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Abdominal Pain ,[object Object],[object Object],[object Object]
Causes of Acute Abdominal Pain Stratified by Age 8500 patients, 200 EDs in 17 countries over a 10-year period . [ Gallagher EJ, in  Emergency Medicine , Tintinalli JE, p 490]   13% 13% Other 4% <0.1% Gynecologic <0.1% 2% Vascular <0.1% 3% Hernia <0.1% 4% Cancer <0.1% 6% Diverticular disease 2% 7% Pancreatitis 2% 12% Bowel obstruction 32% 15% Appendicitis 40% 16% Nonspecific abdominal pain (NSAP) 6% 21% Biliary Tract Disease <50 Years  50 Years FINAL DIAGNOSIS
Causes of Acute Abdominal Pain Stratified by Age ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Immediately Life-Threatening  1 HOUR ,[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Rapidly Life-Threatening BETWEEN 1 H AND 1 DAY
Serious Threat to Health or Life  BETWEEN 1 DAY & 1 WEEK  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Mild-Moderate Morbidity > 1 WEEK ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
No Morbidity ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Rapid Assessment/Stabilization ,[object Object],[object Object]
Your worst nightmare ,[object Object],[object Object]
Rapid Assessment/Stabilization ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Rapid Assessment/Stabilization ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pivotal Findings: History ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pivotal Findings: History ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pivotal Findings: History ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pivotal Findings: History ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Physical Exam ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Ancillary Testing ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Ancillary Testing ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Appendicitis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Appendicitis ,[object Object],[object Object]
Appendicitis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Appendicitis ,[object Object],[object Object]
Appendicitis: History and Exam ,[object Object],[object Object],[object Object],2 Positive psoas sign 2-3 Pain before vomiting 4 Rigidity 3 Pain migration from periumbilical area to RLQ 8 RLQ pain LR(+) CLINICAL FEATURE
Appendicitis:  Ancillary Testing ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Appendicitis:  Ancillary Testing ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Appendicitis:  Ancillary Testing ,[object Object],0.1 18 95% 91% Abdominopelvic helical CT (PO + IV contrast) 0.5 11 95% 55% Abdominopelvic ultrasound 0.9 1 58% 48% Plain Abdominal Radiograph LR(-) LR(+) Spec Sens Test
Appendicitis: Special Populations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Case ,[object Object],[object Object]
Appendicitis: Special Populations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Appendicitis: Disposition ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Biliary Disease ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Biliary Disease: Diagnostic Testing ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Small Bowel Obstruction ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Small Bowel Obstruction ,[object Object],[object Object],[object Object],[object Object],[object Object]
Small Bowel Obstruction
Small Bowel Obstruction
Small Bowel Obstruction ,[object Object],[object Object],[object Object],0.5 3 CT  + IV/po contrast SBO low-grade 0.1 22 CT  + IV/po contrast SBO high-grade 0.7 1 Plain films SBO LR(-) LR(+) Test Target diagnosis
Small Bowel Obstruction ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Large Bowel Obstruction ,[object Object],[object Object],[object Object],[object Object]
Perforation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Perforated Bowel
Volvulus ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Volvulus
Adynamic Ileus ,[object Object],[object Object],[object Object],[object Object],[object Object]
Case ,[object Object],[object Object]
Ectopic Pregnancy: Epidemiology ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Risk Factors for Ectopic Pregnancy Ankum WM, et al.  Fertil Steril  1996;65:1093 1.6 Early age of intercourse (<18 years) 1.1 - 3.1 Vaginal douching 2.5 Smoking 0.9 - 3.8 Previous pelvic/abdominal surgery Low 2.1 Multiple sexual partners 2.5 - 21 Infertility 2.5 - 3.7 Previous genital infections Moderate 2.4 - 13 In utero DES exposure 3.5 - 25 Tubal pathology 21 Previous tubal surgery 8.3 Previous ectopic pregnancy High Odds ratio Risk factors Degree of risk
Ectopic Pregnancy ,[object Object],[object Object],[object Object],[object Object],[object Object]
Ectopic Pregnancy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
IUP OB consultation IUP No IUP ,[object Object],[object Object],[object Object],[object Object],Resuscitation: IV crystalloid + blood bedside  TVS No IUP “ formal” TVS IUP Ectopic or no IUP “ formal” TVS bedside bedside (-)
Abdominal Aortic Aneurysm: Physical Exam ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Abdominal Aortic Aneurysm: Diagnostic Testing ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
AAA
Case ,[object Object],[object Object]
Mesenteric Ischemia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Mesenteric Ischemia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Mesenteric Ischemia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Mesenteric Ischemia

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Abdominal Pain

  • 1.
  • 2. Causes of Acute Abdominal Pain Stratified by Age 8500 patients, 200 EDs in 17 countries over a 10-year period . [ Gallagher EJ, in Emergency Medicine , Tintinalli JE, p 490] 13% 13% Other 4% <0.1% Gynecologic <0.1% 2% Vascular <0.1% 3% Hernia <0.1% 4% Cancer <0.1% 6% Diverticular disease 2% 7% Pancreatitis 2% 12% Bowel obstruction 32% 15% Appendicitis 40% 16% Nonspecific abdominal pain (NSAP) 6% 21% Biliary Tract Disease <50 Years  50 Years FINAL DIAGNOSIS
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  • 48. Risk Factors for Ectopic Pregnancy Ankum WM, et al. Fertil Steril 1996;65:1093 1.6 Early age of intercourse (<18 years) 1.1 - 3.1 Vaginal douching 2.5 Smoking 0.9 - 3.8 Previous pelvic/abdominal surgery Low 2.1 Multiple sexual partners 2.5 - 21 Infertility 2.5 - 3.7 Previous genital infections Moderate 2.4 - 13 In utero DES exposure 3.5 - 25 Tubal pathology 21 Previous tubal surgery 8.3 Previous ectopic pregnancy High Odds ratio Risk factors Degree of risk
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