Teaching topics from the New England Journal of Medicine - Vol. 358, No. 2, January 10, 2008
Differential Diagnosis of Abdominal Pain and Circulatory Shock
The differential diagnosis of shock in a patient with abdominal pain includes hemorrhage, which can result from perforated viscus, a ruptured abdominal aortic aneurysm, or, in female patients, a ruptured ovarian cyst. Other processes that cause hypovolemia because of interstitial fluid sequestration could include pancreatitis or relative hypovolemia due to sepsis caused by bacterial peritonitis. Cardiogenic shock, anaphylaxis, adrenal insufficiency, arterial dissection, and pulmonary embolism are also possible causes.