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ldquoTell me more about your painhelliprdquo
Location
Quality
Severity
Onset
Duration
Modifying factors
Change over time
Differential Diagnosis
bull Appendicitis
bull Biliary colic cholecystitis cholangitis
bull Bowel obstruction
bull Diverticulitis
bull Ectopic pregnancy
bull Gastroenteritis
bull Intussuception
bull Mesenteric Ischemia
bull Ovarian torsion
bull Pancreatitis
bull Pelvic Inflammatory Disease (PID)
bull Perforated peptic ulcer
bull Ruptured or leaking abdominal aortic aneurysm (AAA)
bull Testicular torsion
bull Ureteral colic
bull Volvulus
Immediate Life-Threatening Causes of Abdominal Pain
These must be recognized from the primary survey
Ruptured abdominal aortic aneurism (AAA)
Rupture of the spleen or liver
Ruptured ectopic pregnancy
Bowel infarction
Perforated viscus
Acute myocardial infarction (MI)
What kind of tests should you order
Depends what you are looking for
Abdominal series 3 views upright chest flat view of
abdomen upright view of abdomen
Limited utility restrict use to patients with suspected obstruction or free air
Ultrasound Good for diagnosing AAA but not
ruptured AAA
Good for pelvic pathology
CT abdomenpelvis Noncontrast for free air renal colic
ruptured AAA (bowel obstruction)
Contrast study for abscess infection inflammation unknown cause
MRI Most often used when unable to
obtain CT due to contrast issue
Labs
CBC ldquoWhatrsquos the white countrdquo
Chemistries
Liver function tests Lipase
Coagulation studies
Urinalysis urine culture
GCChlamydia swabs
Lactate
Plain Films Small bowel obstruction
Cecal Volvulus and Sigmoid Volvulus
Pneumoperitoneum
Ultrasound Cholecystitis
Ovarian Torsionhellip
Ultrasound showing 75 cm AAA with intraluminal clot
CT of Rupturing AAA
Patient with Herpes Zoster (ldquoShinglesrdquo) of the abdomen
Pearls Pitfalls and Mythsbull Do not restrict the diagnosis solely by the
location of the pain
bull Consider appendicitis in all patients with abdominal pain and an appendix especially in patients with the presumed diagnosis of gastroenteritis PID or UTI
bull Do not use the presence or absence of fever to distinguish between surgical and medical causes of abdominal pain
bull The WBC count is of little clinical value in the patient with possible appendicitis
bull Any woman with childbearing potential and abdominal pain has an ectopic pregnancy until her pregnancy test comes back negative
bull Pain medications reduce pain and suffering without compromising diagnostic accuracy
bull An elderly patient with abdominal pain has a high likelihood of surgical disease
bull Obtain an ECG in elderly patients and those with cardiac risk factors presenting with abdominal pain
bull A patient with appendicitis by history and physical examination does not need a CT scan to confirm the diagnosis they need an operation
bull The use of abdominal ultrasound or CT may help evaluate patients over the age of 50 with unexplained abdominal or flank pain for the presence of AAA
Disposition
Non-specific abdominal painNo source is identified
Vital signs are normal
Non specific abdominal exam no evidence of peritonitis or severe pain
Patient improves during ED visit
Patient able to take fluids
Have patient return to ED in 12-24 hours for re-examination if not better or if they develop new symptoms
Disposition
bull Surgical consultation
bull Serial evaluation
bull Discharge
ن ومن يتق هللا يجعل له مخرجا ويرزقه م)صدق هللا العظيم( حيث اليحتسب
AND WHOSOEVER FEARS ALLAH AND KEEPS
HIS DUTY TO HIM GOD WILL MAKE A WAY
FOR HIM TO GET OUT (from ever difficulty)
AND WILL PROVIDE ( HIM l HER ) FROM
(SOURCES ) HE l SHE NEVER COULD
IMAGINE( THE NOBLE QURAN )
Differential Diagnosis
bull Appendicitis
bull Biliary colic cholecystitis cholangitis
bull Bowel obstruction
bull Diverticulitis
bull Ectopic pregnancy
bull Gastroenteritis
bull Intussuception
bull Mesenteric Ischemia
bull Ovarian torsion
bull Pancreatitis
bull Pelvic Inflammatory Disease (PID)
bull Perforated peptic ulcer
