A 54-year-old male complains of abdominal pain. He tells you he has had generalized crampy pain and diarrhea for three days. His abdomen is soft to palpation. His vital signs are P 90, R 16, BP 142/86, and SpO2 is 96% on room air. You should suspect:

• A. gastroenteritis.
• B. cholecystitis.
• C. appendicitis.
• D. peritonitis.

Answer: (A)

The main idea here is recognizing gastroenteritis when the presentation is crampy, diffuse abdominal pain with diarrhea and a relatively soft, non-tender abdomen rather than localized, rigid, or rebound tenderness. Gastroenteritis is an infection or inflammation of the stomach and intestines that commonly causes generalized cramping and frequent diarrhea, especially when the history includes several days of diarrhea.

This fits better than the other conditions because:

• Cholecystitis typically causes right upper-quadrant pain, often with fever and a positive Murphy’s sign, and tenderness localized to the RUQ.

• Appendicitis usually starts with periumbilical pain that later localizes to the right lower quadrant, with tenderness and sometimes fever.

• Peritonitis presents with a rigid, distended, or severely tender abdomen, often with signs of systemic illness.

Since the abdomen is soft and there’s a track record of several days of diarrhea without focal abdominal findings or peritoneal signs, gastroenteritis is the most consistent diagnosis.