Upper abdominal pain is commonly due to peptic ulcer disease, and worsening of the symptoms may herald a complication such as perforation or penetration. Develop a differential diagnosis based on age and symptoms. Evaluation of chronic abdominal pain differential diagnosis. The frequency of abdominal pain as a symptom in patients with aids is unknown. Mar 01, 2018 understand the causes and frequency of acute abdominal pain in childhood.
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. Differential diagnosis there are many extraabdominal causes of abdominal pain table 1. Lead toxicity should be considered in the potential differential diagnosis of severe and resistant abdominal pain in patients referring to general eds or gi clinics if a positive history of opium abuse exists. Keywords acute abdomen analgesia diagnosis differential diagnosis guidelines. Evaluation and management of acute abdominal pain in the.
Af, cvs risk factors hypovolaemia shock soft abdomen pain out of proportion to exam. Diagnosis and management of patients with chronic abdominal pain is often challenging and can be a frustrating experience for physician and patient. Evaluation of abdominal pain in the emergency department hartmut gross, m. The underlying pathology may be intraabdominal, thoracic, or systemic and may require urgent surgical intervention. Differential diagnosis of acute abdomen is often carried out depending on the location of pain in abdominal quadrants and further characteristics of pain.
Over 50% of complaints presenting to the ed are related to acute pain, with abdominal pain accounting for 7% of all ed visits. Acute abdomen knowledge for medical students and physicians. The diagnosis and treatment of acute abdominal pain is a collaborative effort, often starting in the emergency department ed. Abdominal pain acute and chronic, differential diagnosis. Hemorrhagic shock 6 bowel perforation 2 ct abdomen and pelvis with iv contrast. Formulate a plan for evaluation and management of acute abdominal pain. Opium, addiction, lead, poisoning, abdominal pain, gastrointestinal symptoms background acute abdominal pain is. Acute abdominal pain and the acute abdomen journal of. Understand the causes and frequency of acute abdominal pain in childhood. Because the properties of pain are important in the differential diagnosis of acute abdomen, they should be ascertained according to opqrst. The initial assessment should attempt to determine if the patient has an acute surgical problem that requires immediate and prompt surgical. Acute abdominal pain in pediatric patients has been a challenge for providers because of the nonspecific nature of symptoms and difficulty in the assessment. Male female perforated ulcer nonspecific gastritis diverticulitis appendicitis acute cholecystitis the other factor is age over 70 years. In pregnant women with acute abdominal pain, ultrasound andor mri of the abdomen andor pelvis without contrast are the preferred initial imaging modalities.
The etiology of the pain may be any of a large number of processes. Table 31 outlines the typical time course associated with different diseases causing abdominal pain. The diagnostic approach to pregnant patients with severe abdominal pain is very similar to that for nonpregnant patients with acute abdomen. The most common nonsurgical condition is gastroenteritis, while the most common surgical condition is appendicitis. Emergency department visits for chest pain and abdominal pain. Describe the characteristics of visceral versus somatic abdominal pain. Abdominal migraine in the differential diagnosis of acute abdominal pain. The differential diagnosis of acute abdominal pain in an adult population is rather broad, including appendicitis, peptic ulcer, urinary stone, inflammatory bowel disease, hepatobiliary disease e. 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 acute abdominal pain in adults american. The initial approach to acute abdomen should be to assess for immediately lifethreatening causes e.
Apr 07, 2020 the diagnostic approach to pregnant patients with severe abdominal pain is very similar to that for nonpregnant patients with acute abdomen. Abdominal pain is usually a feature, but a painfree acute abdomen can occur, particularly in older people, children, and the immunocompromised, and in the last trimester of pregnancy. Diagnosis and management of acute abdominal pain kgmu. Acute intermittent porphyria, an important and rare differential diagnosis of acute abdomen. The foregut contains the pharynx, lower respiratory tract, portions of the esophagus, stomach, portions of the duodenum proximal, liver, biliary tract including the gallbladder and bile ducts, and the pancreas.
This study provides guidelines for the evaluation of acute abdominal pain in adults, including history and physical examination, diagnostic testing, and special patient populations. Acute abdomen refers to severe abdominal pain lasting for. To encourage the presence of the diagnosis of acute abdominal pain, we support by providing the online library. Abdominal pain, also known as a stomach ache, is a symptom associated with both nonserious and serious medical issues common causes of pain in the abdomen include gastroenteritis and irritable bowel syndrome. Neurologic basis for abdominal pain pain receptors in the abdomen respond to mechanical and chemical stimuli. Apr 01, 2008 acute abdominal pain can represent a spectrum of conditions from benign and selflimited disease to surgical emergencies. The differential diagnoses of acute abdomen include. Assessment and differential diagnosis of abdominal pain.