bull Ruptured or leaking abdominal aortic aneurysm (AAA)
bull Testicular torsion
bull Ureteral colic
bull Volvulus
Immediate Life-Threatening Causes of Abdominal Pain
These must be recognized from the primary survey
Ruptured abdominal aortic aneurism (AAA)
Rupture of the spleen or liver
Ruptured ectopic pregnancy
Bowel infarction
Perforated viscus
Acute myocardial infarction (MI)
What kind of tests should you order
Depends what you are looking for
Abdominal series 3 views upright chest flat view of
abdomen upright view of abdomen
Limited utility restrict use to patients with suspected obstruction or free air
Ultrasound Good for diagnosing AAA but not
ruptured AAA
Good for pelvic pathology
CT abdomenpelvis Noncontrast for free air renal colic
ruptured AAA (bowel obstruction)
Contrast study for abscess infection inflammation unknown cause
MRI Most often used when unable to
obtain CT due to contrast issue
Labs
CBC ldquoWhatrsquos the white countrdquo
Chemistries
Liver function tests Lipase
Coagulation studies
Urinalysis urine culture
GCChlamydia swabs
Lactate
Plain Films Small bowel obstruction
Cecal Volvulus and Sigmoid Volvulus
Pneumoperitoneum
Ultrasound Cholecystitis
Ovarian Torsionhellip
Ultrasound showing 75 cm AAA with intraluminal clot
CT of Rupturing AAA
Patient with Herpes Zoster (ldquoShinglesrdquo) of the abdomen
Pearls Pitfalls and Mythsbull Do not restrict the diagnosis solely by the
location of the pain
bull Consider appendicitis in all patients with abdominal pain and an appendix especially in patients with the presumed diagnosis of gastroenteritis PID or UTI
bull Do not use the presence or absence of fever to distinguish between surgical and medical causes of abdominal pain
bull The WBC count is of little clinical value in the patient with possible appendicitis
bull Any woman with childbearing potential and abdominal pain has an ectopic pregnancy until her pregnancy test comes back negative
bull Pain medications reduce pain and suffering without compromising diagnostic accuracy
bull An elderly patient with abdominal pain has a high likelihood of surgical disease
bull Obtain an ECG in elderly patients and those with cardiac risk factors presenting with abdominal pain
bull A patient with appendicitis by history and physical examination does not need a CT scan to confirm the diagnosis they need an operation
bull The use of abdominal ultrasound or CT may help evaluate patients over the age of 50 with unexplained abdominal or flank pain for the presence of AAA
Disposition
Non-specific abdominal painNo source is identified
Vital signs are normal
Non specific abdominal exam no evidence of peritonitis or severe pain
Patient improves during ED visit
Patient able to take fluids
Have patient return to ED in 12-24 hours for re-examination if not better or if they develop new symptoms
Disposition
bull Surgical consultation
bull Serial evaluation
bull Discharge
ن ومن يتق هللا يجعل له مخرجا ويرزقه م)صدق هللا العظيم( حيث اليحتسب
AND WHOSOEVER FEARS ALLAH AND KEEPS
HIS DUTY TO HIM GOD WILL MAKE A WAY
FOR HIM TO GET OUT (from ever difficulty)
AND WILL PROVIDE ( HIM l HER ) FROM
(SOURCES ) HE l SHE NEVER COULD
IMAGINE( THE NOBLE QURAN )
Immediate Life-Threatening Causes of Abdominal Pain
These must be recognized from the primary survey
Ruptured abdominal aortic aneurism (AAA)
Rupture of the spleen or liver
Ruptured ectopic pregnancy
Bowel infarction
Perforated viscus
Acute myocardial infarction (MI)
What kind of tests should you order
Depends what you are looking for
Abdominal series 3 views upright chest flat view of
abdomen upright view of abdomen
Limited utility restrict use to patients with suspected obstruction or free air
Ultrasound Good for diagnosing AAA but not
ruptured AAA
Good for pelvic pathology
CT abdomenpelvis Noncontrast for free air renal colic
ruptured AAA (bowel obstruction)
Contrast study for abscess infection inflammation unknown cause
MRI Most often used when unable to
obtain CT due to contrast issue
Labs
CBC ldquoWhatrsquos the white countrdquo
Chemistries
Liver function tests Lipase
