Browse categories and answer follow-up questions to refine your symptom profile.
History
HPI
Abdominal pain context
Age group
Caregiver reliability
Pain onset context
Symptom trajectory
Prior episodes
Baseline bowel pattern
Baseline appetite and growth
Onset
Onset
Sudden
Gradual
Time since onset
Triggering event
Provocation/Palliation
Provocation and palliation
Worse with movement
Worse with eating
Worse with urination
Worse with defecation
Relief with stool
Relief with vomiting
Quality
Quality
Crampy
Colicky
Sharp
Burning
Constant
Region/Radiation
Region and radiation
Periumbilical
Right lower quadrant
Right upper quadrant
Epigastric
Suprapubic
Flank
Radiation to back
Radiation to groin
Severity
Severity
Current pain score
Peak pain score
Functional impact
Sleep disruption
Timing
Timing
Intermittent
Constant
Episodes duration
Progressive worsening
Nocturnal wakening
Associated symptoms
Associated symptoms
Fever
Nausea
Vomiting
Bilious vomiting
Hematemesis
Diarrhea
Bloody stool
Constipation
Dysuria
Hematuria
Frequency
Vaginal bleeding
Vaginal discharge
Testicular pain
Cough or sore throat
Rash
Weight loss
Intake and output
Intake and output
Oral intake
Urine output
Last wet diaper
Stool frequency
Last stool
Gynecologic and sexual health
Gynecologic and sexual health
Menarche status
LMP
Pregnancy possibility
Sexual activity
Contraception
STI risk
Surgical and ingestion history
Surgical and ingestion history
Prior abdominal surgery
Foreign body ingestion
Toxin exposure
Caustic exposure
Alarm Features
Immediate life threats
Immediate life threats
Shock
Peritonitis
Suspected volvulus
Testicular torsion
Ectopic pregnancy
Vital sign danger thresholds
Vital sign danger thresholds
Hypotension for age
Persistent tachycardia
SpO2 low
Fever with toxicity
High risk vomiting and stool patterns
High risk vomiting and stool patterns
Bilious vomiting
Projectile vomiting in infant
Hematemesis
Bloody stool
Currant jelly stool
High risk exam findings
High risk exam findings
Rebound tenderness
Guarding
Rigidity
Involuntary guarding
Absent bowel sounds with toxicity
Distended tense abdomen
Escalation triggers
Escalation triggers
If shock features then resuscitation bay
If bilious vomiting then emergent surgical evaluation
If peritonitis then NPO and urgent surgery consult
If suspected torsion then immediate urology consult and no delay for imaging
Medications
Current and recent meds
Current and recent meds
Antibiotics in last 30 days
NSAIDs
Acetaminophen
Opioids
Steroids
Laxatives
Antidiarrheals
High risk exposures
High risk exposures
Iron
Salicylates
Acetaminophen overdose risk
Cannabis
Energy drinks
ED symptom control dosing
ED symptom control dosing
Acetaminophen
15 mg/kg PO
Max 1000 mg per dose
Max 60 mg/kg/day
Ibuprofen
10 mg/kg PO
Max 600 mg per dose
Avoid if dehydration or renal risk
Ondansetron
0.15 mg/kg PO or ODT
Max 8 mg per dose
Morphine
0.05 mg/kg IV
Repeat every 10 to 20 minutes as needed
Contraindications and interactions
Contraindications and interactions
NSAIDs with GI bleed risk
NSAIDs with renal impairment risk
Opioids with respiratory depression risk
QT prolonging combinations with ondansetron
Diet
Recent intake patterns
Recent intake patterns
Poor intake duration
Oral fluid tolerance
Food triggers
Hydration indicators
Hydration indicators
Thirst
Dry mouth
Tears reduced
Decreased urine
Foodborne risk
Foodborne risk
Undercooked meats
Unpasteurized dairy
Recent restaurant outbreak exposure
Lactose and fermentable triggers
Lactose and fermentable triggers
Dairy trigger pattern
High sorbitol intake
High fructose intake
Review of Systems
Constitutional
Constitutional
Fever
Fatigue
Weight loss
