Aug 22, 2019 abdominal pain is a common problem, ranking in the top three symptoms of patients presenting to accident and emergency departments, but only a few of those patients will have an acute abdomen. W e l l t h i s o r y s o f s i g n i f i c an t m t r au a n s e e l o c a l i o r g n s w t r au m a. The actual diagnostic workup of a patient with acute abdominal pain presenting to the ed varies greatly between hospitals and physicians. This algorithm has been developed for md anderson using a multidisciplinary approach considering circumstances particular to md andersons specific patient population. Acute and severe abdominal pain, however, is almost always a symptom of intraabdominal disease. Acute abdominal pain gastrointestinal disorders merck. Acute abdominal pain has an onset over minutes but can persist for days. Practice guidelines for primary care of acute abdomen 2015. Here, he discusses his approach to the acute abdomen for the internist. Acute abdominal pain can represent a spectrum of conditions from. Acute abdominal pain is one of the most commonly encountered leading symptoms in the emergency department. Acute abdomen is occasionally used synonymously with peritonitis. Sep 01, 2001 use algorithm to treat abdominal pain. This collection features the best content from afp, as identified by the afp editors, on acute abdominal pain and related issues, including acute pelvic pain, appendicitis, gastroesophageal reflux.
Treatment may depend on the cause of your abdominal pain. Refer to paediatrician and consider commencing treatment with antibiotics. Evaluation and management of acute abdominal pain in the. The differential diagnosis of abdominal pain is extensive and requires a logical evaluation.
Abdominal pain in pregnant and postpartum women and patients with hiv is discussed elsewhere. Acute abdominal pain accounts for approximately 9% of childhood primary care office visits. In women, it can pose a challenging clinical scenario in which history and physical examination findings are often nonspecific, and the clinical presentation of each condition can vary widely. Acute abdominal pain gastrointestinal disorders msd. Pdf treatment of acute abdominal pain in the emergency room. Sep 26, 2012 many medical conditions cause acute abdominal pain, including diabetic ketoacidosis, hypercalcemia, addisons disease, and sickle cell crisis. Triage and disposition acute abdominal pain frequently requires. Evaluation of acute abdomen differential diagnosis of symptoms. The most difficult challenge is making a timely diagnosis so that treatment can be initiated and mor bidity prevented. The key consideration in acute abdominal pain is the differentiation between surgical and nonsurgical causes. Treatment of acute abdominal pain in the emergency room. This collection features afp content on acute abdominal pain and related.
Diagnostic accuracy may be improved by using algorithms or decision tools. Acute abdominal pain in children american family physician. Acute pancreatitis algorithm patient diagnosed with acute pancreatitis1 initial pain nausea management x goal. Evaluation of abdominal pain in the emergency department hartmut gross, m. Nov 12, 2019 acute abdominal pain is a common paediatric complaint. Table 31 outlines the typical time course associated with different diseases causing abdominal pain.
History the history of a patient with abdominal pain includes determining whether the pain is acute or chronic and a detailed description of the pain and associated symptoms, which should be interpreted with other aspects of the medical history. Acute management of abdominal pain summary clinical practice guidelines for the acute management of infants and children with abdominal pain. Acute and severe abdominal pain, however, is almost always a symptom of intra abdominal disease. It manifests on physical examination as rebound tenderness, or pain upon removal of pressure more than on application of pressure to the abdomen. Acute abdominal pain national guidelines cssl 86 section 3 initial management in most instances of acute abdominal pain, management may have to precede investigations. Since the differential diagnosis of abdominal pain varies widely ranging from benign to lifethreatening conditions, a stepwise approach is required to identify the exact cause and its severity. Therefore, the differential diagnosis of abdominal pain can be organized based on whether patients are presenting with their first episode of acute abdominal pain, a recurrent episode of acute abdominal pain, or chronicsubacute abdominal pain. Patients with abdominal pain are common in the ed, but you need a strategy for quickly identifying patients who are at high risk for lifethreatening causes of pain, and you need to order testing and consultation that improves the accuracy of your clinical assessment. Optimization of diagnostic imaging use in patients with acute. Many medical conditions cause acute abdominal pain, including diabetic ketoacidosis, hypercalcemia, addisons disease, and sickle cell crisis. Physical examination of the patient with abdominal pain is.
How do the assessment and management of acute pain differ between patients on prexisting opioid therapy and patients with opiate addiction. Pain in a sick or unstable patient should generally be managed as acute, since patients with chronic abdominal pain may present with an acute exacerbation of a chronic problem or a new and unrelated problem. Diagnostic approach and management of acute abdominal pain. Other less common metabolic causes of acute abdominal pain include uremia, lead poisoning, methanol intoxication, hereditary angioedema, and porphyria. Acute myocardial infarction pain referred to the left arm and jaw.
Evaluation of acute pelvic pain in women american family. Acr appropriateness criteria american college of radiology. Use algorithm to treat abdominal pain 20010901 ahc. A history and focused physical examination will lead to a differential diagnosis of abdominal pain, which will then inform further evaluation with. Although most children with acute abdominal pain have selflimited condi tions, the pain may herald a surgical or medical emergency. Abdominal pain algorithm management of acute abdominal pain in children. See evaluation of the adult with abdominal pain in the emergency department and evaluation of the adult with abdominal pain.
Acute abdominal pain in pediatric patients has been a challenge for providers because of the nonspecific nature of symptoms and difficulty in the assessment and. Consider acute pain consult if clinically indicated. In these instances relief of pain, correction of dehydration etc. Acute abdominal pain answers are found in the pediatric surgery nat powered by unbound medicine. Additionally, this article will discuss the approach to unstable patients with abdominal pain. Assessment and management of acute pain in adult medical.