Apr 01, 2010 understand the principal causes of acute abdominal pain in children. Pdf diagnostic approach and management of acute abdominal. Visceral receptors responsible for these sensations. Most patients have a benign andor selflimited etiology, and the initial goal of evaluation is to identify those patients with a serious etiology that may require urgent intervention. The differential diagnosis of upper abdominal symptoms with ulceration in the. Acute abdominal pain american academy of pediatrics. In the majority of patients with aids, abdominal pain is directly related to hiv and its consequences 33, but the more common causes of abdominal pain in the general population also need to be considered. Walker has an extensive family history of gallstones involving his siblings and his mother. Mar 18, 2020 differential diagnosis of acute abdomen is often carried out depending on the location of pain in abdominal quadrants and further characteristics of pain. A history and focused physical examination will lead to a differential diagnosis of abdominal pain, which will then inform. Request pdf differential diagnosis of acute abdominal pain acute intermittent porphyria acute intermittent porphyria aip is a rare autosomal dominant disorder of heme biosynthesis in liver.
A sound understanding of the principles of a thorough history and examination, with awareness of the specific adaptations and considerations that must be made in pregnancy, is key to the. Abdominal pain differential diagnosis based on location. It has a large number of possible causes and so a structured approach is required. Differential diagnosis for abdominal pain based on history and physical examination in spite of the fact that area of stomach pain or abdominal pain directs the underlying assessment, related signs and indications are prescient of certain reasons for pain in the abdomen and can limit the differential diagnosis. Surgical causes of acute abdominal pain in pregnancy. Factors that contribute to this include poor sensitivity of the history and physical exam, a broad differential diagnosis that crosses several specialties, and an often negative diagnostic workup.
Differential diagnosis of acute abdominal pain oscestop. Acute abdomen, abdominal pain, abdominal emergencies. Acute abdomen symptoms and differential diagnoses medical. There are a variety of conditions that may cause acute abdominal pain in a child. Management of the acute abdomen in primary care should focus on careful assessment to reach a differential diagnosis list, with close attention paid to.
Differential diagnosis of acute abdominal pain by age. Sep 26, 2012 plain abdominal radiographs are of limited utility in the evaluation of acute abdominal pain. 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. An acute abdomen refers to a sudden, severe abdominal pain. It is essential to confirm accurate diagnosis, as visceral pain is generally poorly localized and can mimic other pathologies within the abdomen and pelvis. Differential diagnosis and treatment of visceral pain in. Acute abdominal pain is a common presenting symptom of children and adolescents and prompts the consideration of an extensive differential diagnosis. Triage and disposition acute abdominal pain frequently requires. Acute ami should especially be considered in patients who are over age 60 years, have a history of atrial fibrillation, claudication, hypercoagulable states or a previous history of atherosclerotic disease, myocardial infarction, and a history of postprandial abdominal pain and weight loss. The age of the child determines the differential diagnosis. Be familiar with the differential diagnosis of abdominal pain based on symptoms and location of pain. If you continue browsing the site, you agree to the use of cookies on this website. Dec 31, 20 acute abdominal pain is a common complaint in childhood, and it can be caused by a wide range of underlying surgical and nonsurgical conditions.
Although a common presentation, abdominal pain must be approached in a. A more complete differential diagnosis of abdominal pain and its. Differential diagnosis of pediatric acute abdominal pain. Cause grouping differentials classical history classic examination findings investigation findings initial test, diagnostic test. Many of these causes will be benign and selflimited, while others are medical urgencies or even surgical emergencies. She describes the pain as constant, cramping, currently 810 in severity with radiation to the right flank. The patient states that she has had progressively worsening lower abdominal pain for the past three weeks. The contents of the abdomen can be divided into the foregut, midgut, and hindgut. About 15% of people have a more serious underlying condition such as appendicitis, leaking or ruptured abdominal aortic aneurysm, diverticulitis, or ectopic pregnancy. Practice guidelines for primary care of acute abdomen 2015.
