The Role of Ultrasonography in Patients Referring to the Emergency Department with Acute Abdominal Pain
-
Ali Abdolrazaghnejad
,
Ali Rajabpour-Sanati
,
Hojjat Rastegari-Najafabadi
,
Maryam Ziaei
,
AbdolGhader Pakniyat
Abstract
Context: Acute abdominal pain is a common clinical problem in emergency and non-emergency cases accounting for 5 to 10% of all referrals to the emergency department. Studies have indicated that these widely differentiated diagnoses are common to these complaints. Considering the high prevalence of this complaint in the patients and the wide range of its differential diagnosis, this review study was designed and evaluated aiming at investigating the causes of acute abdominal pain with a focus on assessing the position of ultrasound as a diagnostic tool in the emergency department. Evidence acquisition: This article was conducted as a narrative review of 106 articles from 2005 through 2019. By comparing them, a comprehensive review of ultrasonographic status was conducted in patients with acute abdominal pain referring to the emergency department. Results: In this review study, we attempted to use the articles of the clinical approach, the required laboratory tests, the disadvantages and advantages of each imaging technique, the differential diagnosis for acute abdominal pain according to the location of the pain, and the position of ultrasound as a diagnostic aid tool. Eventually, the proposed protrusion will be considered in dealing with a patient with acute abdominal pain. Conclusion: Regarding the wide range of causes providing multiple differential diagnosis, as well as the limited time of the health team in the emergency department for diagnostic and therapeutic measures, particularly in time-sensitive clinical conditions, ultrasound offered by emergency medicine specialists as a diagnostic aid is considered to improve the overall diagnosis and treatment of patients, thereby reducing complications.
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2. Macaluso CR, McNamara RM. Evaluation and management of acute abdominal pain in the emergency department. Int J Gen Med. 2012;5:789-97.
3. de Burlet K, Lam A, Larsen P, Dennett E. Acute abdominal pain-changes in the way we assess it over a decade. N Z Med J. 2017;130(1463):39-44.
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5. Selbst SM, Friedman MJ, Singh SB. Epidemiology and etiology of malpractice lawsuits involving children in US emergency departments and urgent care centers. Pediatr Emerg Care. 2005;21(3):165-9.
6. Natesan S, Lee J, Volkamer H, Thoureen TJEmcoNA. Evidence-Based Medicine Approach to Abdominal Pain. Emerg Med Clin North Am. 2016;34(2):165-90.
7. Rittenhouse DW, Chojnacki KA. Massive portal venous air and pneumatosis intestinalis associated with cocaine-induced mesenteric ischemia. J Gastrointest Surg. 2012;16(1):223-5.
8. Lacy BE, Spangler CC. Acute, Recurrent, and Chronic Abdominal Pain. Problem-based Approach to Gastroenterology and Hepatology. 2012:44.
9. Utzolino S, Kousoulas L. The patient with acute abdomen in a critical care setting. Anasthesiol Intensivmed Notfallmed Schmerzther. 2018;59:640-53.
10. Riccardello GJ, Jr., Barr LK, Bassani L. Bowel perforation presenting with acute abdominal pain and subcutaneous emphysema in a 14-year-old girl with an abandoned distal peritoneal shunt catheter: case report. J Neurosurg Pediatr. 2016;18(3):325-8.
11. Aggarwal S, Qamar A, Sharma V, Sharma A. Abdominal aortic aneurysm: A comprehensive review. Exp Clin Cardiol. 2011;16(1):11-5.
12. