All patients older than 15 years and presenting with nontraumatic abdominal pain to the ed from may 2012 to october 2012 were recruited and the demographic characteristics, diagnosis and outcome were analyzed. This prospective observational study was conducted in a large ed of a tertiary care center in india. However, the physiologic changes associated with pregnancy must be considered in the interpretation of findings from the history and physical examination. Abdominal organs produce symptoms based on their location, e.
Cardinal presentations this post is part of a series called cardinal presentations, based on rosens emergency medicine 8th edition. This article covers abdominal pain differential diagnosis. The underlying pathology may be intraabdominal, thoracic, or systemic and may require urgent surgical. Evaluation of acute abdomen differential diagnosis of. Acute abdomen symptoms and differential diagnoses medical. Af, cvs risk factors hypovolaemia shock soft abdomen pain out of proportion to exam. 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. The age of the child determines the differential diagnosis. Pancreas epigastrium acutesymps of or back shock chronicvague in nature. Abdominal pain is reported to be the chief complaint ofas manyas5% of patients attending. Differential diagnosis of acute abdomen is often carried out depending on the location of pain in abdominal quadrants and further characteristics of pain. The primary symptom of the acute abdomen is abdominal pain.
Abdominal pain in children modified from a lecture by dr. Differential diagnosis of low back pain ppt xpowerpoint. The most common nonsurgical condition is gastroenteritis, while the most common surgical condition is appendicitis. In elderly patients with abdominal pain, do not rely on descriptions of the classic presentation for diseases in the diagnosis of acute abdomen, and do not rely on the presence. The differential diagnosis can then be limited to a subset of conditions that cause pain in that particular quadrant of the abdomen figure 31. Though bloating is typically not as serious as abdominal pain from the physicians perspective, patients often report significant difficulties. View and download powerpoint presentations on acute abdomen ppt. Abdominal pain differential diagnosis based on location. A history and focused physical examination will lead to a differential diagnosis of abdominal pain, which will then inform. Table 31 outlines the typical time course associated with different diseases causing abdominal pain. Only a few of emergency cases can be diagnosed by physical and laboratory tests 2 because the. Abdominal pain in pregnancy, abdominal pains patient. 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. Abdominal pain society for academic emergency medicine.
Abdominal pain is a common presentation to the acute medical unit and outpatient department. Christopher cheung approach to pediatric abdominal pain. Evaluation of pediatric abdominal pain can prove a diagnostic challenge. Nov 14, 2015 cardinal presentations this post is part of a series called cardinal presentations, based on rosens emergency medicine 8th edition. Acute abdominal pain aap is one of the most common reasons for emergency service applications 1. Differential diagnosis of pediatric acute abdominal pain. Ppt abdominal pain powerpoint presentation free to. Evaluation of abdominal pain in the emergency department. 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. All patients older than 15 years and presenting with nontraumatic. Acute abdomen knowledge for medical students and physicians. Inflammatory disease of wall of appendix diagnosis based on history and physical classic sequence of symptoms abdominal pain begins epigastrium or periumbilical area, anorexia, nausea or vomiting followed by pain over appendix and low grade fever 18. Apr 19, 2018 patients with chronic abdominal pain douglas a. Abdominal pain is occasionally the sole presenting complaint in a patient with lower lobe pneumonia.
Jul 17, 2018 in elderly patients with abdominal pain, do not rely on descriptions of the classic presentation for diseases in the diagnosis of acute abdomen, and do not rely on the presence of fever or leukocytosis as a sign of infection. A history and focused physical examination will lead to a differential diagnosis of abdominal pain, which will then inform further evaluation with. The differential diagnosis of abdominal pain is extensive making a concise approach sometimes difficult. Colic is an abdominal pain that crescendos to become very severe and then goes away completely. Evaluation of acute abdominal pain in emergency department. 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. Overview of ed abdominal pain epidemiology extensive differential timely identification of the acute abdomen is key approach manage. Emergency department visits for chest pain and abdominal pain. Diagnostic approach and management of acute abdominal pain. The acute abdomen is defined as a sudden onset of severe abdominal pain of less than 24 hours duration. 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.
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. Find powerpoint presentations and slides using the power of, find free. Clinical evaluation of abdominal pain in adults medicine. Other common diagnoses of abdominal pain in men and women are as. In pregnant women with acute abdominal pain, ultrasound andor mri of the abdomen andor pelvis without contrast are the preferred initial imaging modalities. Patients with more severe or persistent presentations, and. In the case described here abdominal pain, a common reason for presentation to general practitioners, was found to be due to a rare condition. Clinical profile of nontraumatic acute abdominal pain. Parents or guardians may also have difficulty interpreting the complaints of small children.
Rightsided upper abdominal pain is a common cause of presentation to general practitioners. Evaluation of abdominal pain in children approach bmj. The most common approach to the diagnosis of abdominal pain focuses on the. Abdominal pain is reported to be the chief complaint ofas manyas5% of patients attending emergency rooms 20 level 4. Stretch is the principal mechanical stimulus involved in visceral nociception, although distention, contraction, traction, compression, and torsion are also perceived 1. The patient noted that when the abdominal pain began, the pain in her leg became more frequent and of higher intensity, with intermittent numbness. 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.