Symptoms and signs that increase the likelihood of a surgical cause for pain include fever, bilious vomiting, bloody diarrhea, absent bowel sounds, voluntary guarding, rigidity, and rebound tenderness. The challenges involved in assessing paediatric patients with abdominal pain relate to the wide differential diagnoses that are both age and gender dependent. This study provides guidelines for the evaluation of acute abdominal pain in adults, including history and physical examination, diagnostic testing, and special patient populations. Plain radiograph requesting algorithm for patients presenting with acute abdominal pain results the results of the audit were as follows. Gangrene and perforation of the gut can occur 18 years at an urban academic hospital. Page 6 nsw health infants and children acute management of abdominal pain. Since the differential diagnosis of abdominal pain varies widely ranging from benign to lifethreatening conditions, a stepwise approach is required to identify the.
Acute abdominal pain can represent a spectrum of conditions from benign and selflimited disease to surgical emergencies. Abdominal pain is common and often inconsequential. Evaluation of acute abdominal pain in adults american family. Medicines may be given to decrease pain, treat an infection, and manage your symptoms, such as constipation. Non specific abdominal pain is very common but is a diagnosis of exclusion once red flags are considered. This consensus algorithm excludes patients who are in the icu, perioperative or preprocedural settings, or are currently receiving epidural or intrathecal analgesia. Many of these causes will be benign and selflimited, while others are medical urgencies or even surgical emergencies. Abdominal pain pathophysiology, classification and causes. Employing these guidelines helps providers enhance quality of care and contribute to the most efficacious use of radiology. The etiology of the pain may be any of a large number of processes. Abdominal pain is the most common cause for hospital admission in the united states.
Development of a plain radiograph requesting algorithm for. Abdominal pain is usually a feature, but a painfree acute abdomen can occur. A comprehensive algorithm for analgesia for acute abdominal pain in the general adult population was developed. A set of 12 clinical symptoms and signs attributes that are routinely considered in the diagnosis of appendicitis were reduced to nine attributes that were identified for the development of. Assessment of acute abdomen in the emergency department mario luka csenar summary. The optima study was designed to provide the evidence base for constructing an optimal diagnostic imaging guideline for patients with acute abdominal pain at the ed. An acute exacerbation of chronic abdominal pain should not be described as acute abdominal pain. P g abdominal pain algorithm management of acute 6. Abdominal pain is most frequently the primary presenting complaint.
An overview and algorithms assessment of the patient with an acute abdomen. This collection features the best content from afp, as identified by the afp editors, on acute abdominal pain and related issues, including acute pelvic pain, appendicitis, gastroesophageal reflux disease gerd, irritable bowel syndrome ibs, and pancreatitis. Abdominal pain algorithm management of acute abdominal pain in. Cq108 is the algorithm for the management of acute abdomen based on current. Evaluation of acute abdominal pain in adults american. This is particularly true in patients who are ill or in severe pain. Acute abdominal pain in the emergency department a clinical. The acute abdomen remains a challenge to surgeons and other physicians. Furthermore, the acute abdomen can present as acute exacerbation of chronic. Evaluation of the adult with abdominal pain uptodate.
The practice guidelines for primary care of acute abdomen 2015. The causes of abdominal pain and its pathophysiology, the evaluation of the adult with abdominal pain in the emergency department, and the evaluation of abdominal pain related to trauma is discussed elsewhere. A more complete differential diagnosis of abdominal pain and its. Assessment of acute abdomen in the emergency department. Surgery may be needed to treat a serious cause of abdominal pain. When a 52yearold woman came to the ed at university of california at irvine medical center in orange with severe abdominal pain, nausea, and a lowgrade fever, staff were able to use a new abdominal pain pathway to streamline her care. Pdf acute abdominal pain in the emergency department a. The pain may frequently be associated with nausea and vomiting, abdominal distention, fever and signs of shock. Managing acute abdominal pain in pediatric patients. Acute abdominal pain surgical abdomen the first diagnoses that must be considered in patients with acute abdominal pain are those that. Although it is oftentimes held for a purely surgical problem, two thirds of patients do not require operative management. Evaluating abdominal pain requires an approach that relies on the likelihood of disease, patient history, physical examination, laboratory tests, and imaging studies. One of the most common conditions associated with acute.
While this is not entirely incorrect, peritonitis is the more specific term, referring to inflammation of the peritoneum. Acute abdomen can be defined as severe, persistent abdominal pain of sudden onset that is likely to require surgical intervention to treat its cause. The purpose of the present study was to develop a clinical algorithm for the triage of a child with abdominal pain. Other less common metabolic causes of acute abdominal pain include uremia, lead poisoning, methanol.
An acute crisis of aip can present as a combination of symptoms, such as abdominal pain. Acute abdominal pain in the emergency department a clinical algorithm for adult patients. Algorithm for the evaluation of right upper quadrant abdominal pain. Acute abdominal pain is a common paediatric complaint. Algorithm of evaluation approach in patients with abdominal pain abcairway. Farmer is on faculty with the university of louisville with the department of surgery as a colorectal and general surgeon. No yes request acute pain consult see page 3 see page 3 assessment pnc peripheral nerve catheter pca patient controlled analgesia page 2 of 21 disclaimer. Evaluation of abdominal pain in the emergency department. It has a large number of possible causes and so a structured approach is required. Acute intermittent porphyria aip is a rare condition, a metabolic disorder of the haem biosynthesis. The emergency and nonurgent evaluation of abdominal pain of adults discussed elsewhere. The acute abdomen is defined as a sudden onset of severe abdominal pain of less than 24 hours duration. The incidence of acute abdominal pain ranges between 510% of all visits at emergency.