Differential Diagnosis for ACNES Abdominal Pain
Single Most Likely Diagnosis
- Appendicitis: This is the most common cause of acute abdominal pain in the right lower quadrant, which is often referred to as ACNES (Acute Appendicitis, Cholecystitis, Nephrolithiasis, Ectopic pregnancy, and Salpingitis). The symptoms of appendicitis, such as pain starting around the navel and then moving to the lower right abdomen, nausea, vomiting, and loss of appetite, align closely with the presentation of ACNES abdominal pain.
Other Likely Diagnoses
- Cholecystitis: Inflammation of the gallbladder, often due to gallstones, can cause severe abdominal pain, typically in the right upper quadrant, but can radiate or be felt in the lower abdomen, fitting the ACNES profile.
- Nephrolithiasis (Kidney Stones): While kidney stones usually cause flank pain, they can also cause abdominal pain if the stone is moving down the ureter, especially if it's impacting the lower ureter, which could be confused with ACNES.
- Ectopic Pregnancy: Although more specific to women, ectopic pregnancy can cause lower abdominal pain, often on one side, and is a critical diagnosis to consider in women of childbearing age presenting with ACNES symptoms.
- Salpingitis: Inflammation of the fallopian tubes, often due to pelvic inflammatory disease (PID), can cause lower abdominal pain, fitting the ACNES criteria, especially in sexually active women.
Do Not Miss Diagnoses
- Ruptured Ectopic Pregnancy: This is a life-threatening condition that requires immediate surgical intervention. Missing this diagnosis can lead to severe hemorrhage and death.
- Ruptured Appendix: If appendicitis progresses to appendiceal rupture, it can lead to peritonitis, a severe and potentially life-threatening infection of the abdominal cavity.
- Ovarian Torsion: A condition where the ovary twists around its ligaments, cutting off blood supply. It's extremely painful and requires urgent surgical intervention to save the ovary.
- Intestinal Obstruction: Although not typically the first diagnosis considered for ACNES, an obstruction can cause severe abdominal pain and vomiting, and missing this diagnosis can lead to bowel ischemia and necrosis.
Rare Diagnoses
- Mesenteric Lymphadenitis: An inflammation of the lymph nodes in the mesentery, which can mimic appendicitis in its presentation.
- Meckel's Diverticulitis: Inflammation of a Meckel's diverticulum, a congenital anomaly of the small intestine, can cause abdominal pain similar to appendicitis.
- Intussusception: A condition where a part of the intestine slides into an adjacent part, which can cause abdominal pain, vomiting, and bloody stools, more common in children but can occur in adults.
- Primary Epiploic Appendagitis: Inflammation of the epiploic appendages (small fatty protrusions from the colon), which can cause acute abdominal pain, often mimicking appendicitis or diverticulitis.