Night sweats
Gastrointestinal
Gastrointestinal
Vomiting
Bilious vomiting
Diarrhea
Constipation
Blood in stool
Melena
Jaundice
Genitourinary
Genitourinary
Dysuria
Hematuria
Frequency
Flank pain
Vaginal bleeding
Vaginal discharge
Testicular pain
Respiratory and ENT
Respiratory and ENT
Cough
Sore throat
Otalgia
Dyspnea
Skin and musculoskeletal
Skin and musculoskeletal
Rash
Joint pain
Limp
Back pain
Neurologic and endocrine
Neurologic and endocrine
Headache
Altered mental status
Polyuria
Polydipsia
Collateral History and Family History
Collateral source
Collateral source
Parent
Guardian
School
EMS
Family history GI and surgical
Family history GI and surgical
Inflammatory bowel disease
Celiac disease
Appendicitis in siblings
Gallstones
Family history renal and metabolic
Family history renal and metabolic
Nephrolithiasis
Type 1 diabetes mellitus
Sickle cell disease (D57.1)
Household exposures
Household exposures
Sick contacts
Daycare outbreak
Pets and reptiles
Travel exposures
Risk Factors
Age specific risks
Age specific risks
Infant volvulus risk
Toddler intussusception risk
Adolescent pregnancy risk
Adolescent STI risk
Infection and inflammation risks
Infection and inflammation risks
Recent gastroenteritis
Recent URI
Recent antibiotics
Immunocompromise
Surgical abdomen risks
Surgical abdomen risks
Prior abdominal surgery
Hernia history
Known malrotation
Known gallstones
Renal stone and UTI risks
Renal stone and UTI risks
Prior UTI
Vesicoureteral reflux history
Poor hydration
High salt intake
Medication and toxin risks
Medication and toxin risks
NSAID use
Iron access
Cannabis use
Caustic exposure
Differential Diagnosis
Life threatening
Life threatening
Malrotation with volvulus (K56.2)
Bilious vomiting
Rapid deterioration
Appendicitis with perforation (K35.32)
Migration to RLQ
Peritonitis
Intussusception (K56.1)
Colicky pain episodes
Bloody stool
Ovarian torsion (N83.5)
Sudden unilateral lower abdominal pain
Vomiting
Testicular torsion (N44)
Scrotal pain
High riding testis
Ectopic pregnancy (O00.9)
Positive pregnancy test
Syncope or hypotension
Diabetic ketoacidosis (E10.10)
Abdominal pain with vomiting
Kussmaul breathing
Sepsis (A41.9)
Toxic appearance
Hypotension
Common
Common
Viral gastroenteritis (A08.4)
Vomiting and diarrhea
Sick contacts
Constipation (K59.00)
Infrequent stools
Stool burden
Mesenteric adenitis (I88.0)
URI symptoms
RLQ tenderness mimic
UTI (N39.0)
Dysuria
Suprapubic pain
Functional abdominal pain (R10.84)
Normal growth
No alarm features
Gastritis or GERD (K29.70)
Epigastric burning
Relation to meals
Less common
Less common
Pancreatitis (K85.90)
Epigastric pain
Pain to back
Cholecystitis (K81.0)
RUQ pain
Murphy sign
Nephrolithiasis (N20.0)
Colicky flank pain
Hematuria
Pneumonia with referred pain (J18.9)
Cough
Tachypnea
Henoch Schonlein purpura (D69.0)
Palpable purpura
Arthralgia
Inflammatory bowel disease (K50.90)
Weight loss
Bloody diarrhea
Mimics and pitfalls
Mimics and pitfalls
Abdominal wall pain
Pain with tensing muscles
Localized tenderness
Anxiety related symptoms
Hyperventilation
Normal exam trend
Early appendicitis
Initially periumbilical pain
Normal early labs
Past Medical History
Chronic conditions
Chronic conditions
Asthma (J45.909)
Diabetes mellitus type 1 (E10.9)
Sickle cell disease (D57.1)
Inflammatory bowel disease (K50.90)
Prior similar episodes
Prior similar episodes
Prior appendicitis evaluation
Prior constipation episodes
Prior UTIs
Surgeries and procedures
Surgeries and procedures
Appendectomy
Hernia repair
Abdominal surgery history
Baseline function
Baseline function
Normal activity level
Baseline diet
Growth trajectory
Physical Exam