Coagulation studies
Urinalysis urine culture
GCChlamydia swabs
Lactate
Plain Films Small bowel obstruction
Cecal Volvulus and Sigmoid Volvulus
Pneumoperitoneum
Ultrasound Cholecystitis
Ovarian Torsionhellip
Ultrasound showing 75 cm AAA with intraluminal clot
CT of Rupturing AAA
Patient with Herpes Zoster (ldquoShinglesrdquo) of the abdomen
Pearls Pitfalls and Mythsbull Do not restrict the diagnosis solely by the
location of the pain
bull Consider appendicitis in all patients with abdominal pain and an appendix especially in patients with the presumed diagnosis of gastroenteritis PID or UTI
bull Do not use the presence or absence of fever to distinguish between surgical and medical causes of abdominal pain
bull The WBC count is of little clinical value in the patient with possible appendicitis
bull Any woman with childbearing potential and abdominal pain has an ectopic pregnancy until her pregnancy test comes back negative
bull Pain medications reduce pain and suffering without compromising diagnostic accuracy
bull An elderly patient with abdominal pain has a high likelihood of surgical disease
bull Obtain an ECG in elderly patients and those with cardiac risk factors presenting with abdominal pain
bull A patient with appendicitis by history and physical examination does not need a CT scan to confirm the diagnosis they need an operation
bull The use of abdominal ultrasound or CT may help evaluate patients over the age of 50 with unexplained abdominal or flank pain for the presence of AAA
Disposition
Non-specific abdominal painNo source is identified
Vital signs are normal
Non specific abdominal exam no evidence of peritonitis or severe pain
Patient improves during ED visit
Patient able to take fluids
Have patient return to ED in 12-24 hours for re-examination if not better or if they develop new symptoms
Disposition
bull Surgical consultation
bull Serial evaluation
bull Discharge
ن ومن يتق هللا يجعل له مخرجا ويرزقه م)صدق هللا العظيم( حيث اليحتسب
AND WHOSOEVER FEARS ALLAH AND KEEPS
HIS DUTY TO HIM GOD WILL MAKE A WAY
FOR HIM TO GET OUT (from ever difficulty)
AND WILL PROVIDE ( HIM l HER ) FROM
(SOURCES ) HE l SHE NEVER COULD
IMAGINE( THE NOBLE QURAN )
What kind of tests should you order
Depends what you are looking for
Abdominal series 3 views upright chest flat view of
abdomen upright view of abdomen
Limited utility restrict use to patients with suspected obstruction or free air
Ultrasound Good for diagnosing AAA but not
ruptured AAA
Good for pelvic pathology
CT abdomenpelvis Noncontrast for free air renal colic
ruptured AAA (bowel obstruction)
Contrast study for abscess infection inflammation unknown cause
MRI Most often used when unable to
obtain CT due to contrast issue
Labs
CBC ldquoWhatrsquos the white countrdquo
Chemistries
Liver function tests Lipase
Coagulation studies
Urinalysis urine culture
GCChlamydia swabs
Lactate
Plain Films Small bowel obstruction
Cecal Volvulus and Sigmoid Volvulus
Pneumoperitoneum
Ultrasound Cholecystitis
Ovarian Torsionhellip
Ultrasound showing 75 cm AAA with intraluminal clot
CT of Rupturing AAA
Patient with Herpes Zoster (ldquoShinglesrdquo) of the abdomen
Pearls Pitfalls and Mythsbull Do not restrict the diagnosis solely by the
location of the pain
bull Consider appendicitis in all patients with abdominal pain and an appendix especially in patients with the presumed diagnosis of gastroenteritis PID or UTI
bull Do not use the presence or absence of fever to distinguish between surgical and medical causes of abdominal pain
bull The WBC count is of little clinical value in the patient with possible appendicitis
bull Any woman with childbearing potential and abdominal pain has an ectopic pregnancy until her pregnancy test comes back negative
bull Pain medications reduce pain and suffering without compromising diagnostic accuracy
bull An elderly patient with abdominal pain has a high likelihood of surgical disease
bull Obtain an ECG in elderly patients and those with cardiac risk factors presenting with abdominal pain
