Management of a patient with acute abdominal pain slcog. The initial approach to acute abdomen should be to assess for immediately lifethreatening causes e. Check and record vital signs every 5 minutes if severe pain or 15 minutes if minor to. Acute abdominal pain develops, and often resolves, over a few hours to a few days. Acute abdominal pain gastrointestinal disorders merck. The physiology and mechanism of acute abdominal pain. It may be the sole indicator of the need for surgery and must be attended to swiftly.
Evaluation of acute abdominal pain in adults sarah l. Guideline for the diagnostic pathway in patients with acute. Acute abdominal pain is usually a selflimiting, benign condition that is commonly caused by. Clinical protocols for adults with acute abdominal pain in. Acute appendicitis accounts for many surgical emergencies as a common cause of nongynecologic pelvic pain. Appropriate pain therapy prior to diagnosis in patients with acute abdominal pain remains controversial.
This type of pain may be present for weeks to months, or even years. The most common causes of acute abdomen are appendicitis. Abdominal pain is the most common reason for a visit to the emergency department ed, accounting for 8 million 7% of the 119 million ed visits in 2006. There is a documented standard for pain management of acute abdominal pain in about three quarters of participating australian emergency departments. Triage and disposition acute abdominal pain frequently requires.
Only a few of emergency cases can be diagnosed by physical and laboratory tests 2 because the. Acute abdominal pain emr emt intermediate paramedic medical control legend universal patient care smo emr emt emt p p i i 1. The initial assessment should attempt to determine if the patient has an acute surgical problem that requires immediate and prompt surgical. Treatment of acute abdominal pain in the emergency room. Severe pain to light palpation percussion tenderness erect cxr. Acute and severe abdominal pain, however, is almost always a symptom of intra abdominal disease. Urgent causes require immediate treatment within 24 h to prevent. Apr 01, 2008 acute abdominal pain can represent a spectrum of conditions from benign and selflimited disease to surgical emergencies. Pdf diagnostic approach and management of acute abdominal. Over 50% of complaints presenting to the ed are related to acute pain, with abdominal pain accounting for 7% of all ed visits. Pdf diagnostic approach and management of acute abdominal pain. It is in many cases a medical surgical non trauma emergency, requiring urgent and specific diagnosis. We aimed at developing an evidencebased guideline for the diagnostic pathway of patients with abdominal pain of nontraumatic origin. Cronicon open access ec clinical and medical case reports.
Mortality from nonsurgical acute abdominal pain was low, it represented 1. General surgeons are often asked to evaluate acute abdominal pain which has an expanded differential diagnosis in women of childbearing age. Treatment may depend on the cause of your abdominal pain. Acute abdominal pain has a sudden onset, can persist for several hours or days, and may be caused by a variety of conditions or diseases. It has a large number of possible causes and so a structured approach is required. Although the acute abdomen is oftentimes viewed as a surgical problem, a surgical intervention is. Causes for acute abdominal pain can be classified as urgent or nonurgent. All patients presenting with acute abdominal pain should be assessed by a medical officer. Acute abdomen refers to severe abdominal pain lasting for. Attending staff, michael reese hospital, chicago, illinois associate in surgery, chicago medical school. Interventions include use of steroids and avoidance of trigger foods. Treatment options for abdominal pain or stomach ache. The most frequent cause was found to be acute appendicitis, followed by nonspecific abdominal pain.
Evaluation of acute abdominal pain in adults american. The acute abdomen is defined as a sudden onset of severe abdominal pain of less than 24 hours duration. Abdominal pain is usually a feature, but a pain free acute abdomen can occur, particularly in older people, children, and the immunocompromised, and in the last trimester of pregnancy. Mar 01, 2018 acute abdominal pain is a frequent and challenging problem facing pediatricians. The underlying pathology may be intraabdominal, thoracic, or systemic and may require urgent surgical intervention. Severe generalised abdominal pain back pain reduced gscollapse shock peritonitis expansile mass uss abdomen if freely available ct only if stable dont delay theatre aim for permissive hypotension sbp. Nursing care plan acute pain continued nursing interventionsselected activities rationale pain management 1400 perform a comprehensive assessment of pain to include location, characteristics, onset, duration, frequency, quality, intensity or severity, and precipitating factors of pain. Medicines may be given to decrease pain, treat an infection, and manage your symptoms, such as constipation.
Many of these causes will be benign and selflimited, while others are medical urgencies or even surgical emergencies. Acute and severe abdominal pain, however, is almost always a symptom of intraabdominal disease. Attending staff, michael reese hospital, chicago, illinois chicago illinois references 1. Acute abdominal pain and the acute abdomen journal of. This type of abdominal pain is a common physical complaint and prompted more than 7 million emergency department visits last year in the united states. The differential diagnosis of abdominal pain is extensive and requires a logical evaluation. Usually subacute associated with repeated previous episodes the most common cause of large bowel obstruction seen at the district hospital associated with massive but soft abdominal distension seen in well hydrated patients complicated with vomiting and abdominal pain as a late finding 7. Acute abdominal pain aap is one of the most common reasons for emergency service applications 1. Acute abdominal pain gastrointestinal disorders msd. Cronicon open access ec clinical and medical case reports case report an unexpected case of acute abdomen in a young adult. Assessment of acute abdomen differential diagnosis of. 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.
