Principal signs and symptoms: Pain, fever, vomiting, circulatory depression, hematologic changes, muscular guarding (rigidity), occasional retention of stool.
The differential diagnosis is reviewed in Table bellow, where the possible diagnoses arelisted in order of their frequency in the general hospital setting.
|Differential diagnosis of upper abdominal pain|
|Acute cholecystitis||Thickened, three-layered wall; possible gallbladder hydrops|
|Biliary colic||Stone echo, acoustic shadow, obstructed duct|
|Acute pancreatitis||Pancreatic enlargement; hypoechoic, hazy internal echo|
|pattern, circumscribed hypoechoic lesions|
|Impaired gastric emptying||Greatly distended, fluid-filled stomach with internal echoes|
|Myocardial infarction||Echocardiography : circumscribed abnormality of wall motion|
|Pulmonary embolism||Peripheral embolism : wedge-shaped hypoechoic area|
|Renal colic||Obstructed, anechoic pyelocalyceal system; stone echo with|
|Hernia||Hernia sac, gap in peritoneum, possible thickening of bowel|
|Perforated gastric or||Detectable free air, possible wall thickening at the ulcer site|
|Perforated gallbladder||Wedge-shaped parenchymal lesion, absence of flow by CDS|
|Splenic infarction||Usually wedge-shaped, hypoechoic parenchymal lesion|
|Renal vein thrombosis||Kidneys initially enlarged, then small; dilated veins|
|Subphrenic abscess||Nonhomogeneous mass with ill-defined margins located|
|between the diaphragm and the liver or spleen|
|Cholangitis||Hypoechoic wall thickness, hypoechoic intraductal mass|
|Intraorgan bleeding||Hypoechoic mass, usually with associated organ enlargement|
Conditions that cannot be diagnosed with ultrasound
Common: Gastroenteritis, pleurisy Less common: Diabetic coma with pseudoperitonitis, uremia, thyrotoxicosis, Meckel diverticulum, Boerhave syndrome Rare: Hemolytic crisis, hepatic porphyria (e.g., acute intermittent porphyria), Addisonian
crisis, intoxication (lead, arsenic, mushroom, thallium), type I hypertriglyceridemia..