bull A patient with appendicitis by history and physical examination does not need a CT scan to confirm the diagnosis they need an operation
bull The use of abdominal ultrasound or CT may help evaluate patients over the age of 50 with unexplained abdominal or flank pain for the presence of AAA
Disposition
Non-specific abdominal painNo source is identified
Vital signs are normal
Non specific abdominal exam no evidence of peritonitis or severe pain
Patient improves during ED visit
Patient able to take fluids
Have patient return to ED in 12-24 hours for re-examination if not better or if they develop new symptoms
Disposition
bull Surgical consultation
bull Serial evaluation
bull Discharge
ن ومن يتق هللا يجعل له مخرجا ويرزقه م)صدق هللا العظيم( حيث اليحتسب
AND WHOSOEVER FEARS ALLAH AND KEEPS
HIS DUTY TO HIM GOD WILL MAKE A WAY
FOR HIM TO GET OUT (from ever difficulty)
AND WILL PROVIDE ( HIM l HER ) FROM
(SOURCES ) HE l SHE NEVER COULD
IMAGINE( THE NOBLE QURAN )
Plain Films Small bowel obstruction
Cecal Volvulus and Sigmoid Volvulus
Pneumoperitoneum
Ultrasound Cholecystitis
Ovarian Torsionhellip
Ultrasound showing 75 cm AAA with intraluminal clot
CT of Rupturing AAA
Patient with Herpes Zoster (ldquoShinglesrdquo) of the abdomen
Pearls Pitfalls and Mythsbull Do not restrict the diagnosis solely by the
location of the pain
bull Consider appendicitis in all patients with abdominal pain and an appendix especially in patients with the presumed diagnosis of gastroenteritis PID or UTI
bull Do not use the presence or absence of fever to distinguish between surgical and medical causes of abdominal pain
bull The WBC count is of little clinical value in the patient with possible appendicitis
bull Any woman with childbearing potential and abdominal pain has an ectopic pregnancy until her pregnancy test comes back negative
bull Pain medications reduce pain and suffering without compromising diagnostic accuracy
bull An elderly patient with abdominal pain has a high likelihood of surgical disease
bull Obtain an ECG in elderly patients and those with cardiac risk factors presenting with abdominal pain
bull A patient with appendicitis by history and physical examination does not need a CT scan to confirm the diagnosis they need an operation
bull The use of abdominal ultrasound or CT may help evaluate patients over the age of 50 with unexplained abdominal or flank pain for the presence of AAA
Disposition
Non-specific abdominal painNo source is identified
Vital signs are normal
Non specific abdominal exam no evidence of peritonitis or severe pain
Patient improves during ED visit
Patient able to take fluids
Have patient return to ED in 12-24 hours for re-examination if not better or if they develop new symptoms
Disposition
bull Surgical consultation
bull Serial evaluation
bull Discharge
ن ومن يتق هللا يجعل له مخرجا ويرزقه م)صدق هللا العظيم( حيث اليحتسب
AND WHOSOEVER FEARS ALLAH AND KEEPS
HIS DUTY TO HIM GOD WILL MAKE A WAY
FOR HIM TO GET OUT (from ever difficulty)
AND WILL PROVIDE ( HIM l HER ) FROM
(SOURCES ) HE l SHE NEVER COULD
IMAGINE( THE NOBLE QURAN )
Cecal Volvulus and Sigmoid Volvulus
Pneumoperitoneum
Ultrasound Cholecystitis
Ovarian Torsionhellip
Ultrasound showing 75 cm AAA with intraluminal clot
CT of Rupturing AAA
Patient with Herpes Zoster (ldquoShinglesrdquo) of the abdomen
Pearls Pitfalls and Mythsbull Do not restrict the diagnosis solely by the
location of the pain
bull Consider appendicitis in all patients with abdominal pain and an appendix especially in patients with the presumed diagnosis of gastroenteritis PID or UTI
bull Do not use the presence or absence of fever to distinguish between surgical and medical causes of abdominal pain
bull The WBC count is of little clinical value in the patient with possible appendicitis
bull Any woman with childbearing potential and abdominal pain has an ectopic pregnancy until her pregnancy test comes back negative
bull Pain medications reduce pain and suffering without compromising diagnostic accuracy
bull An elderly patient with abdominal pain has a high likelihood of surgical disease
