++
This chapter is a general guide
to commonly encountered symptoms and conditions and their frequent
causes primarily in adults unless specified. Remember: “There
are more uncommon presentations of common diseases than common presentations
of uncommon diseases.”
++
Ascites, intestinal obstruction, cysts (ovarian or renal), tumors,
hepatosplenomegaly, aortic aneurysm, uterine enlargement (pregnancy),
bladder distention, inflammatory mass
++
Intestinal angina, early appendicitis, colitis, diabetic ketoacidosis,
hereditary angioedema, gastroenteritis, mesenteric thrombosis, mesenteric
lymphadenitis, peritonitis, porphyria, sickle cell crisis, uremia,
renal colic, renal infarct, pancreatitis
+++
Right Upper Quadrant:
++
Dissecting aneurysm, gallbladder disease (cholecystitis, cholangitis,
choledocholithiasis), hepatitis, hepatomegaly, pancreatitis, PUD,
pneumonia, pulmonary embolus, pyelonephritis, renal colic, renal
infarct, appendicitis (retroperitoneal)
++
Dissecting aneurysm, esophagitis, hiatal hernia, esophageal rupture,
gastritis, pancreatitis, PUD, myocardial infarction, pericarditis,
pneumonia, pulmonary embolus, pyelonephritis, renal colic, renal
infarction, splenic abscess, splenic rupture, splenic infarction
++
Aortic aneurysm, colitis including inflammatory bowel disease,
diverticulitis including Meckel diverticulum, intestinal obstruction,
hernia, perforated viscus, pregnancy, ectopic pregnancy, dysmenorrhea,
endometriosis, mittelschmerz (ovulation), ovarian cyst or tumor
(especially with torsion), PID, renal colic, UTI, rectal hematoma,
bladder distention
+++
Right Lower Quadrant:
++
Appendicitis, ectopic pregnancy, ovarian cyst or tumor, salpingitis,
mittelschmerz, cholecystitis, perforated duodenal ulcer, Crohn disease
++
Adrenal adenoma, adrenal hyperplasia (unilateral or bilateral),
adrenal metastasis (solid tumors, lymphoma, leukemia), adrenocortical
carcinoma, pheochromocytoma, adrenal myelolipoma, adrenal cyst,
adrenal varices, hemorrhage, congenital adrenal hyperplasia, ganglioneuroma, micronodular
adrenal disease
++
Male pattern baldness (alopecia, androgenic type in both men
and women), trauma and hair pulling, congenital, tinea capitis,
bacterial folliculitis, telogen arrest, anagen arrest (chemotherapy, radiation
therapy), alopecia areata, discoid lupus
++
Pregnancy, menopause (physiologic or premature), severe illness,
weight loss, stress, excessive athletic training, physiologically
delayed puberty, anatomic anomaly (eg, imperforate hymen, uterine
agenesis, etc), gonadal dysgenesis (eg, Turner syndrome), hypothalamic
and pituitary tumors, virilizing syndromes (eg, polycystic ovaries,
idiopathic hirsutism). Amenorrhea is categorized as primary (never
had menses) or secondary (cessation of menses).
++
Hepatitis, carcinoma (most types, especially advanced), anorexia
nervosa, generalized debilitating diseases, digitalis toxicity,
uremia, depression, CHF, pulmonary failure, radiation exposure,
chemotherapy
++
++
Osteoarthritis, bursitis, tendonitis, connective tissue disease
(rheumatoid arthritis, SLE, rheumatic fever, scleroderma, gout,
pseudogout, rheumatoid variants [ankylosing spondylitis,
psoriatic arthritis, Reiter syndrome]), infection (bacterial,
viral, TB, fungal Lyme disease), trauma, sarcoidosis, sickle cell
anemia, hemochromatosis, amyloidosis, coagulopathy
++
(See Chapter 13, Peritoneal [Abdominal] Paracentesis
for more details.) Use the serum albumin to ascitic albumin difference
(serum albumin minus ascites albumin) to help differentiate the
cause of ascites. If the difference is > 1.1, portal hypertension
is present. If the difference is < 1.1, the cause is not portal hypertension).
CHF, tricuspid insufficiency, constrictive pericarditis, venous
occlusion (including Budd–Chiari syndrome), cirrhosis,
pancreatitis, peritonitis ...