Practice Guidelines for Primary Care of Acute Abdomen 2015

Abstract

Since acute abdomen requires accurate diagnosis and treatment within a particular time limit to prevent mortality, the Japanese Society for Abdominal Emergency Medicine, in collaboration with four other medical societies, launched the Practice Guidelines for Primary Care of Acute Abdomen that were the first English guidelines in the world for the management of acute abdomen. Here we provide the highlights of these guidelines (all clinical questions and recommendations were shown in supplementary information). A systematic and comprehensive evaluation of the evidence for epidemiology, diagnosis, differential diagnosis, and primary treatment for acute abdomen was performed to develop the Practice Guidelines for Primary Care of Acute Abdomen 2015. Because many types of pathophysiological events underlie acute abdomen, these guidelines cover the primary care of adult patients with nontraumatic acute abdomen. A total of 108 questions based on nine subject areas were used to compile 113 recommendations. The subject areas included definition, epidemiology, history taking, physical examination, laboratory test, imaging studies, differential diagnosis, initial treatment, and education. Japanese medical circumstances were considered for grading the recommendations to assure useful information. The two-step methods for the initial management of acute abdomen were proposed. Early use of transfusion and analgesia, particularly intravenous acetaminophen, were recommended. The Practice Guidelines for Primary Care of Acute Abdomen 2015 have been prepared as the first evidence-based guidelines for the management of acute abdomen. We hope that these guidelines contribute to clinical practice and improve the primary care and prognosis of patients with acute abdomen.

Analgesia of acute abdominal pain in the Emergency Department

“…16,17 In a study by Sokoloff et al, 18 According to a number of surveys, achieving this goal is far from the reality and was first identified as a problem by Wilson and Pendleton 1 in the 1980s when the definition of oligoanalgesia was used for the first time. 10,19,20 As far as the imaging test used, in order to investigate the cause of the abdominal pain, the results of this study, seem to agree with the ones of the research by Vellisaris et al 21 The most frequent imaging tests were x-ray scan followed by ultrasound, CT scan and MRI scan, although, according to Mayumi et al, 14 CT scan shows greater sensitivity and accuracy in the diagnosis of abdominal pain than simple x-ray scan and is suggested along with ultrasound.…”

Changes in bowel sounds of inpatients undergoing general anesthesia

“…Research on BSs use the characteristics of BSs to observe gastrointestinal status and diagnose gastrointestinal diseases. In clinical practice, the observation of gastrointestinal peristalsis is used to monitor feeding events, thus for example, providing a reference for the monitoring of blood glucose in an arti cial pancreas system [4]; BSs can also be used as one of the indicative parameters of gastrointestinal diseases [5]. If a gastrointestinal tract development lesions occur, such as gastroduodenal disease, intestinal disease, and large bowel disease, the corresponding intensity or number of BSs may also be abnormal.…”

“…4 Anesthesia and Operation Center, Chinese PLA General Hospital, Beijing, China. 5 College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China.…”

MR Imaging-based Evaluation of Mesenteric Ischemia Caused by Strangulated Small Bowel Obstruction and Mesenteric Venous Occlusion: An Experimental Study Using Rabbits

“…2 Contrast-enhanced CT plays a pivotal role in diagnosing acute mesenteric ischemia and contributes to improving the prognosis of acute mesenteric ischemia; 3 however, imaging modalities lacking ionizing radiation exposure are ideal for pregnant females and children. 4 Intravenous administration of iodine contrast medium is avoided in patients with renal dysfunction or those with contraindications to iodine contrast medium such as anaphylaxis. 5 Consequently, delays in diagnosis can lead to massive bowel necrosis and death.…”