bull Obtain an ECG in elderly patients and those with cardiac risk factors presenting with abdominal pain
bull A patient with appendicitis by history and physical examination does not need a CT scan to confirm the diagnosis they need an operation
bull The use of abdominal ultrasound or CT may help evaluate patients over the age of 50 with unexplained abdominal or flank pain for the presence of AAA
Disposition
Non-specific abdominal painNo source is identified
Vital signs are normal
Non specific abdominal exam no evidence of peritonitis or severe pain
Patient improves during ED visit
Patient able to take fluids
Have patient return to ED in 12-24 hours for re-examination if not better or if they develop new symptoms
Disposition
bull Surgical consultation
bull Serial evaluation
bull Discharge
ن ومن يتق هللا يجعل له مخرجا ويرزقه م)صدق هللا العظيم( حيث اليحتسب
AND WHOSOEVER FEARS ALLAH AND KEEPS
HIS DUTY TO HIM GOD WILL MAKE A WAY
FOR HIM TO GET OUT (from ever difficulty)
AND WILL PROVIDE ( HIM l HER ) FROM
(SOURCES ) HE l SHE NEVER COULD
IMAGINE( THE NOBLE QURAN )
Pneumoperitoneum
Ultrasound Cholecystitis
Ovarian Torsionhellip
Ultrasound showing 75 cm AAA with intraluminal clot
CT of Rupturing AAA
Patient with Herpes Zoster (ldquoShinglesrdquo) of the abdomen
Pearls Pitfalls and Mythsbull Do not restrict the diagnosis solely by the
location of the pain
bull Consider appendicitis in all patients with abdominal pain and an appendix especially in patients with the presumed diagnosis of gastroenteritis PID or UTI
bull Do not use the presence or absence of fever to distinguish between surgical and medical causes of abdominal pain
bull The WBC count is of little clinical value in the patient with possible appendicitis
bull Any woman with childbearing potential and abdominal pain has an ectopic pregnancy until her pregnancy test comes back negative
bull Pain medications reduce pain and suffering without compromising diagnostic accuracy
bull An elderly patient with abdominal pain has a high likelihood of surgical disease
bull Obtain an ECG in elderly patients and those with cardiac risk factors presenting with abdominal pain
bull A patient with appendicitis by history and physical examination does not need a CT scan to confirm the diagnosis they need an operation
bull The use of abdominal ultrasound or CT may help evaluate patients over the age of 50 with unexplained abdominal or flank pain for the presence of AAA
Disposition
Non-specific abdominal painNo source is identified
Vital signs are normal
Non specific abdominal exam no evidence of peritonitis or severe pain
Patient improves during ED visit
Patient able to take fluids
Have patient return to ED in 12-24 hours for re-examination if not better or if they develop new symptoms
Disposition
bull Surgical consultation
bull Serial evaluation
bull Discharge
ن ومن يتق هللا يجعل له مخرجا ويرزقه م)صدق هللا العظيم( حيث اليحتسب
AND WHOSOEVER FEARS ALLAH AND KEEPS
HIS DUTY TO HIM GOD WILL MAKE A WAY
FOR HIM TO GET OUT (from ever difficulty)
AND WILL PROVIDE ( HIM l HER ) FROM
(SOURCES ) HE l SHE NEVER COULD
IMAGINE( THE NOBLE QURAN )
Ultrasound Cholecystitis
Ovarian Torsionhellip
Ultrasound showing 75 cm AAA with intraluminal clot
CT of Rupturing AAA
Patient with Herpes Zoster (ldquoShinglesrdquo) of the abdomen
Pearls Pitfalls and Mythsbull Do not restrict the diagnosis solely by the
location of the pain
bull Consider appendicitis in all patients with abdominal pain and an appendix especially in patients with the presumed diagnosis of gastroenteritis PID or UTI
bull Do not use the presence or absence of fever to distinguish between surgical and medical causes of abdominal pain
bull The WBC count is of little clinical value in the patient with possible appendicitis
bull Any woman with childbearing potential and abdominal pain has an ectopic pregnancy until her pregnancy test comes back negative
bull Pain medications reduce pain and suffering without compromising diagnostic accuracy
