|Evaluation of Abdominal Pain|
|Abdominal X-Ray: Most helpful for the following diagnoses:|
|Ultrasound: Most useful for:|
|Abdominal CT: Distinct advantage in identifying abdominal path:|
|Diagnosis||>50 years||<50 years|
Foreign Body Obstruction/Mass
Lesion of Transverse Colon
Lesion of right colon
Lesion of left colon
Mid AbdomenIleus (small bowel)
Carcinoma, Left colon
(Med Clinics of NA 1993;77:940)
|Finding||Likelihood Ratio (LR)|
|Predictive of abnormality (LR>1):|
|Increased, High Pitched B Sounds||57|
|H/O Abd Surgery||7|
|Blood in Urine||6|
|H/O Renal Calc||6|
|H/O Abd Tumor||5|
|H/O Gallbladder Disease||4|
|Gen abd pain and tenderness||3|
|Abd pain < 1 day||2|
|Predictive of Normality:|
|H/O Ulcer Disease||0.3|
|Mild Abd Pain||0.3|
|Abd pain > 1 week||0.5|
Bedell SE, Fulton EJ. Unexpected findings and complications at autopsy after cardiopulmonary resuscitation. Arch
Intern Med 1986;146:1725-1728.
Looked at autopsy findings of 130 patients dying after CPR. 14% of cases there was a major misdiagnosis discoveredthe two diseases most frequently undetected clinically were ischemic bowel and PE which together accounted for almost 90% of misdiagnoses.
Brazaitis MP, Dachman AH. The radiologic evaluation of acute abdominal pain of intestinal origin: a clinical approach.
Med Clin NA 1993,77:939-961.
An excellent review of selecting radiologic studies in the setting of the acute abdomen. In evaluating the "difficult case ", the abdominal CT is most helpful.
Eisenberg RL et al. Evaluation of plain abdominal radiographs in the diagnosis of abdmoninal pain. Ann Surg
Have you eyer wondered what the value of plain films are in the evaluation of abdominal pain? These authors prospectively studied the relation between clinical data and radiographic abnormalities. If abdominal radiographs would have been limited to those patients who had mod to severe abdominal tenderness, or those with high clinical suspicion of bowel obstruction, renal calculi, trauma, ischemia or gallbladder disease regardless of the degree of tenderness, 54% the examinations would not have been done and all radiographic abnormalities would have been identified.
Other References of Interest:
Brewer RJ. Abdommal pain. An analysis of 1000 consecutive cases in a university hospital emergency room. Am. Surgery 1976:131:219-223.
Irvin TT. Abdominal pain: a surgical audit of 1190 emergency admissions. Br J Snrg 1989;76:1121-1125.
Jess P et al. Prognosis of acute nonsoecific abdominal nain. Am J Surg 1982; 144:338-340.