Likely clinical diagnosis imaging recommendation comments. Patient cases illustrate the differential diagnosis and management of an often misdiagnosed cause of severe acute abdominal pain. This pathway provides guidance for imaging adult patients with nontraumatic acute abdominal pain. Imaging patients with acute abdominal pain rsna publications. Abrief discussion of the common causes of acute abdominal emergencies with the appropriate and uptodate usage of imaging diagnostic strategies and techniques with illus. We aimed to evaluate the use and diagnostic performance of imaging techniques in adult patients with aap in an ed in italy. Diagnostic imaging in adults with chronic abdominal pain is overused. An approach to the causes of acute abdominal pain in adults. Diagnostic pitfalls and accuracy of diagnosis in acute. May 29, 2009 conclusions imaging plays an increasingly important role in diagnosis of etiology of acute abdomen ct is widely used in several acute abdominal indications. The goal of this activity is to provide information on the differential diagnosis of acute. Acr appropriateness criteria american college of radiology. Imaging of nontraumatic acute abdominal pain in adults presenting to the emergency department.
Diagnostic pitfalls and accuracy of diagnosis in acute abdominal pain article in scandinavian journal of gastroenterology 4110. Evaluation of abdominal pain in the emergency department. Many of these causes will be benign and selflimited, while others are medical urgencies or even surgical emergencies. Diagnostic imaging in ed varies for adults with suspected appendicitis. Assessing abdominal complaints without imaging correctly identifies the etiology in only 43% to 59% of cases, and scoring algorithms do little to improve this accuracy. Diagnostic approach and management of acute abdominal pain article pdf available in acta medica indonesiana 444. Emergency abdominal radiology table ii suggested algorithmic imaging approach for the diagnostic workup of acute.
Tomorrow, ill go over the laboratory and imaging diagnosis of abdominal pain. Diagnostic errors related to acute abdominal pain in the. Apr 01, 2015 acute abdominal pain is a common presentation in the outpatient setting and can represent conditions ranging from benign to lifethreatening. Apr 01, 2008 acute abdominal pain can represent a spectrum of conditions from benign and selflimited disease to surgical emergencies. The role of laboratory data in narrowing a differential diagnosis should not be underestimated. Imaging for chronic abdominal pain in adults australian. Lower abdominal pain is caused by lesions of the lower git or pelvic organs. When patients present with acute nontraumatic abdominal pain, knowing what disorders. Evaluating abdominal pain requires an approach that relies on the. Table 31 outlines the typical time course associated with different diseases causing abdominal pain. If imaging is required, the most appropriate modality will depend on the symptoms present and the individual clinical scenario. Transabdominal ultrasound should be the firstline imaging test. An approach is used based on categorization of symptoms with associated links to more specific pathways. The diagnosis, however, can be obscure and therefore some centres support the use of routine imaging in the form of us andor ct scanning.
In patients with highgrade intestinal obstruction, ultrasound evaluation of the abdomen historically had diagnostic sensitivity approaching 85%. Start studying diagnostic imaging of acute abdominal pain in adults. Both the referrer and the imaging specialist should ensure all procedures are justified, with potential benefits outweighing the risks. At a minimum, a radiologist interpreting an imaging study of a patient with acute abdominal pain should be familiar with the patients blood cell counts, liver function tests, amylase and lipase levels, and urinalysis if they are available.
Oct 01, 2009 therefore, imaging plays an important role in the treatment of patients with acute abdominal pain. Acute abdominal pain in adults approach to the patient. Upper abdominal pain is caused by lesions of the upper git. Diagnostic sensitivity and specificity are 5088% and 8088%, respectively. Ultrasonography is the initial imaging test of choice for patients presenting with right upper quadrant pain. Employing these guidelines helps providers enhance quality of care and contribute to the most efficacious use of radiology. Imaging strategies for detection of urgent conditions in patients with. Records of 1,000 consecutive patients presenting to the emergency department with acute abdominal pain from april to june 1998 were retrospectively.
Therefore, imaging plays an important role in the treatment of patients with acute abdominal pain. Gangrene and perforation of the gut can occur diagnostic imaging in adults with chronic abdominal pain is overused. Conclusions imaging plays an increasingly important role in diagnosis of etiology of acute abdomen ct is widely used in several acute abdominal indications. 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. The provider has taken a history, performed a physical exam, and obtained laboratory tests. Our focus is acute abdominal pain in general, but we also discuss a number of frequently encountered urgent diagnoses in patients with acute abdominal pain. Five percent of patients presenting to the er with acute abdominal pain have acute cholecystitis. Imaging of nontraumatic acute abdominal pain in adults. Digital rectal examination in patients with acute abdominal pain. Optimization of diagnostic imaging use in patients with. Appendicitis is frequently diagnosed in the emergency department, most commonly using ct. Diagnostic imaging for acute abdominal pain in an emergency. Imaging recommendations for evaluating select causes of acute abdominal pain in adults. Imaging in the adult patient with nontraumatic abdominal pain.