The differential diagnosis is lengthy, differs from that in adults, and varies. Mar 24, 2009 diagnosis and management of acute abdominal pain for students slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Abdominal organs produce symptoms based on their location, e. Differential diagnosis when evaluating a patient with acute abdominal pain.
In summary, when assessing the pregnant woman with acute abdominal pain, it is essential to consider surgical conditions in the differential diagnosis. Once confirmed, visceral and pelvic pain may improve or resolve with appropriate treatment. However, the physiologic changes associated with pregnancy must be considered in the interpretation of findings from the history and physical examination. Choose the appropriate imaging study for various diagnoses.
Abdominal pain may be a single acute event tables 10. The initial assessment should attempt to determine if the patient has an acute surgical problem that requires immediate and prompt surgical intervention, or urgent medical therapy. Two important factors modify the differential diagnosis in patients who present with abdominal pain. Abdominal pain syndromes may have diffuse, nonspecific abdominal or variable presentations of pain. Upper abdominal pain an overview sciencedirect topics. Acute abdominal pain in children pubmed central pmc. Pdf abdominal migraine in the differential diagnosis of. While a variety of diagnostic imaging tests can rule in or out a particular diagnosis, the clinician must make several judgment calls before getting to that point. Acute abdominal pain is a frequent and challenging problem facing.
Evaluation of abdominal pain in the emergency department. Differential diagnosis and treatment of visceral pain in the. Its actually not for diagnosis of acute abdominal pain only. Acute abdominal pain in children differential diagnosis. Differential diagnosis of acute abdominal pain acute. Abdominal pain is reported to be the chief complaint ofas manyas5% of patients attending.
The acute abdomen is defined as a sudden onset of severe abdominal pain of less than 24 hours duration. Managing acute abdominal pain in pediatric patients. Understand the principal causes of acute abdominal pain in children. Stretch is the principal mechanical stimulus involved in visceral nociception, although distention, contraction, traction, compression, and torsion are also perceived 1. It is in many cases a medical emergency, requiring urgent and specific diagnosis. Pdf the incidence of acute abdominal pain ranges between 510% of all visits at. Intestinal obstruction should be considered when the patient. Ramnik j xavier, harry j thomas, in hunters tropical medicine and emerging infectious disease ninth edition, 20. The differential diagnosis is lengthy, differs from that in adults, and varies by age group. Abdominal distension abdominal pain acute illness anaesthetics arm weakness atls back pain bleeding problems cardiac arrest chest pain clinical cases clinical presentations collapse cough diarrhoea differential diagnosis dizziness emergencies examination fatigue gastroenterology cases gi bleeding headache itch jaundice joint problems leg pain. Other common diagnoses of abdominal pain in men and women are as follows.
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. The differential diagnosis of abdominal pain is extensive and requires a logical evaluation. Acute abdominal pain is a common complaint in childhood, and it can be caused by a wide range of underlying surgical and nonsurgical conditions. Subscribe to the isabel blog to receive clinical content and articles abdominal pain differential diagnosis. Acute abdomen is occasionally used synonymously with peritonitis. Evaluation and management of acute abdominal pain in the emergency department. Abdominal pain as a chief complaint can present a significant diagnostic challenge in the primary care setting. Diagnosis and management of acute abdominal pain for students slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Abdominal pain acute and chronic, differential diagnosis ddx, gastroenterology if you want to be thorough and not forget anything, use both the anatomic framework and the vindicated men framework. Abdominal pain can be referred to as visceral pain or peritoneal pain. 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. Obstruction severe, acute diffuse abdominal pain can be caused by either partial or complete obstruction of the intestines.
Its what diagnosis of acute abdominal pain will give the thoughts for you. The isabel healthcare 1 minute read program highlights various diseases and conditions, providing the isabel tool differential list. Evaluating abdominal pain requires an approach that relies. Abdominal pain in children varies with age, associated symptoms, and pain location. May 25, 2018 differential diagnosis for abdominal pain based on history and physical examination in spite of the fact that area of stomach pain or abdominal pain directs the underlying assessment, related signs and indications are prescient of certain reasons for pain in the abdomen and can limit the differential diagnosis. With abdominal pain, it is important to determine what the cause is by taking a good history and the cause of the pain like how the. Walker because of the abdominal pain he has described, along with the rebound tenderness and guarding found on physical examination. Evaluating abdominal pain requires an approach that relies on the.
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