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Nova L Panebianco, Katherine Jahnes, Angela M Mills
When discussing which laboratory tests or imaging to order in the setting of acute abdominal pain, it is practical to organize information by disease process (eg, acute appendicitis, cholecystitis). Because studies on the accuracy of diagnostic tests are of necessity related to the presence or absence of specific diagnoses, and because clinicians frequently look to tests to help them rule in or rule out specific conditions, this article is organized by region of pain and common abdominal diagnoses. It focuses on the contributions that laboratory testing and imaging make in the emergency management of abdominal complaints...
May 2011: Emergency Medicine Clinics of North America
Stephan W Anderson, Jorge A Soto
This article discusses the critical protocol considerations in imaging patients with abdominal pain in the emergency department, specifically, the use of oral contrast, intravenous contrast, image postprocessing, and radiation dose. These considerations related to the use of computed tomography imaging of abdominal pain are reviewed in an evidence-based fashion.
January 2012: Radiologic Clinics of North America
Esther H Chen, Angela M Mills
Evaluation and management of acute abdominal pain in special populations can be challenging for the emergency physician. This article focuses on two specific populations: patients with altered immunologic function and postprocedural patients. Recognition of life-threatening abdominal diseases may be delayed in immunosuppressed patients because of the atypical presentations of these conditions. In postprocedural patients, evaluation of acute abdominal symptoms requires an understanding of the complications of procedures often performed by others...
May 2011: Emergency Medicine Clinics of North America
Robert McNamara, Anthony J Dean
Evaluation of the emergency department patient with acute abdominal pain may be challenging. Many factors can obscure the clinical findings leading to incorrect diagnosis and subsequent adverse outcomes. Clinicians must consider multiple diagnoses with limited time and information, giving priority to life-threatening conditions that require expeditious management to avoid morbidity and mortality. This article seeks to provide the clinician with the clinical tools to achieve these goals by reviewing the anatomic and physiological basis of abdominal pain and key components of the history and the physical examination...
May 2011: Emergency Medicine Clinics of North America
Sarah L Gans, Margreet A Pols, Jaap Stoker, Marja A Boermeester
The interdisciplinary, evidence-based guideline 'Diagnostics in acute abdominal pain in adults' describes the optimal in-hospital diagnostic work-up of patients with acute abdominal pain. Amongst other recommendations, the guideline advises the use of C-reactive protein and white blood cell count to differentiate urgent from non-urgent causes in an adult with acute abdominal pain presenting at the Emergency Department. If there is clinical suspicion of an urgent condition the guideline advises that additional imaging be performed...
2014: Nederlands Tijdschrift Voor Geneeskunde
Jonathan McKean, Sarah Ronan-Bentle
Patients with human immunodeficiency virus, those who are posttransplant, and those undergoing chemotherapy are populations who are immunocompromised and present to the emergency department with abdominal pain related to their disease processes, opportunistic infections, and complications of treatment. Emergency department practitioners must maintain vigilance, as the physical examination is often unreliable in these patients. Cross-sectional imaging and early treatment of symptoms with aggressive resuscitation is often required...
May 2016: Emergency Medicine Clinics of North America
Sreeja Natesan, Jerry Lee, Heather Volkamer, Traci Thoureen
The chief complaint of abdominal pain accounts for 5% to 10% of all presentations in the emergency department. With such broad differential and diagnostic modalities available, this article focuses on a systematic approach to evaluating abdominal pain, essential to providing patients with efficient and accurate care.
May 2016: Emergency Medicine Clinics of North America
Sumant R Ranji, L Elizabeth Goldman, David L Simel, Kaveh G Shojania
CONTEXT: Clinicians have traditionally withheld opiate analgesia from patients with acute abdominal pain until after evaluation by a surgeon, out of concern that analgesia may alter the physical findings and interfere with diagnosis. OBJECTIVE: To determine the impact of opiate analgesics on the rational clinical examination and operative decision for patients with acute abdominal pain. DATA SOURCES AND STUDY SELECTION: MEDLINE (through May 2006), EMBASE, and hand searches of article bibliographies to identify placebo-controlled randomized trials of opiate analgesia reporting changes in the history, physical examination findings, or diagnostic errors (those resulting in "management errors," defined as the performance of unnecessary surgery or failure to perform necessary surgery in a timely fashion)...
