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American Family Physician Oct 2018Abdominal wall pain is often mistaken for intra-abdominal visceral pain, resulting in expensive and unnecessary laboratory tests, imaging studies, consultations, and... (Review)
Review
Abdominal wall pain is often mistaken for intra-abdominal visceral pain, resulting in expensive and unnecessary laboratory tests, imaging studies, consultations, and invasive procedures. Those evaluations generally are nondiagnostic, and lingering pain can become frustrating to the patient and clinician. Common causes of abdominal wall pain include nerve entrapment, hernia, and surgical or procedural complications. Anterior cutaneous nerve entrapment syndrome is the most common and frequently missed type of abdominal wall pain. This condition typically presents with acute or chronic localized pain at the lateral edge of the rectus abdominis that worsens with position changes or increased abdominal muscle tension. Abdominal wall pain should be suspected in patients with no symptoms or signs of visceral etiology and a localized small tender spot. A positive Carnett test, in which tenderness stays the same or worsens when the patient tenses the abdominal muscles, suggests abdominal wall pain. A local anesthetic injection can confirm the diagnosis when there is 50% postprocedural pain improvement. Point-of-care ultrasonography may help rule out other abdominal wall pathologies and guide injections. The management of abdominal wall pain depends on the etiology. Reassurance and patient education can be helpful. Local injection with an anesthetic and a corticosteroid is an effective treatment for anterior cutaneous nerve entrapment syndrome, with an overall response rate of 70% to 99%. For refractory cases that require more than two injections, surgical neurectomy generally resolves the pain.
Topics: Abdominal Pain; Abdominal Wall; Diagnosis, Differential; Humans; Physical Examination; Point-of-Care Systems; Ultrasonography
PubMed: 30252418
DOI: No ID Found -
Digestive Diseases (Basel, Switzerland) 2021Background and Summary: Chronic abdominal pain is a challenging complaint for both primary care providers and gastroenterologists alike, due to a broad differential... (Review)
Review
Background and Summary: Chronic abdominal pain is a challenging complaint for both primary care providers and gastroenterologists alike, due to a broad differential diagnosis and sometimes extensive and negative workup. In the absence of red flag features that herald more acute conditions, the majority of patients with chronic abdominal pain have a benign cause or a functional disorder (e.g., irritable bowel syndrome). The costs associated with a diagnostic workup are an expensive burden to health care. A systematic approach for evaluating patients and initiating a management plan are recommended in the primary care setting. Undiagnosed abdominal pain should be investigated starting with a detailed history and physical examination. Diagnostic investigations should be limited and adapted according to the clinical features, the alarm symptoms, and the symptom severity. This review will focus on the diagnostic tools which general practitioners utilize in the evaluation of chronic abdominal pain. Key Messages: The primary role of the general practitioner is to differentiate an organic disease from a functional one, to refer to a specialist, or to provide treatment for the underlying cause of pain. The functional disorders should be considered after the organic pathology has been confidently excluded. Once a diagnosis of functional pain is established, repetitive testing is not recommended and the patient should be referred to receive psychological support (e.g., cognitive therapy) associated with available pharmacological therapeutic options.
Topics: Abdominal Pain; Diagnosis, Differential; General Practice; Humans; Irritable Bowel Syndrome; Primary Health Care
PubMed: 33631744
DOI: 10.1159/000515433 -
Acta Gastro-enterologica Belgica 2022We hereby describe a case of an acutely ill 41-year-old male without any medical history who presented with an acute abdomen in the emergency department. An abdominal CT...
We hereby describe a case of an acutely ill 41-year-old male without any medical history who presented with an acute abdomen in the emergency department. An abdominal CT showed a dissection of the coeliac trunk and infarction of the spleen. Because of a presumed diagnosis of vasculitis he was started on high dose IV steroids. However, after additional testing the diagnosis of segmental arteriolar Mediolysis (SAM) was made. In this case report we describe the presentation, diagnosis, treatment and follow-up of this patient and provide the readers with background about common differential diagnosis and criteria for diagnosing SAM.
Topics: Male; Humans; Adult; Abdomen, Acute; Abdominal Pain; Abdomen; Vasculitis; Celiac Artery
PubMed: 35770291
DOI: 10.51821/85.4.9860 -
Emergency Medicine Clinics of North... May 2016Emergency department providers have become skilled at triaging patients with abdominal pain requiring surgical interventions. Abdominal pain mimics, medical conditions... (Review)
Review
Emergency department providers have become skilled at triaging patients with abdominal pain requiring surgical interventions. Abdominal pain mimics, medical conditions that cause the sensation of abdominal pain without abdominal abnormality, continue to puzzle the best physicians.
Topics: Abdominal Pain; Acute Disease; Chronic Disease; Emergency Service, Hospital; Humans
PubMed: 27133252
DOI: 10.1016/j.emc.2015.12.007 -
Emergency Medicine Clinics of North... May 2016Right upper quadrant (RUQ) pain is among the most common complaints in the emergency department. The differential diagnosis is broad and includes gastrointestinal (GI)... (Review)
Review
Right upper quadrant (RUQ) pain is among the most common complaints in the emergency department. The differential diagnosis is broad and includes gastrointestinal (GI) and non-GI causes for pain. Evaluation of patients requires a combination of history, physical examination, laboratory testing, and diagnostic imaging. This article details the anatomy and physiology of the right upper abdomen and approach to the history and physical examination of the most common diseases encountered in the emergency department. "Can't miss," non-GI diagnoses are discussed. Best practices of laboratory and imaging, and treatment of most common diagnoses of RUQ pain are reviewed.