bull An elderly patient with abdominal pain has a high likelihood of surgical disease
bull Obtain an ECG in elderly patients and those with cardiac risk factors presenting with abdominal pain
bull A patient with appendicitis by history and physical examination does not need a CT scan to confirm the diagnosis they need an operation
bull The use of abdominal ultrasound or CT may help evaluate patients over the age of 50 with unexplained abdominal or flank pain for the presence of AAA
Disposition
Non-specific abdominal painNo source is identified
Vital signs are normal
Non specific abdominal exam no evidence of peritonitis or severe pain
Patient improves during ED visit
Patient able to take fluids
Have patient return to ED in 12-24 hours for re-examination if not better or if they develop new symptoms
Disposition
bull Surgical consultation
bull Serial evaluation
bull Discharge
ن ومن يتق هللا يجعل له مخرجا ويرزقه م)صدق هللا العظيم( حيث اليحتسب
AND WHOSOEVER FEARS ALLAH AND KEEPS
HIS DUTY TO HIM GOD WILL MAKE A WAY
FOR HIM TO GET OUT (from ever difficulty)
AND WILL PROVIDE ( HIM l HER ) FROM
(SOURCES ) HE l SHE NEVER COULD
IMAGINE( THE NOBLE QURAN )
Ovarian Torsionhellip
Ultrasound showing 75 cm AAA with intraluminal clot
CT of Rupturing AAA
Patient with Herpes Zoster (ldquoShinglesrdquo) of the abdomen
Pearls Pitfalls and Mythsbull Do not restrict the diagnosis solely by the
location of the pain
bull Consider appendicitis in all patients with abdominal pain and an appendix especially in patients with the presumed diagnosis of gastroenteritis PID or UTI
bull Do not use the presence or absence of fever to distinguish between surgical and medical causes of abdominal pain
bull The WBC count is of little clinical value in the patient with possible appendicitis
bull Any woman with childbearing potential and abdominal pain has an ectopic pregnancy until her pregnancy test comes back negative
bull Pain medications reduce pain and suffering without compromising diagnostic accuracy
bull An elderly patient with abdominal pain has a high likelihood of surgical disease
bull Obtain an ECG in elderly patients and those with cardiac risk factors presenting with abdominal pain
bull A patient with appendicitis by history and physical examination does not need a CT scan to confirm the diagnosis they need an operation
bull The use of abdominal ultrasound or CT may help evaluate patients over the age of 50 with unexplained abdominal or flank pain for the presence of AAA
Disposition
Non-specific abdominal painNo source is identified
Vital signs are normal
Non specific abdominal exam no evidence of peritonitis or severe pain
Patient improves during ED visit
Patient able to take fluids
Have patient return to ED in 12-24 hours for re-examination if not better or if they develop new symptoms
Disposition
bull Surgical consultation
bull Serial evaluation
bull Discharge
ن ومن يتق هللا يجعل له مخرجا ويرزقه م)صدق هللا العظيم( حيث اليحتسب
AND WHOSOEVER FEARS ALLAH AND KEEPS
HIS DUTY TO HIM GOD WILL MAKE A WAY
FOR HIM TO GET OUT (from ever difficulty)
AND WILL PROVIDE ( HIM l HER ) FROM
(SOURCES ) HE l SHE NEVER COULD
IMAGINE( THE NOBLE QURAN )
Ultrasound showing 75 cm AAA with intraluminal clot
CT of Rupturing AAA
Patient with Herpes Zoster (ldquoShinglesrdquo) of the abdomen
Pearls Pitfalls and Mythsbull Do not restrict the diagnosis solely by the
location of the pain
bull Consider appendicitis in all patients with abdominal pain and an appendix especially in patients with the presumed diagnosis of gastroenteritis PID or UTI
bull Do not use the presence or absence of fever to distinguish between surgical and medical causes of abdominal pain
bull The WBC count is of little clinical value in the patient with possible appendicitis
bull Any woman with childbearing potential and abdominal pain has an ectopic pregnancy until her pregnancy test comes back negative
bull Pain medications reduce pain and suffering without compromising diagnostic accuracy
bull An elderly patient with abdominal pain has a high likelihood of surgical disease