October 11, 2006: JAMA: the Journal of the American Medical Association
Adrienne van Randen, Wytze Laméris, H Wouter van Es, Hans P M van Heesewijk, Bert van Ramshorst, Wim Ten Hove, Willem H Bouma, Maarten S van Leeuwen, Esteban M van Keulen, Patrick M Bossuyt, Jaap Stoker, Marja A Boermeester
OBJECTIVES: Head-to-head comparison of ultrasound and CT accuracy in common diagnoses causing acute abdominal pain. MATERIALS AND METHODS: Consecutive patients with abdominal pain for >2 h and <5 days referred for imaging underwent both US and CT by different radiologists/radiological residents. An expert panel assigned a final diagnosis. Ultrasound and CT sensitivity and predictive values were calculated for frequent final diagnoses. Effect of patient characteristics and observer experience on ultrasound sensitivity was studied...
July 2011: European Radiology
Jessica Palmer, Elizabeth Pontius
Emergency department providers have become skilled at triaging patients with abdominal pain requiring surgical interventions. Abdominal pain mimics, medical conditions that cause the sensation of abdominal pain without abdominal abnormality, continue to puzzle the best physicians.
May 2016: Emergency Medicine Clinics of North America
Pasquale Paolantonio, Marco Rengo, Riccardo Ferrari, Andrea Laghi
Multidetector CT (MDCT) is an imaging technique that provides otherwise unobtainable information in the diagnostic work-up of patients presenting with acute abdominal pain. A correct working diagnosis depends essentially on understanding the individual patient's clinical data and laboratory findings. In haemodynamically stable patients with acute severe and generalized abdominal pain, MDCT is now the preferred imaging test and gives invaluable diagnostic information, also in unstable patients after stabilization...
2016: British Journal of Radiology
Ciro Paolillo, Ilenia Spallino
Up to 10% of all patients at the Emergency Department present for acute abdominal pain. The C-reactive protein (CRP) and white blood cell (WBC) are routinely determined as part of the workup of patients with abdominal pain. Three large prospective cohort studies comprising a total of 2961 adult patients with acute abdominal pain were selected. CRP levels and WBC counts were compared between patients with urgent and nonurgent final diagnoses. These studies conclude that the laboratory values individually are weak discriminators and cannot be used as a triage instrument in the selection of patients with acute abdominal pain requiring additional diagnostic tests...
February 2016: Internal and Emergency Medicine
Sarah L Cartwright, Mark P Knudson
Acute abdominal pain is a common presentation in the outpatient setting and can represent conditions ranging from benign to life-threatening. If the patient history, physical examination, and laboratory testing do not identify an underlying cause of pain and if serious pathology remains a clinical concern, diagnostic imaging is indicated. The American College of Radiology has developed clinical guidelines, the Appropriateness Criteria, based on the location of abdominal pain to help physicians choose the most appropriate imaging study...
April 1, 2015: American Family Physician
Jaap Stoker, Adrienne van Randen, Wytze Laméris, Marja A Boermeester
UNLABELLED: Acute abdominal pain may be caused by a myriad of diagnoses, including acute appendicitis, diverticulitis, and cholecystitis. Imaging plays an important role in the treatment management of patients because clinical evaluation results can be inaccurate. Performing computed tomography (CT) is most important because it facilitates an accurate and reproducible diagnosis in urgent conditions. Also, CT findings have been demonstrated to have a marked effect on the management of acute abdominal pain...
