Abdominal pain is one of the frequent reasons for admission to emergency departments in hospitals. Diagnosis in patients presenting abdominal pain is a challenge for physicians owing to several indications, and a lack of contraindications. Delay in diagnosis and misdiagnosis is a common problem even for the most experienced emergency physician or general surgeon. Disruptions that may be related to ancillary services such as radiology and biochemistry also increase the difficulty. Abdominal Pain: Essential Diagnosis and Management in Acute Medicine is a definitive diagnosis guide that serves as a quick reference that supplements medical examinations. It gives physicians involved in a range of medical specialties (emergency medicine, family medicine, gastroenterology, general surgery) an understanding of how to apply procedures to expediently relieve pain where possible, after evaluating and recording the initial vital signs and findings on systemic examination. Key Features - Covers abdominal pain diagnosis and patient management patient in a systematic and structured manner in 12 chapters - Chapters are dedicated to specific topics - Presents an individualized approach tailored for the patient to address common problems - Gives general working knowledge for specific diseases in the list of possible diagnoses - Provides a guide to situations involving trauma and surgery
: Urinary tract infections (UTIs) and genital tract diseases (GTD) are among the most common infectious diseases with female predominance. On the other hand, acute epididymitis and orchitis are the most common GTDs which cause scrotal pain in adult males. Testicular torsion is a true medical emergency with vascular compromise and mandates immediate intervention to beware of serious complications. Although a majority are self-limiting diseases which can be treated easily, rapid diagnosis and management of certain UTIs and GTDs are a must to prevent grave outcomes. The infections may inflict the lower and/or the upper parts of urinary tract which also determines the severity of the disease. The urinary stone disease generally presents with ureteral colicky pain, blunt flank pain, nausea/vomiting, and hematuria with a male predominance. Most patients are managed easily in the acute setting but some are prone to deterioration with protracted urinary obstruction and resultant renal damage. The utilization of reliable, easy-to-use diagnostic tools with high accuracy is the key to expedient detection, identification and treatment. Ultrasound provides invaluable information in point-of-care diagnosis of most urinary tract diseases in both sexes. Management should be individualized in accord with the patients’ signs and symptoms, general status and outcome estimations
Hepatobiliary and pancreatic diseases are among common illnesses which cause major morbidity and mortality in the middle-aged and elderly patients and some specific subpopulations. Some geographic predispositions also exist for some diseases. For example, pain, fever, jaundice, and hepatomegaly can be noted in hydatic cyst disease which may cause allergic reaction and portal hypertension in the Southeast Europe and the Middle East. Of note, hepatobiliary and pancreatic diseases are commonly confused with each other, which may complicate diagnostic and therapeutic processes. A patient with biliary stones may be asymptomatic or suffer from acute or chronic cholecystitis, biliary colic, obstructive jaundice, cholangitis, mucocele, empyema, acute pancreatitis, gallstone ileus, and carcinoma. Cholecystitis and cholangitis are among diseases with high morbidity especially in the elderly and thus need to be ruled out in any patient with abdominal pain evaluated in acute and primary care setting. Some diagnostic clues are extremely helpful, such as Charcot triad which suggest severe cholecystitis (right upper quadrant AP, jaundice and fever) or cholangitis when complicated by altered mental status and hemodynamic instability. Acute pancreatitis refers to acute response to injury of the pancreas is referred to. Chronic pancreatitis, on the contrary, results from permanent damage to the endocrine and exocrine functions of the gland. Ultrasound, computed tomography and magnetic resonance imaging are among invaluable tools in diagnosing these diseases, together with specific laboratory adjuncts such as serum lipase for pancreatitis and bilirubin for obstructive jaundice. Definitive treatment encompasses surgical procedures, mostly in patients with acute abdomen due to gallstones or pancreatic necrosis.
Acute abdominal conditions which frequently necessitate emergency interventions and/or surgery include visceral perforations i.e., gastric and duodenal ulcer, bleeding and rarely, ingested foreign bodies causing tissue damage, e.g., button batteries. However, the differential diagnosis (DD) of patients presenting with acute abdominal pain is much broader than this, including many benign conditions as well. Acute gastroenteritis, acute gastritis and peptic ulcer disease are benign and mostly temporary diseases which may be relieved with simple treatments and follow-up. Gastrointestinal bleeding (with or without esophageal varices) may cause hemorrhagic shock unless expedient management is pursued. Ingested foreign bodies can constitute emergency conditions with tissue damage, especially when lodged in a specific site. The most important thing about button batteries is the prevention of their ingestion. Complications increase in direct proportion to time wasted.
Chronic abdominal pain is a very common condition all over the world. Although not expected to present emergently, acute exacerbations of chronic pain or the slightest change that worsens the patient's condition (e.g, acute-onset diarrhea, vomiting, or loss of appetite) will trigger admissions to ED. Functional bowel diseases include irritable bowel syndrome (IBS, a.k.a. spastic colon), functional bloating, functional constipation, functional diarrhea, and unspecified functional bowel disorders. Epidemiologic, pathophysiologic and therapeutic studies of functional bowel diseases, employed the Rome Criteria with universal validity. Patients with malignancy can experience different types of cancer-related pain at any time during the disease process, perceived by the organs or systems involved.
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