bull Obtain an ECG in elderly patients and those with cardiac risk factors presenting with abdominal pain
bull A patient with appendicitis by history and physical examination does not need a CT scan to confirm the diagnosis they need an operation
bull The use of abdominal ultrasound or CT may help evaluate patients over the age of 50 with unexplained abdominal or flank pain for the presence of AAA
Disposition
Non-specific abdominal painNo source is identified
Vital signs are normal
Non specific abdominal exam no evidence of peritonitis or severe pain
Patient improves during ED visit
Patient able to take fluids
Have patient return to ED in 12-24 hours for re-examination if not better or if they develop new symptoms
Disposition
bull Surgical consultation
bull Serial evaluation
bull Discharge
ن ومن يتق هللا يجعل له مخرجا ويرزقه م)صدق هللا العظيم( حيث اليحتسب
AND WHOSOEVER FEARS ALLAH AND KEEPS
HIS DUTY TO HIM GOD WILL MAKE A WAY
FOR HIM TO GET OUT (from ever difficulty)
AND WILL PROVIDE ( HIM l HER ) FROM
(SOURCES ) HE l SHE NEVER COULD
IMAGINE( THE NOBLE QURAN )
CT of Rupturing AAA
Patient with Herpes Zoster (ldquoShinglesrdquo) of the abdomen
Pearls Pitfalls and Mythsbull Do not restrict the diagnosis solely by the
location of the pain
bull Consider appendicitis in all patients with abdominal pain and an appendix especially in patients with the presumed diagnosis of gastroenteritis PID or UTI
bull Do not use the presence or absence of fever to distinguish between surgical and medical causes of abdominal pain
bull The WBC count is of little clinical value in the patient with possible appendicitis
bull Any woman with childbearing potential and abdominal pain has an ectopic pregnancy until her pregnancy test comes back negative
bull Pain medications reduce pain and suffering without compromising diagnostic accuracy
bull An elderly patient with abdominal pain has a high likelihood of surgical disease
bull Obtain an ECG in elderly patients and those with cardiac risk factors presenting with abdominal pain
bull A patient with appendicitis by history and physical examination does not need a CT scan to confirm the diagnosis they need an operation
bull The use of abdominal ultrasound or CT may help evaluate patients over the age of 50 with unexplained abdominal or flank pain for the presence of AAA
Disposition
Non-specific abdominal painNo source is identified
Vital signs are normal
Non specific abdominal exam no evidence of peritonitis or severe pain
Patient improves during ED visit
Patient able to take fluids
Have patient return to ED in 12-24 hours for re-examination if not better or if they develop new symptoms
Disposition
bull Surgical consultation
bull Serial evaluation
bull Discharge
ن ومن يتق هللا يجعل له مخرجا ويرزقه م)صدق هللا العظيم( حيث اليحتسب
AND WHOSOEVER FEARS ALLAH AND KEEPS
HIS DUTY TO HIM GOD WILL MAKE A WAY
FOR HIM TO GET OUT (from ever difficulty)
AND WILL PROVIDE ( HIM l HER ) FROM
(SOURCES ) HE l SHE NEVER COULD
IMAGINE( THE NOBLE QURAN )
Patient with Herpes Zoster (ldquoShinglesrdquo) of the abdomen
Pearls Pitfalls and Mythsbull Do not restrict the diagnosis solely by the
location of the pain
bull Consider appendicitis in all patients with abdominal pain and an appendix especially in patients with the presumed diagnosis of gastroenteritis PID or UTI
bull Do not use the presence or absence of fever to distinguish between surgical and medical causes of abdominal pain
bull The WBC count is of little clinical value in the patient with possible appendicitis
bull Any woman with childbearing potential and abdominal pain has an ectopic pregnancy until her pregnancy test comes back negative
bull Pain medications reduce pain and suffering without compromising diagnostic accuracy
bull An elderly patient with abdominal pain has a high likelihood of surgical disease
bull Obtain an ECG in elderly patients and those with cardiac risk factors presenting with abdominal pain
bull A patient with appendicitis by history and physical examination does not need a CT scan to confirm the diagnosis they need an operation