Topics: Abdomen; Abdominal Pain; Biliary Tract Diseases; Diagnosis, Differential; Emergency Service, Hospital; Evidence-Based Medicine; Gastrointestinal Diseases; Humans; Liver Diseases; Pancreatic Diseases; Physical Examination
PubMed: 27133241
DOI: 10.1016/j.emc.2015.12.011 -
JAAPA : Official Journal of the... Jan 2022Acute abdominal pain is a common complaint in children. The care of these patients is challenging for clinicians because presentation, diagnosis, and treatment are...
Acute abdominal pain is a common complaint in children. The care of these patients is challenging for clinicians because presentation, diagnosis, and treatment are different in children than adults. This article describes the presentation, physical examination, diagnosis, and treatment of common causes of acute abdominal pain in children and discusses emerging trends in diagnosis and treatment.
Topics: Abdomen, Acute; Abdominal Pain; Adult; Child; Diagnosis, Differential; Humans; Medical History Taking; Physical Examination
PubMed: 34908557
DOI: 10.1097/01.JAA.0000803624.08871.5f -
Indian Journal of Pediatrics Jan 2018Abdominal pain is one of the common symptoms reported by children in urgent care clinics. While most children tend to have self-limiting conditions, the treating... (Review)
Review
Abdominal pain is one of the common symptoms reported by children in urgent care clinics. While most children tend to have self-limiting conditions, the treating pediatrician should watch out for underlying serious causes like intestinal obstruction and perforation peritonitis, which require immediate referral to an emergency department (ED). Abdominal pain may be secondary to surgical or non-surgical causes, and will differ as per the age of the child. The common etiologies for abdominal pain presenting to an urgent care clinic are acute gastro-enteritis, constipation and functional abdominal pain; however, a variety of extra-abdominal conditions may also present as abdominal pain. Meticulous history taking and physical examination are the best tools for diagnosis, while investigations have a limited role in treating benign etiologies.
Topics: Abdominal Pain; Ambulatory Care; Child; Humans; Physical Examination
PubMed: 28913814
DOI: 10.1007/s12098-017-2447-5 -
American Family Physician Jun 2018Recurrent abdominal pain (RAP) in children is defined as at least three episodes of pain that occur over at least three months and affect the child's ability to perform... (Review)
Review
Recurrent abdominal pain (RAP) in children is defined as at least three episodes of pain that occur over at least three months and affect the child's ability to perform normal activities. RAP is most often considered functional (nonorganic) abdominal pain, but an organic cause is found in 5% to 10% of cases. Further workup is warranted in children who have RAP and fever, vomiting, blood in the stool, more than three alarm symptoms, or a history of urinary tract infections. Physical examination findings that should prompt further workup include weight loss or failure to grow; jaundice; costovertebral tenderness or back pain with lower extremity neurologic symptoms; liver, spleen, or kidney enlargement; an abdominal mass; or localized tenderness on abdominal examination. Workup may include complete blood count, erythrocyte sedimentation rate, C-reactive protein level, fecal guaiac testing, fecal ova and parasite testing, or urinalysis. Pregnancy testing and screening for sexually transmitted infections should be considered in adolescents or if there are concerns about sexual abuse. Abdominal radiography can be helpful for diagnosing obstruction or constipation. Abdominal ultrasonography identifies an abnormality in up to 10% of children with RAP who meet criteria for further workup, compared with 1% of those who do not meet these criteria. Functional abdominal pain is a clinical diagnosis and no workup is needed. Management of functional abdominal pain focuses on improving quality of life, reducing parent and child concerns about the seriousness of the condition, and reducing the disability associated with pain rather than complete resolution of pain. Although evidence is lacking for most pharmacologic treatments of functional abdominal pain, psychological therapies such as cognitive behavior therapy and hypnotherapy have been shown to be beneficial.
Topics: Abdominal Pain; Child; Diagnosis, Differential; Humans; Quality of Life
PubMed: 30216016
DOI: No ID Found -
Terapevticheskii Arkhiv Mar 2023Abdominal pain is a symptom that determines the accuracy and timeliness of diagnosis, treatment, and prognosis. The article describes the causes of acute and chronic...
Abdominal pain is a symptom that determines the accuracy and timeliness of diagnosis, treatment, and prognosis. The article describes the causes of acute and chronic abdominal pain, particularly the pain in the abdominal wall, and the challenges in recognizing them. The pathogenetic features of visceral, parietal, referred, and psychogenic pain and the principles of symptomatic therapy are addressed. It is emphasized that complex invasive examinations of the abdominal organs are especially relevant for elderly patients who often have conditions that require computed tomography, including contrast-enhanced scans. Without losing the importance of modern examination methods used in clinical practice, the author states that a detailed medical history and a thorough physical examination can significantly narrow the work-up. Endoscopic and other instrumental invasive examinations should be strictly justified and applied with a cost-effective rational approach.
Topics: Humans; Aged; Abdominal Pain; Prognosis
PubMed: 37167126
DOI: 10.26442/00403660.2023.02.202055 -
Pediatrics in Review Apr 2010
Review
Topics: Abdominal Pain; Acute Disease; Child; Diagnosis, Differential; Hematologic Tests; Humans; Medical History Taking; Nociceptors
PubMed: 20360407
DOI: 10.1542/pir.31-4-135