Abdominal emergencies
Sam Mehta, Andrew Hindmarsh, Leila Rees in Handbook of General Surgical Emergencies, 2018
An acute abdomen is defined as a condition associated with abdominal pain that requires surgical consultation. Remember the following points when clerking a patient with an acute abdomen: ensure adequate analgesia to relieve the patient’s discomfort. This will not alter outcome or cause delay in diagnosis1take a good history: an accurate diagnosis can be made in the majority of cases based on history aloneif the diagnosis is unclear and the patient is stable, a period of observation with re-assessment may be appropriate.
Abdominal Pain
Tony Hollingworth in Differential Diagnosis in Obstetrics and Gynaecology: An A-Z, 2015
The term acute abdomen is used to describe the sudden onset of severe symptoms related to the abdomen and its contents. The symptoms may be due to pathological changes which require urgent surgical intervention. The pain may be somatic, visceral, or referred, all of which have different innervations. Somatic pain, transmitted through the somatic nerve fibres from the parietal peritoneum, may be caused by physical or chemical irritation of the peritoneum; the pain feels sharp, is very localised, and is constant until the cause of the pain is removed. Visceral pain is transmitted through the autonomic nerves. The quality of this pain is different from that of somatic pain, being dull, sometimes described as cramp-like. Women may describe the quality of visceral pain as ‘like just before the start of a period’.
Thinking to Decide in Clinical and Community Medicine: Subjects, Thinking Tools, and Vehicles for the Best Possible Decisions in Practice and Research 1
Milos Jenicek in How to Think in Medicine, 2018
Figure 10.1 is an example of a decision tree used to visualize a situation in emergency medicine. We want to decide the best way to treat a patient presenting an acute abdomen. How can this be done, analyzed, and interpreted? Only a shortened summary and principles of this decision-making tool will be given here for our elementary understanding; more details, especially the computational aspects may be found elsewhere.27,15,11 Interested readers may also notice that decision trees can cover single stage events like the problem to operate or not with ensuing outcomes and their values. Many clinical problems, especially chronic and episodic issues, in which events may occur repetitively at various moments in time or after multiple interventions, have different values and utilities. Such disease courses are analyzed by Markov models which divide them into multiple “Markov states” with their own events/decisions/outcomes/utilities sets which follow in time.28 Our example is from the former simpler situation.
The association between insurance status and diagnostic imaging for acute abdominal pain among emergency department patients in the United States, 2005–2014
Published in Current Medical Research and Opinion, 2019
Bailey Roberts, Reese Courington, Erik VerHage, Melissa Ward-Peterson, Juan Lozano
Acute abdominal pain (often called an “acute abdomen”, ICD-9-CM 789.00) is one of the most common presentations to the emergency department (ED) with a vast array of possible diagnoses, some of which may require emergent surgical intervention1. It is the most common cause for a surgical consult in the ED, the most common surgical emergency, the most common cause for non-traumatic hospital admissions and one of the most common causes of presentation to the emergency department2,3. Acute abdominal pain is a generalized symptom that typically represents very difficult and often missed clinical diagnoses, regardless of the level of experience of the evaluating physician4. As such, it is essential to have effective diagnostic studies and imaging methods to rapidly and accurately identify the underlying pathology of a patient presenting with acute abdominal pain.
Beyond the commonest: right lower quadrant abdominal pain is not always appendicitis
Published in Alexandria Journal of Medicine, 2020
Mahmoud Agha, Maha Sallam, Mohamed Eid
Three patients (0.3%) had been presented with chronic right iliac fossa pain, with acute exacerbation. WBC was normal in two patients and elevated in only one patient. They had been diagnosed with CT scan as ileocecal tumors; which were proven pathologically to be adenocarcinoma. The one who had associated high WBC was presented with carcinoma associated with acute appendicitis (Figure 1). Acute abdomen may be the initial presentation of an ileocecal malignant tumor, commonly at this site adenocarcinoma or lymphoma, gastrointestinal stromal tumor, or metastasis, especially if complicated with perforation or abscess. The differentiation between an appendicular mass and a malignant ileocecal lump may be straightforward at the CT scan; if the appendix could be clearly identified and separated from the ileocecal mass lesion. However, this is not always a simple easy task. [10,11]
Black widow spider bite in Johannesburg
Published in Southern African Journal of Infectious Diseases, 2018
Teressa Sumy Thomas, Alan Kemp, Kim Pieton Roberg
Laboratory and imaging investigations are of little assistance in making a diagnosis, but should be done to exclude differential diagnoses. Mimics of black widow envenomation may include scorpion and snake bites, an acute abdomen, myocardial infarction, alcohol withdrawal, organophosphate poisoning and tetanus. Most of these differentials may be suggested on patient history and a detailed account of events leading up to the current symptoms should be taken. Should the patient clearly report an incident he/she thinks to be a bite, scorpion and snake bites should be considered. Features in keeping with latrodectism that may suggest a snake bite include necrosis and severe swelling at the bite site (cytotoxic spider bite) or neurological symptoms such as visual disturbances, muscle weakness, dysphagia and ptosis. These neurological manifestations may also occur with scorpion bites.2 Should abdominal pain be the prominent symptom, causes of an acute abdomen (appendicitis, cholecystitis, renal colic, pancreatitis and perforated peptic ulcer) should be sought with the necessary blood workup and imaging. In a patient who is sweaty and anxious, a myocardial infarct or alchohol withdrawal may be present. Organophosphate poisoning is very common in certain areas of South Africa and should be excluded if cholinergic symptoms predominate. Tetanus and rabies should be considered if symptoms of muscles spasms, sweating and fever occur several days to weeks after a bite or injury.1,4,5
Related Knowledge Centers
- Abdominal Pain
- Appendicitis
- Ectopic Pregnancy
- Ovarian Torsion
- Surgery
- Ischemia
- Diverticulitis
- Cholecystitis
- Pancreatitis
- Peptic Ulcer Disease