Medical imaging is rapidly evolving due to advanced computer applications. Acute abdominal pain, defined as pain of less than a week in duration, is a common complaint among elderly patients. 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. Emergency department visits for chest pain and abdominal pain. Conventional radiography has limited diagnostic value in the assessment of most patients with abdominal pain. When fever is present, the need for quick, definitive diagnosis is considerably heightened. Imaging plays a key role in the diagnostic workup of patients with nontraumatic acute abdominal pain aap in emergency department ed. Amongst other recommendations, the guideline advises the use of creactive protein and white blood cell count to differentiate urgent from nonurgent causes in an adult with acute abdominal pain presenting at the emergency department.
Abdominal hernia abdominal muscle wall pain abdominal pain evaluation abdominal wall pain causes acalculous cholecystitis acute abdominal pain acute abdominal pain causes in adults acute cholecystitis acute gallstone cholangitis adynamic ileus appendicitis biliary colic bowel pseudoobstruction choledocholithiasis chronic mesenteric ischemia. Acute nonlocalized abdominal pain appropriateness criteria. Some documents for download on this website are in a portable. The elderly, the immunocompromised, women of childbearing age, and patients with prior abdominal surgeries are at a. While the clinical diagnosis may be straightforward in patients who present with classic signs and symptoms, atypical presentations may result in diagnostic confusion and delay in treatment. 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. Nontraumatic acute abdominal pain aap is one of the most common symptoms in. Acute nontraumatic abdominal pain in adult patients. Download citation diagnostic imaging of acute abdominal pain in adults acute abdominal pain is a common presentation in the outpatient setting and can.
Acute abdominal pain is a common chief complaint in patients examined in. Appendicitis is the most common diagnosis for patients to be referred to general surgery with acute abdominal pain. Acute abdominal pain accounts for 710% of all emergency department accesses. 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. Evaluation of acute abdominal pain in adults american. To compare the diagnostic yield of abdominal radiography with that of computed tomography ct in adult patients presenting to the emergency department with nontraumatic abdominal pain. Diagnostic imaging of acute abdominal pain in adults american. In children with rlq pain suggestive of acute appendicitis, us is the first line imaging method due to its relatively high sensitivity and specificity and lack of ionizing radiation score9. The obturator sign was positive, with increased pain, level 4, in the right lower quadrant. When patients present with acute nontraumatic abdominal pain, knowing what disorders and which imaging modalities to consider is essential. Evaluation and management of acute abdominal pain in the emergency department. Diagnostic imaging of acute abdominal pain in adults attending kvg. Assessment of acute abdomen in the emergency department. Acute abdominal pain accounts for 510% of visits to the emergency department.
Acute abdominal pain is one of the most commonly encountered leading symptoms in the emergency department. Only studies with adult patients 18 years were eligible for. The purpose of this study was to compare the diagnostic accuracy of contrastenhanced mri with that of contrastenhanced ct for the diagnosis of appendicitis in adolescents when interpreted by abdominal radiologists and pediatric radiologists. Related articles ct suite preparedness, chest imaging guidance, and covid19s breast imaging impact.
C order computed tomography with contrast of the abdomen andor pelvis for adults with acute pain of new onset in the right or left lower quadrant, or both. Imaging is especially helpful in the elderly with acute abdominal pain and. Severe lower left abdominal pain diagnostic imaging. Results 661 65% patients had a final diagnosis classified as urgent. Abdominal emergencies of hospital visits may include surgical and nonsurgical emergencies. Triage and disposition acute abdominal pain frequently requires urgent. Differential diagnosis of abdominal pain in adults. Unlabelled three imaging modalities are available for the diagnosis of acute appendicitis. Acute appendicitis features a characteristic march of symptoms. Diagnostic imaging of acute abdominal pain in adults attending kvg medical college and hospital, sullia. Generations of medical students and trainee doctors have been taught that digital rectal examination dre is an essential part of the clinical examination required in any patient with abdominal pain suspected of having abdominal or pelvic pathology. Imaging patients with acute abdominal pain radiology. Diagnostic imaging of acute abdominal pain in adults. Acute abdominal pain is a common presentation in the outpatient setting and can represent conditions ranging from benign to lifethreatening.