The diagnostic approach to pregnant patients with severe abdominal pain is very similar to that for nonpregnant patients with acute abdomen. Definition the term acute abdomen refers to a sudden, severe abdominal pain of unclear etiology that is less than 24 hours in duration. There are a variety of conditions that may cause acute abdominal pain in a child. The differential diagnosis can then be limited to a subset of conditions that cause pain in that particular quadrant of the abdomen. Christopher cheung approach to pediatric abdominal. Neurologic basis for abdominal pain pain receptors in the abdomen respond to mechanical and chemical stimuli. John snyder, cnmc objectives know the differential diagnosis of recurrent abdominal pain recognize the. Neurologic basis for abdominal pain stretch is the primary mechanical stimulus. Jun 04, 2015 abdominal pain in pregnancy may be difficult to diagnose. By continuing to browse this site you are agreeing to our use of cookies. The broad differential of common causes of abdominal pain ranges from benign to life threatening, underscoring the need for rapid diagnosis and treatment to avoid potentially catastrophic complications. The assessment of abdominal pain involves an understanding of the mechanisms responsible for pain, a wide differential of common causes, and recognition of classic patterns and clinical. Patients with abdominal pain have a wide range of potential presentations. The evaluation of abdominal pain requires an understanding of the possible mechanisms responsible for pain, a broad differential of common causes, and recognition of typical patterns and clinical presentations.
In many cases, the causes are benign with few longterm sequelae. Acute abdominal pain in children differential diagnosis. Nonspecific low back pain is common and usually selflimited. The differential diagnosis of abdominal pain by location. A patient presenting with abdominal pain to the general. It is in many cases a medical surgical non trauma emergency, requiring urgent and specific diagnosis. Selected differential diagnosis of abdominal pain pain location possible diagnoses right upper quadrant biliary. The frequency of abdominal pain as a symptom in patients with aids is unknown. Acute abdomen refers to severe abdominal pain lasting for. May be colicky or persistant and have associated nv and pallor. Acute abdominal pain in children pubmed central pmc.
Acute abdominal pain is a common complaint in childhood, and it can be caused by a wide range of underlying surgical and nonsurgical conditions. Abdominal pain in the emergency department basic abcs benign, more serious, life threats extraabdominal considerations visceral pain parietal pain referred. 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. An approach to abdominal pain in the ed an approach to abdominal pain in the ed nisarg shah md, facep introduction complaints related to abdominal pain comprise between 57% of all visits to the ed. Parietal pain parietal peritoneum inflammation, infection,neoplasia sharp,well localised and lateralised pain 5. Walker has an extensive family history of gallstones involving his siblings and his mother. Walker because of the abdominal pain he has described, along with the rebound tenderness and guarding found on physical examination. 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. Approach to pediatric abdominal pain learn pediatrics. Pain characterization and differential diagnosis sudden onset of. An otherwise well 46yearold woman presented to her general practitioner with. With consideration of the mechanisms and clinical pathophysiology underlying abdominal pain, aggravation should be avoided through. How to create a differential diagnosis part 1 of 3 duration.
Diagnosis of pelvic pain in women can be challenging because many symptoms and signs are insensitive and nonspecific. As the first priority, urgent lifethreatening conditions. Especially in immigrants, the possibility of echinococcosis must be considered in the differential diagnosis of abdominal pain. Ppt abdominal pain in children powerpoint presentation. Evaluation of acute pelvic pain in women american family. Abdominal pain in elderly persons differential diagnoses. A free powerpoint ppt presentation displayed as a flash slide show on id. The initial assessment should attempt to determine if the patient has an acute surgical problem that requires immediate and prompt surgical. View and download powerpoint presentations on differential diagnosis of low back pain ppt. Cause grouping differentials classical history classic examination findings investigation findings initial test, diagnostic test. Pdf diagnostic approach and management of acute abdominal pain. Several other pivotal points can help narrow the differential diagnosis including 1 the time course of the pain, 2 peritoneal findings on exam, 3 unexplained hypotension, and 4 abdominal distention. Find powerpoint presentations and slides using the power of, find free presentations.
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. Apr 07, 2020 the diagnostic approach to pregnant patients with severe abdominal pain is very similar to that for nonpregnant patients with acute abdomen. Two important factors modify the differential diagnosis in patients who present with abdominal pain. Download this books into available format 2019 update. As the first priority, urgent lifethreatening conditions e. The emergency and nonurgent evaluation of abdominal pain of. In early pregnancy, ectopic pregnancy must be excluded before diagnosing any other cause of abdominal pain. 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. Urgent hospital referral is often required, unless a benign cause can be established with certainty in the absence of maternal or fetal distress. Most common cause of chronic abdominal pain accounting for 90% of abd pain in children recurrent attacks of abd pain at least 2x week for 2 months pain is usally periumbilical and. Jul 15, 2010 diagnosis of pelvic pain in women can be challenging because many symptoms and signs are insensitive and nonspecific.
Other common diagnoses of abdominal pain in men and women are as follows. It has a large number of possible causes and so a structured approach is required. Feverweaknesssyncopealtered mental statusseizuredizziness and vertigoheadachesore throatdyspneachest painabdominal painnausea and vomitinggastrointestinal bleedingacute pelvic painback pain pathophysiology of abdominal pain visceral. John snyder, cnmc objectives know the differential diagnosis of recurrent abdominal pain. What causes abdominal swelling abdominal distension. 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. Displaying differential diagnosis of low back pain powerpoint presentations advanced imaging for low back pain 869473 ppt presentation summary. The patient may have poorly localized pain and, given the wide differential diagnosis, a. Pneumonia pneumonia involving the lower lobes of the lung is a common cause of abdominal pain syndromes, presumably related to diaphragmatic irritation, and may be confused with acute cholecystitis or, rarely, an acute abdomen. The assessment of abdominal pain involves an understanding of the mechanisms responsible for pain, a wide differential of common causes, and recognition of classic patterns and clinical presentations. Only a few of emergency cases can be diagnosed by physical and laboratory. 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. Most common cause of chronic abdominal pain accounting for 90% of abd pain in children recurrent attacks of abd pain at least 2x week for 2 months pain is usally periumbilical and varies in intensity and duration. In the majority of patients with aids, abdominal pain.
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