General and vital signs
General and vital signs
Toxic appearance
Hydration status
Perfusion
Mental status
Abdomen inspection and auscultation
Abdomen inspection and auscultation
Distension
Visible peristalsis
Surgical scars
Bowel sounds
Abdomen palpation and percussion
Abdomen palpation and percussion
Focal tenderness location
Guarding
Rebound
Rigidity
Hepatosplenomegaly
Mass
Peritoneal and appendicitis maneuvers
Peritoneal and appendicitis maneuvers
Pain with cough or hop
Rovsing sign
Psoas sign
Obturator sign
Hernia and genitourinary
Hernia and genitourinary
Inguinal hernia exam
Costovertebral angle tenderness
Suprapubic tenderness
Testicular and pelvic considerations
Testicular and pelvic considerations
Cremasteric reflex
Testis lie and tenderness
Scrotal edema or erythema
External genital exam findings
Skin and joints
Skin and joints
Purpura
Urticaria
Joint swelling
Limp
Cardiopulmonary
Cardiopulmonary
Tachypnea
Focal crackles
Chest wall tenderness
Murmur
Lab Studies
Core ED labs by risk profile
Core ED labs by risk profile
CBC for infection or anemia concern
Electrolytes for dehydration or vomiting
Glucose for DKA screen
CRP for inflammatory process support
Urine testing
Urine testing
Urinalysis for UTI
Urine culture if UA suggestive
Hematuria for stone support
Pregnancy and STI testing
Pregnancy and STI testing
Urine beta hCG in post menarche
NAAT for gonorrhea
NAAT for chlamydia
Pancreatic and hepatobiliary labs
Pancreatic and hepatobiliary labs
Lipase for pancreatitis
AST
ALT
Bilirubin
Severe illness labs
Severe illness labs
Venous blood gas for acidosis
Lactate for hypoperfusion
Blood culture if sepsis concern
Interpretation pitfalls
Interpretation pitfalls
Normal WBC does not exclude appendicitis
Early appendicitis may have normal CRP
Ketonuria may reflect starvation
UTI and appendicitis can coexist
Imaging
Scoring Systems
Appendicitis risk tools
Pediatric Appendicitis Score
Migration of pain
Anorexia
Nausea or vomiting
Fever
RLQ tenderness
Cough percussion hopping tenderness
Leukocytosis
Neutrophilia
pARC
Use with clinical exam and labs
Local protocol dependent thresholds
MRI
MRI abdomen and pelvis
Appendicitis evaluation when ultrasound nondiagnostic
Pregnancy or radiation avoidance priority
Limited availability and motion sensitivity
CT
CT abdomen and pelvis
Reserved for equivocal cases after ultrasound
Contrast considerations
Allergy history
Renal risk
Radiation risk higher in children
Ultrasound
Ultrasound first line
RLQ ultrasound for appendicitis
Pelvic ultrasound for ovarian pathology
Pyloric ultrasound for infant vomiting pattern
Intussusception ultrasound for colicky pain
False negatives with early appendicitis
Nondiagnostic appendix common
Special Tests
Bedside maneuvers
Bedside maneuvers
Carnett test for abdominal wall pain
Jump or hop test for peritoneal irritation
Rectal exam selective
POCUS
POCUS
Hydration assessment
Bladder volume
Free fluid screening
Procedural diagnostics
Procedural diagnostics
Enema reduction pathway for intussusception
Surgical exploration pathway if volvulus suspected
ECG
When ECG matters in abdominal pain
When ECG matters in abdominal pain
Epigastric pain with risk factors
Syncope or presyncope
Hyperkalemia concern
High risk patterns
High risk patterns
ST elevation
Wide QRS
QT prolongation
Serial ECG logic
Serial ECG logic
Persistent concerning symptoms
Evolving vitals or exam
Assessment
Problem representation
Problem representation
Age
Pain location
Time course
Associated symptoms
Severity and acuity
Severity and acuity
Hemodynamic stability
Toxic appearance
Hydration severity
Risk stratification
Risk stratification
Appendicitis score category
