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Acute Abdominal PainAka: Acute Abdomen, Abdominal Pain

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  1. See Also
    1. Acute Pelvic Pain
    2. Pediatric Abdominal Pain
    3. Abdominal Pain in Older Adults
  2. Definition
    1. Acute abdominal pain: Onset under 6 hours
  3. Epidemiology
    1. Abdominal pain represents 5% of ER visits
    2. Only 10% of these evaluations require surgery
    3. Accounts for 10% of malpractice claims
  4. Pearls
    1. Use low threshold for admiting elderly for observation
    2. Most commonly missed surgical diagnoses
      1. Appendicitis
      2. Small Bowel Obstruction
    3. Specific Warning signs
      1. Low Back Pain in elderly
        1. Abdominal Aortic Aneurysm
      2. Atrial Fibrillation and abdominal pain
        1. Mesenteric Ischemia
  5. Signs and symptoms: Findings suggestive of surgical abdomen
    1. Duration of pain at presentation
      1. Severe, sudden onset pain under 1 hour
        1. High risk for intra-abdominal catastrophe
        2. Causes (especially in elderly)
          1. Ruptured Abdominal Aortic Aneurysm
          2. Mesenteric Ischemia
          3. Myocardial Infarction
          4. Perforated viscus
          5. Nephrolithiasis
      2. Pain duration under 48 hours: 18% need surgery
      3. Pain duration over 48 hours: 11% need surgery
      4. Delayed presentation in young and old
    2. Pain precedes Vomiting
      1. Appendicitis
      2. Cholecystitis
      3. Small Bowel Obstruction
    3. Fever >38 C (only when accompanied by another sign)
      1. Fever lags symptoms in elderly
    4. Tachycardia (Heart Rate exceeds 110 bpm)
    5. Leukocytosis with Neutrophils >75%
    6. Peritoneal signs
    7. Age over 65 years
  6. Signs and symptoms: Findings suggestive of non-surgical abdomen
    1. Anorexia not present
  7. Differential Diagnosis
    1. See Acute Abdominal Pain Causes
  8. Evaluation
    1. See Acute Abdominal Pain Evaluation
  9. Labs and Diagnostic Studies
    1. See Acute Abdominal Pain Evaluation
  10. Imaging
    1. See Acute Abdominal Pain Evaluation
  11. Management: General
    1. Do not delay adequate analgesia
      1. Does not interfere with exam
      2. References
        1. Pace (1996) Acad Emerg Med 3:1086
        2. Thomas (2003) J Am Coll Surg 196:18
  12. Management: Surgery Consultation Indications
    1. Severe abdominal pain or progressive abdominal pain
    2. Vomit feculent or bile-stained
    3. Abdominal guarding or rigidity
    4. Abdominal rebound tenderness
    5. Abdominal distention and hypertympanic to percussion
    6. Significant traumatic injury to abdomen
    7. Abdominal pain of unclear etiology
    8. Intra-abdominal fluid accumulation
  13. References
    1. Graff (2001) Emerg Med Clin North Am 19:123

Abdominal Pain (C0000737)

Definition (MSH)Sensation of discomfort, distress, or agony in the abdominal region; generally associated with functional disorders, tissue injuries, or diseases.
ConceptsSign or Symptom (T184)
ICD9789.0, 789.00
EnglishABDMNAL PAIN UNSPCF SITE, Abdomen pain, Abdominal Pain, Abdominal Pains, PAIN ABDOMINAL
Spanishdolor abdominal
CreditsDerived from the NIH UMLS (Unified Medical Language System)



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