Clinical diagnosis of abdominal pain in the elderly is complicated by many factors, including diminished immune function, vague symptoms, multiple comorbidities, and normal senescent anatomic alterations. Ct should be used as a complementary study for selected cases. Guideline diagnostics in acute abdominal pain in adults. Sonography should be the first imaging technique in adult patients for the diagnosis of acute appendicitis and triage of acute abdominal pain. Guideline for the diagnostic pathway in patients with acute. Assessment of acute abdomen in the emergency department mario luka csenar summary. Abdominal pain, acute in adults murtaghs diagnostic. Early severe vomiting indicates a high obstruction of the git. Appropriate use of imaging for acute abdominal pain. Clinical assessment is sufficient to decide on the level of urgency, but not on the specific. Although it is oftentimes held for a purely surgical problem, two thirds of patients do not require operative management. American college of radiology appropriateness criteria. Us should be the initial imaging study for the diagnosis of ruq pain and acute cholecystitis.
Acute abdominal pain can represent a spectrum of conditions from benign and selflimited disease to surgical emergencies. It may be the sole indicator of the need for surgery and must be attended to swiftly. The actual diagnostic workup of a patient with acute abdominal pain presenting to the ed varies greatly between hospitals and physicians. Diagnosis of acute appendicitis in adults abdominal imaging. Gangrene and perforation of the gut can occur of symptoms in certain conditions eg, interruption of the intestinal blood supply due to a. An approach is used based on categorization of symptoms. Acute abdominal pain gastrointestinal disorders msd. Acute abdominal pain is a common chief complaint in patients. Diagnostic imaging is often not indicated in patients with chronic abdominal pain.
Acute abdominal pain aap is a common complaint in the emergency department ed. Patients with abdominal pain from a presumed renal source should undergo a noncontrast ct of the abdomen and pelvis for initial imaging, according to the acr score8. Optimization of diagnostic imaging use in patients with acute abdominal pain optima. Diagnostic imaging pathways acute abdomen overview. When discussing which laboratory tests or imaging to order in the setting of acute abdominal pain, it is practical to organize information by disease process eg, acute appendicitis, cholecystitis. In haemodynamically stable patients with acute severe and generalized abdominal pain, mdct is now the preferred imaging test and gives invaluable diagnostic information, also in unstable patients after stabilization.
Practice recommendations choose ultrasonography as the initial imaging test for patients with pain in the right upper quadrant. It has been shown that routine diagnostic imaging lowers the nar to 1. Diagnostic accuracy of mri versus ct for the evaluation of. The usefulness of mri in emergency patients presenting with acute abdominal pain may be low at this time. The utility of ct scan for the diagnostic evaluation of. The etiology of the pain may be any of a large number of processes. Appendicitis is the most common abdominal emergency. If the patient history, physical examination, and laboratory testing do not identify an underlying cause of pain and if serious pathology remains a clinical concern, diagnostic imaging is indicated. An imaging guide to abdominal pain mdedge family medicine.
The incidence of acute abdominal pain ranges between 510% of all visits at emergency department. The most common causes of acute abdomen are appendicitis, biliary colic, cholecystitis, diverticulitis, bowel obstruction, visceral perforation. Diagnostic practice for acute abdominal pain at the. Her abdomen was diffusely tender, with significant tenderness to deep palpation in the right upper quadrant at first. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Acute and severe abdominal pain, however, is almost always a symptom of intra abdominal disease. Pdf optimization of diagnostic imaging use in patients. Diagnosis of appendicitis in children and pregnant women is discussed separately, as are the pathogenesis, clinical manifestations, differential diagnosis, and management.
Imaging and laboratory testing in acute abdominal pain. Order computed tomography with contrast of the abdomen andor pelvis for adults with acute pain of new onset in the right or. Objective diagnostic errors in the emergency department ed are harmful and costly. Because us and ct are widely available, radiography is rarely indicated for the examination of patients with acute abdominal pain, with the exception of select patients groupsfor example, patients with bowel obstruction. Nontraumatic acute abdominal pain aap is one of the most common symptoms in adults presenting to the emergency department ed. Pdf imaging of nontraumatic acute abdominal pain in adults. Imaging of nontraumatic abdominal emergencies in adults. Computed tomography ct is recommended for evaluating right or left lower quadrant pain. All imaging investigations should be justified a responsibility shared by the referrer and the imaging specialist.
The sensitivity is 95% to 96% and specificity is 98%. Evaluation of abdominal pain in the emergency department hartmut gross, m. If there is clinical suspicion of an urgent condition the guideline advises that additional imaging be performed. In patients suspected of an urgent condition, additional imaging is. Abdominal ct is superior to us and is required immediately in patients with atypical clinical presentation of appendicitis and suspected perforation. Diagnostic imaging pathways abdominal pain chronic population covered by the guidance this pathway provides guidance on imaging in adult patients with non acute abdominal pain. Diagnostic imaging of acute abdominal pain in adults researchgate. Be wary of early diagnostic closure and misdiagnosis of abdominal pain. Diagnostic approach and management of acute abdominal pain. Abdominal pain is the primary presenting complaint of patients with acute appendicitis.
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