bull The use of abdominal ultrasound or CT may help evaluate patients over the age of 50 with unexplained abdominal or flank pain for the presence of AAA
Disposition
Non-specific abdominal painNo source is identified
Vital signs are normal
Non specific abdominal exam no evidence of peritonitis or severe pain
Patient improves during ED visit
Patient able to take fluids
Have patient return to ED in 12-24 hours for re-examination if not better or if they develop new symptoms
Disposition
bull Surgical consultation
bull Serial evaluation
bull Discharge
ن ومن يتق هللا يجعل له مخرجا ويرزقه م)صدق هللا العظيم( حيث اليحتسب
AND WHOSOEVER FEARS ALLAH AND KEEPS
HIS DUTY TO HIM GOD WILL MAKE A WAY
FOR HIM TO GET OUT (from ever difficulty)
AND WILL PROVIDE ( HIM l HER ) FROM
(SOURCES ) HE l SHE NEVER COULD
IMAGINE( THE NOBLE QURAN )
Pearls Pitfalls and Mythsbull Do not restrict the diagnosis solely by the
location of the pain
bull Consider appendicitis in all patients with abdominal pain and an appendix especially in patients with the presumed diagnosis of gastroenteritis PID or UTI
bull Do not use the presence or absence of fever to distinguish between surgical and medical causes of abdominal pain
bull The WBC count is of little clinical value in the patient with possible appendicitis
bull Any woman with childbearing potential and abdominal pain has an ectopic pregnancy until her pregnancy test comes back negative
bull Pain medications reduce pain and suffering without compromising diagnostic accuracy
bull An elderly patient with abdominal pain has a high likelihood of surgical disease
bull Obtain an ECG in elderly patients and those with cardiac risk factors presenting with abdominal pain
bull A patient with appendicitis by history and physical examination does not need a CT scan to confirm the diagnosis they need an operation
bull The use of abdominal ultrasound or CT may help evaluate patients over the age of 50 with unexplained abdominal or flank pain for the presence of AAA
Disposition
Non-specific abdominal painNo source is identified
Vital signs are normal
Non specific abdominal exam no evidence of peritonitis or severe pain
Patient improves during ED visit
Patient able to take fluids
Have patient return to ED in 12-24 hours for re-examination if not better or if they develop new symptoms
Disposition
bull Surgical consultation
bull Serial evaluation
bull Discharge
ن ومن يتق هللا يجعل له مخرجا ويرزقه م)صدق هللا العظيم( حيث اليحتسب
AND WHOSOEVER FEARS ALLAH AND KEEPS
HIS DUTY TO HIM GOD WILL MAKE A WAY
FOR HIM TO GET OUT (from ever difficulty)
AND WILL PROVIDE ( HIM l HER ) FROM
(SOURCES ) HE l SHE NEVER COULD
IMAGINE( THE NOBLE QURAN )
Disposition
Non-specific abdominal painNo source is identified
Vital signs are normal
Non specific abdominal exam no evidence of peritonitis or severe pain
Patient improves during ED visit
Patient able to take fluids
Have patient return to ED in 12-24 hours for re-examination if not better or if they develop new symptoms
Disposition
bull Surgical consultation
bull Serial evaluation
bull Discharge
ن ومن يتق هللا يجعل له مخرجا ويرزقه م)صدق هللا العظيم( حيث اليحتسب
AND WHOSOEVER FEARS ALLAH AND KEEPS
HIS DUTY TO HIM GOD WILL MAKE A WAY
FOR HIM TO GET OUT (from ever difficulty)
AND WILL PROVIDE ( HIM l HER ) FROM
(SOURCES ) HE l SHE NEVER COULD
IMAGINE( THE NOBLE QURAN )
Disposition
bull Surgical consultation
bull Serial evaluation
bull Discharge
ن ومن يتق هللا يجعل له مخرجا ويرزقه م)صدق هللا العظيم( حيث اليحتسب
AND WHOSOEVER FEARS ALLAH AND KEEPS
HIS DUTY TO HIM GOD WILL MAKE A WAY
FOR HIM TO GET OUT (from ever difficulty)
AND WILL PROVIDE ( HIM l HER ) FROM
(SOURCES ) HE l SHE NEVER COULD
IMAGINE( THE NOBLE QURAN )
ن ومن يتق هللا يجعل له مخرجا ويرزقه م)صدق هللا العظيم( حيث اليحتسب
AND WHOSOEVER FEARS ALLAH AND KEEPS
HIS DUTY TO HIM GOD WILL MAKE A WAY
FOR HIM TO GET OUT (from ever difficulty)
AND WILL PROVIDE ( HIM l HER ) FROM
(SOURCES ) HE l SHE NEVER COULD
IMAGINE( THE NOBLE QURAN )