Need for serial exams
Need for surgical consult now
Working diagnoses
Working diagnoses
Gastroenteritis (A08.4)
Constipation (K59.00)
Appendicitis rule out (K35.80)
UTI (N39.0)
Complications to exclude
Complications to exclude
Perforation
Sepsis
Dehydration with electrolyte derangement
Diagnostic uncertainty
Diagnostic uncertainty
Alternative diagnoses listed
Plan for reassessment timing
Plan
First 5 minutes
First 5 minutes
Airway and breathing risk
Continuous monitoring if unstable
IV access criteria
If shock features then two IVs
If difficult access then IO
Point of care glucose if altered or vomiting
NPO if surgical abdomen possible
Analgesia and antiemetics
Analgesia and antiemetics
Acetaminophen dosing per weight
Ibuprofen dosing per weight
Opioid for severe pain with monitoring
Ondansetron dosing per weight
Fluids and electrolytes
Fluids and electrolytes
Isotonic bolus
20 mL/kg IV
Repeat based on perfusion
Maintenance fluids if ongoing losses
Electrolyte correction if abnormal
Diagnostic sequencing
Diagnostic sequencing
Pregnancy test early in post menarche
UA early if urinary symptoms
Ultrasound first line for RLQ or pelvic pain
CT or MRI if ultrasound nondiagnostic and high suspicion
Consultations
Consultations
Surgery for suspected appendicitis or obstruction
Urology for suspected torsion
Gynecology for suspected ovarian torsion or ectopic pregnancy
Reassessment loop
Reassessment loop
Repeat vitals every 30 to 60 minutes if concerning
Repeat abdominal exam after analgesia
Track urine output
Escalate if worsening tenderness or new guarding
Disposition
ICU criteria
ICU criteria
Shock requiring ongoing boluses
Vasopressor requirement
Severe DKA
Inpatient admission criteria
Inpatient admission criteria
Surgical diagnosis
Persistent vomiting with dehydration
Intractable pain
Unsafe home observation
Observation pathway criteria
Observation pathway criteria
Equivocal appendicitis with stable vitals
Serial exams planned
Repeat imaging planned
Discharge criteria
Discharge criteria
Stable vitals
Pain controlled with oral meds
Tolerating oral fluids
No peritoneal signs
Reliable follow up
Follow up timing
Follow up timing
Primary care within 24 to 72 hours
Earlier if symptoms persist
Specialty follow up if indicated
Discharge Instructions
Copy discharge instructions
Summary
Today you were evaluated for belly pain
Your exam and tests did not show an emergency right now
Medicines
Use acetaminophen for pain as directed
Use ibuprofen only if drinking well
Use ondansetron only as prescribed
Eating and drinking
Small frequent sips of fluids
Return to regular diet as tolerated
Activity
Rest today
Normal activity as tolerated
Follow up
See your clinician in 1 to 3 days
Return sooner if symptoms worsen
Return now for
Trouble breathing
Fainting
Severe or worsening pain
New pain in the right lower belly
Green vomit
Blood in vomit
Blood in stool
Fever with worsening pain
Hard swollen belly
Testicle pain
Vaginal bleeding with pain
Not peeing much
References
Guidelines and decision tools
American College of Radiology
ACR Appropriateness Criteria for suspected appendicitis in children
Imaging first line ultrasound emphasis
American Pediatric Surgical Association
Appendicitis management guidance
Nonoperative pathways local protocol dependent
Pediatric Appendicitis Risk Calculator
Risk stratification tool for suspected appendicitis
Use with clinical judgment
NASPGHAN
Functional abdominal pain disorders guidance
Alarm feature based evaluation
Infectious Diseases Society guidance
Pediatric UTI diagnostic and treatment principles
Local antibiogram dependent
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.