EVALUATION OF ABDOMINAL PAIN
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Toggle navigation. Gastroenterology Chapter. From Related Chapters. Page Contents Precautions See Acute Abdominal Pain for precautions and red flags. Appendicitis Especially true when clinical findings e. Images: Related links to external sites from Bing. Related Studies. TrendMD Trip Database. Ontology: Abdominal Pain C Definition NCI Painful sensation in the abdominal region. Definition MSH Sensation of discomfort, distress, or agony in the abdominal region; generally associated with functional disorders, tissue injuries, or diseases.
Related Topics in Gastroenterology. Surgery Chapters. Surgery - Gastroenterology Pages. Back Links pages that link to this page. Search other sites for 'Abdominal Pain Evaluation'. Get medical help immediately if You have abdominal pain that is sudden and sharp You also have pain in your chest, neck or shoulder You're vomiting blood or have blood in your stool Your abdomen is stiff, hard and tender to touch You can't move your bowels, especially if you're also vomiting. A disorder characterized by a sensation of marked discomfort in the abdominal region.
Painful sensation in the abdominal region. Recommendations for initial imaging studies are based on the location of abdominal pain Table 3 14 — Ultrasonography is recommended when a patient presents with right upper quadrant pain. Right upper quadrant Right lower quadrant Left lower quadrant Information from references 14 through Computed tomography CT with intravenous contrast media is recommended for evaluating adults with acute right lower quadrant pain; CT with oral and intravenous contrast media is recommended for patients with left lower quadrant pain.
Left upper quadrant pain is caused by a variety of clinical conditions; therefore, imaging recommendations are not clear-cut.
If the patient's history and physical examination suggest esophageal or gastric pathology, endoscopy or an upper gastrointestinal series is recommended. In other patients with left upper quadrant pain, CT is useful because it provides imaging of the pancreas, spleen, kidneys, intestines, and vasculature. Plain radiography of the abdomen is often more readily obtainable and less expensive than ultrasonography or CT and can be helpful in several circumstances. An upright radiograph of the chest or abdomen can detect free air under the diaphragm, which indicates a perforation of the gastrointestinal tract.
Abnormal calcifications also can be seen on a plain radiograph; this includes 10 percent of gallstones, 90 percent of kidney stones, and appendicoliths in 5 percent of patients with appendicitis. Women of childbearing age present a specific challenge when making decisions about diagnostic imaging. Gynecologic causes of abdominal pain are more common in these women, and radiation exposure should be avoided if pregnancy is likely. Therefore, abdominal or transvaginal ultrasonography is generally recommended for evaluating left lower quadrant pain in women of childbearing age 16 and in pregnant patients with right lower quadrant abdominal pain.
If ectopic pregnancy is suspected, transvaginal ultrasonography should be performed. The sensitivity of transvaginal ultrasonography for detecting ectopic pregnancy is 95 percent in a patient with a positive pregnancy test human chorionic gonadotropin level greater than 25 mIU per mL [25 IU per L] and any abnormal ultrasound finding, whereas a negative pregnancy test and normal ultrasound findings virtually exclude ectopic pregnancy.
Evaluation of Acute Abdominal Pain in Adults
There are certain populations in which the spectrum of disease is significantly different than the majority of patients. Extra attention is warranted when evaluating special populations, such as women and older persons, with abdominal pain Figure 1. Abdominal pain in women may be related to pathology in the pelvic organs. Ovarian cysts, uterine fibroids, tuboovarian abscesses, and endometriosis are common causes of lower abdominal pain in women.
In women of reproductive age, special attention to pregnancy, including ectopic pregnancy, and loss of pregnancy is critical in forming an appropriate differential diagnosis. The possibility of pregnancy modifies the likelihood of disease and significantly changes the diagnostic approach e.
Older patients with abdominal pain present a particular diagnostic challenge. Disease frequency and severity may be exaggerated in this population e. Presentation may differ in older patients, and poor patient recall or a reduction in symptom severity may cause misdiagnosis. There are several diseases that should be considered in all older patients with abdominal pain because of the increased incidence and high risk of morbidity and mortality in these patients.
Occult urinary tract infection, perforated viscus, and ischemic bowel disease are potentially fatal conditions commonly missed or diagnosed late in older patients.
A stepwise approach to abdominal pain requires identification of specific high-risk populations. In low-risk patients, the pain location guides the initial differential diagnosis. Several areas of the abdomen deserve special attention because the clearest evidence for a consistent work-up is in these areas. For right upper quadrant pain, the history focuses on differentiating pulmonary, urinary, and hepatobiliary pain Figure 2. If urinary tract infection or nephrolithiasis is suspected, urinalysis is appropriate. Patients with colic, fever, steatorrhea, or a positive Murphy's sign should receive ultrasonography.
Algorithm for the evaluation of right upper quadrant abdominal pain. The evaluation of right lower quadrant pain is guided by the patient's history Figure 3. Patients with symptoms e. Normal CT findings should trigger additional urine, colon, or pelvic examination. Finally, left lower quadrant pain focuses on evaluation for diverticulitis Figure 4. Fever, previous diverticular disease, or suggestive physical examination findings e.
A normal evaluation should prompt further consideration of urinary or gynecologic pathology. Patients with undiagnosed pain should be followed closely, and consultation with a subspecialist should be considered. Already a member or subscriber? Log in.
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She received her medical degree and completed her residency at Wake Forest University School of Medicine. MARK P.
Article - MR evaluation of acute abdominal pain in pregnant patients
He received his medical degree at the University of Virginia School of Medicine, Charlottesville, and completed his residency at the University of Missouri School of Medicine, Columbia. Address correspondence to Sarah L. Reprints are not available from the authors. National Ambulatory Medical Care Survey: summar. Adv Data.
Pearls and pitfalls in the emergency department evaluation of abdominal pain. Emerg Med Clin North Am. Does this patient have appendicitis? Simple data from history and physical examination help to exclude bowel obstruction and to avoid radiographic studies in patients with acute abdominal pain.
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Eur J Surg. Does this patient have acute cholecystitis? Correlation among clinical, laboratory, and hepatobiliary scanning findings in patients with suspected acute cholecystitis.
Ann Emerg Med. Variability in emergency physician decision making about prescribing opioid analgesics. Diagnostic tests for Helicobacter pylori —can they help select patients for endoscopy? Srinivasan R, Greenbaum DS. Chronic abdominal wall pain: a frequently overlooked problem. Practical approach to diagnosis and management. Am J Gastroenterol.