October 2009: Radiology
Z Mujagic, D Keszthelyi, Q Aziz, W Reinisch, E G Quetglas, F De Leonardis, M Segerdahl, A A M Masclee
BACKGROUND: Consensus on standard methods to assess chronic abdominal pain in patients with irritable bowel syndrome (IBS) is currently lacking. AIM: To systematically review the literature with respect to instruments of measurement of chronic abdominal pain in IBS patients. METHODS: Systematic literature search was performed in PubMed/Medline databases for studies using pain measurement instruments in patients with IBS. RESULTS: One hundred and ten publications were reviewed...
November 2015: Alimentary Pharmacology & Therapeutics
Meng Xue, Xueqin Chen, Liuhong Shi, Jianmin Si, Liangjing Wang, Shujie Chen
BACKGROUND: Patients frequently consult primary care physicians and gastroenterologists when experiencing chronic abdominal pain. Although its diagnostic efficacy in these settings is uncertain, small-bowel capsule endoscopy (SBCE) has been used to evaluate the unexplained reasons for abdominal pain. OBJECTIVE: To evaluate the diagnostic yield of SBCE in patients with unexplained chronic abdominal pain. DESIGN: We performed a retrospective review of publications reporting the diagnostic yield of SBCE in patients with unexplained chronic abdominal pain and calculated the overall diagnostic yield...
January 2015: Gastrointestinal Endoscopy
Annika Viniol, Christian Keunecke, Tobias Biroga, Rebekka Stadje, Katharina Dornieden, Stefan Bösner, Norbert Donner-Banzhoff, Jörg Haasenritter, Annette Becker
BACKGROUND: Diagnostic reasoning in primary care patients with abdominal pain is a complex challenge for GPs. To ensure evidence-based decision making for this symptom, GPs need setting-specific knowledge about the prevalence, potential risks for diseases and chance of recovery or risk of undesirable courses of disease. AIM: We conducted a systematic review of symptom-evaluating studies on prevalence, aetiology or prognosis of abdominal pain. METHODS: We included all studies evaluating the symptom 'abdominal pain' as a reason for consultation in primary care...
October 2014: Family Practice
Tim Vanuytsel, Jan F Tack, Guy E Boeckxstaens
Functional abdominal pain in the context of irritable bowel syndrome (IBS) is a challenging problem for primary care physicians, gastroenterologists and pain specialists. We review the evidence for the current and future non-pharmacological and pharmacological treatment options targeting the central nervous system and the gastrointestinal tract. Cognitive interventions such as cognitive behavioral therapy and hypnotherapy have demonstrated excellent results in IBS patients, but the limited availability and labor-intensive nature limit their routine use in daily practice...
August 2014: Journal of Gastroenterology
C Falch, D Vicente, H Häberle, A Kirschniak, S Müller, A Nissan, B L D M Brücher
Appropriate pain therapy prior to diagnosis in patients with acute abdominal pain remains controversial. Several recent studies have demonstrated that pain therapy does not negatively influence either the diagnosis or subsequent treatment of these patients; however, current practice patterns continue to favour withholding pain medication prior to diagnosis and surgical treatment decision. A systematic review of PubMed, Web-of-Science and The-Cochrane-Library from 1929 to 2011 was carried out using the key words of 'acute', 'abdomen', 'pain', 'emergency' as well as different pain drugs in use, revealed 84 papers...
August 2014: European Journal of Pain: EJP
Maunak V Rana, Kenneth D Candido, Omar Raja, Nebojsa Nick Knezevic
Chronic abdominal pain is a devastating problem for patients and providers, due to the difficulty of effectively treating the entity. Both benign and malignant conditions can lead to chronic abdominal pain. Precision in diagnosis is required before effective treatment can be instituted. Celiac Plexus Block is an interventional technique utilized for diagnostic and therapeutic purposes in the treatment of abdominovisceral pain. The richly innervated plexus provides sensory input about pathologic processes in the liver, pancreas, spleen, omentum, alimentary tract to the mid-transverse colon, adrenal glands, and kidney...
February 2014: Current Pain and Headache Reports
2016-06-02 16:00:54
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