Diagnostic tests: Imaging for chronic abdominal pain in adults

Abstract

SUMMARYDiagnostic imaging is often not indicated in chronic abdominal pain. In particular, undifferentiated abdominal pain is rarely an indication for a CT scan.CT scanning is overused even when imaging is required. Other modalities may be preferable. A normal CT scan does not rule out cancer.Alarm symptoms, including anaemia, blood in the stool, waking at night with gastrointestinal symptoms, and weight loss, should be investigated. The most appropriate modality depends on the symptoms.Clinical information on request forms for CT scans should be specific and include the suspected condition as this helps the radiologist to determine an appropriate imaging protocol.outweighs the risk), CT should be performed and the patient reassured about the risks.

Ultrasound and Computed Tomography in Abdominal and Pelvic Diagnoses

“…The major origins of undifferentiated abdominal pain include the functional gastrointestinal disorders including irritable bowel syndrome and functional abdominal pain syndrome. Yet, inflammatory bowel disease, celiac disease and mechanical obstruction may have to be excluded first [3] . In general, clinical localization of cause of pain by the site of the patient"s symptoms is unreliable.…”

“…Dyspepsia is a symptom of complex of epigastric pain or discomfort originating in the upper gastrointestinal tract. It includes acid regurgitation, heartburn, excessive burping or belching, increased abdominal bloating, nausea and early satiety [3] . Diagnostic imaging has little role in the modern investigation of dyspepsia except to exclude, using US, biliary disease as an alternate or concomitant diagnosis or pancreatic disorder if there is clinical suspicion, that is pain radiating to the back, weight loss, jaundice, abnormal liver function, and recent onset of diabetes.…”

“…In the absence of these red flags, management of dyspepsia is typically with empirical treatment. However, if red flags are present, or if the patient does not respond to empirical treatment, investigation is generally by endoscopy, which makes functional dyspepsia essentially a diagnosis of exclusion [3] .…”

Role of ultrasonogram in chronic lower abdominal pain: special reference to gyenecologoical problems

“…It may occur due to problems of the gut, biliary tract, pancreas, gynaecological or genitourinary origin. Sometimes Chronic abdominal pain may be part of a functional syndrome [2]. The term "chronic abdominal pain" also includes "recurrent abdominal pain," which is characterised by more than 3 episodes of abdominal pain; severe pain sufficient to affect daily activities; symptoms lasting more than 3 months; and absence of any organic cause [3].…”

“…Ultrasound is useful for suspected Crohn's disease due to its high negative predictive value [12,13]. Pelvic ultrasound is the most important investigation for women of reproductive age with suspected endometriosis,ovarian or other adnexal disease [14].…”