The appendix is a small structure located at the base of the ascending colon in the right lower quadrant of the abdomen. Inflammation of the appendix is known as appendicitis and it was a once life-threatening condition now routinely treated with surgery. The classic symptoms of appendicitis are abdominal pain initially around the belly button or upper abdomen and then later in the right lower abdomen. Symptoms can include nausea, vomiting, and loss of appetite but can be highly variable.

Diagnosis is made by clinical examination and often CT scanning or ultrasound. Prompt surgical intervention is the usual treatment.

Code 3 ER appendicitis

Abdominal Aortic Aneurysm

The aorta is the major artery that carries oxygenated blood from the heart. It arises in the chest and descends into the abdomen giving off many major arterial branches as it goes. The aorta can weaken and balloon in size placing it at risk of rupture, which is often fatal. Prior to rupture, an abdominal aneurysm may cause pain and other symptoms, depending on the location of the aneurysm.

Diagnosis of abdominal aortic aneurysm usually requires either an abdominal ultrasound or CT scan. Treatment depends upon the size of the aneurysm but is usually surgical.

Code 3 Abdominal Aortic Aneurysm


Diverticulosis is a condition in which small pockets form along the length of the large intestine. This condition is very common and is believed to be the result of low fiber diets, making this one of the most common medical problems in western countries. These pockets, or diverticula, can sometimes become inflamed or infected which is called diverticulitis.

Symptoms of diverticulitis include abdominal pain and sometimes fever. Diverticulitis can be complicated by perforation of the intestine and the formation of an abscess. Treatment is often medical with multiple courses of antibiotics but severe or complicated diverticulitis may require hospitalization and surgery.

Code 3 ER Diverticultis

Stomach Ulcers

Ulcers are damage that occurs within the stomach or the upper intestine (the duodenum). Although for many years it was believed ulcers were caused by the over production of stomach acid, it was later found that an infection with a corkscrew shaped bacteria (Helicobacter pylori) is the cause of many stomach ulcers. Whereas treatment for stomach ulcers in the past was often surgery, it is more common to treat stomach ulcers with a combination of antibiotics and antacids today.

Untreated, stomach ulcers and duodenal ulcers can progress and erode through the stomach wall leading to perforation of the stomach or intestine or into major arteries resulting which can be life threatening.

Diagnosis includes a careful history and physical examination to suggest the diagnosis followed by an upper GI study such as an endoscopy in which a camera is inserted into the stomach to visualize the ulcer.

Code 3 ER stomach ulcer

Gastroesophageal Reflux Disease

Gastroesophageal Reflux Disease, frequently abbreviated as “GERD” is caused by weakness of the muscular ring at the bottom of the esophagus that keeps food and stomach acid within the stomach from leaking back into the esophagus. When stomach acid “refluxes” back into the esophagus, it can cause pain and sometimes a bad bitter taste in the mouth. Over time, the acid can damage the esophagus and increase the risk of esophageal cancer.

The diagnosis is often made based on history and physical exam but a definite diagnosis can be made by an upper GI study that show the weakness of the lower esophageal sphincter. Treatment first begins with behavioral modifications like eating small meals, avoiding meals close to bed time, and reduction in alcohol consumption. If these efforts do not control the symptoms, then medications that reduce acid production can be helpful. Severe uncontrolled cases may require surgery to reinforce the esophageal sphincter.

Code 3 ER gastroesophageal reflux disease GERD

Other Causes of Abdominal Pain

There are many more causes of abdominal pain some of which are serious. There are many gynecologic causes of abdominal pain as well as complications of pregnancy that can cause pain. Investigation of abdominal pain can be difficult and often requires the use of advanced medical imaging such as ultrasound or CT scanning as well as an experienced physician.