes Ruptured abdominal aortic aneurysm - Diffuse - - - N Normal CT scan Unstable hemodynamics
Intra-abdominal or retroperitoneal hemorrhage - Diffuse - - - N Anemia CT scan History of trauma
Gynaecological Causes Ovarian Cyst Complications Torsion of the cyst - RLQ / LLQ - +/- +/- N Increased ESR and CRP Ultrasound Sudden onset sever pain with nausea and vomiting
Cyst rupture - RLQ / LLQ - +/- +/- N Increased ESR and CRP Ultrasound Sudden onset sever pain with nausea and vomiting
Pregnancy Ruptured ectopic pregnancy - RLQ / LLQ - - - N Positive pregnancy test Ultrasound History of missed period and vaginal bleeding

References

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