Evaluation of abdominal pain in the emergency department. Lack of blood supply or ischemia of intraabdominal organ can cause severe pain as seen in ischemic bowel disease or embolism of mesenteric blood vessels. Acute abdominal pain patient information jama jama network. In some rare instances, acute appendicitis has been shown to occur simultaneously with a variety of gynecologic diseases. Acute abdominal pain is a common complaint in childhood, and it can be caused by a wide range of underlying surgical and nonsurgical conditions. A more complete differential diagnosis of abdominal pain and its. Gangrene and perforation of the gut can occur acute abdominal pain is a common clinical presentation in the emergency department and primary care setting. Evaluating abdominal pain requires an approach that relies on the. An interdisciplinary approach is of great importance in the assessment of acute abdominal pain. Practice guidelines for primary care of acute abdomen 2015. This study provides guidelines for the evaluation of acute abdominal pain in adults, including history and physical examination, diagnostic testing, and special patient populations.
Evaluating abdominal pain requires an approach that relies on the likelihood of disease, patient history, physical examination, laboratory tests, and imaging studies. Pdf the incidence of acute abdominal pain ranges between 510% of. The etiology of the pain may be any of a large number of processes. For management purposes we have divided the conditions commonly causing abdominal pain in to two categories a and b. Abdominal pain may be a single acute event tables 10. Acute abdominal pain in adults approach to the patient.
Assessment of acute abdomen in the emergency department. Chronic abdominal pain may be intermittent, or episodic, meaning it may come and go. Surgery may be needed to treat a serious cause of abdominal pain. Evaluating abdominal pain requires an approach that relies.
Describe the differential diagnosis of acute abdominal pain as well the acute abdomen for children of varying chronological and developmental ages. The clinician addressing the patient with acute abdominal pain ideally should eliminate acute medical causes of abdominal pain and recognize the proper setting for surgical consultation. Abdominal emergencies of hospital visits may include surgical and nonsurgical emergencies. Additionally, this article will discuss the approach to unstable patients with abdominal pain. The most common causes of acute abdomen are appendicitis, biliary. Several recent studies have demonstrated that pain therapy does not negatively influence eithe. Gangrene and perforation of the gut can occur acute abdominal pain ranges between 510% of all visits at emergency department. Diagnostic practice for acute abdominal pain at the emergency department varies widely and is mostly based on doctors preferences. Differential diagnosis mapped to location of abdominal pain some conditions can cause pain in different regions, and it may be difficult to associate the disease with the location of the pain. Acute pain nursing diagnosis is defined as an unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage international association for the study of pain. Management of the acute abdomen in primary care should focus on careful assessment to reach a differential diagnosis list, with close attention paid to.
Therefore, the differential diagnosis of abdominal pain can be organized based on whether patients are presenting with their 1 first episode of acute abdominal pain, 2 a recurrent episode of acute abdominal pain, or 3 chronicsubacute abdominal pain. A high degree of relapse exists with the condition because of poor dietary compliance. The diagnosis and treatment of acute abdominal pain is a collaborative effort, often starting in the emergency department ed. It was found that mortality was higher among older age group 80% of died cases were above 60 years old. Gangrene and perforation of the gut can occur acute abdominal pain in adults sarah l. The incidence of these patients varies considerably in different studies varying from 1542%. Abdominal pain pathophysiology, classification and causes.
Apr 01, 2010 acute abdominal pain can be classified according to its location and nature, history, or associated signs table 1. Evaluation of abdominal pain in the emergency department hartmut gross, m. Acute abdomen knowledge for medical students and physicians. The cause of acute abdominal pain can range from john apleys little bellyacher 1 to an emergency requiring immediate action. Evaluation and management of acute abdominal pain in the. Identify the role congenital anomalies may play in the child with an acute abdomen. Category a, has conditions which could be managed in a center without a specialist and referred subsequently. In a large proportion of patients with acute abdomen a specific diagnosis can not be reached. Some conditions cause progressive pain, which steadily gets worse over time. Abdominal pain is common and often inconsequential. Acute myocardial infarction pain referred to the left arm and jaw. A case report kara fitzgerald, nd case report eosinophil infiltration. The use and quality of clinical protocols is influenced by the physical location of hospitals and staff and skill mix of clinicians. Acute abdominal pain can represent a spectrum of conditions from benign and selflimited disease to surgical emergencies.
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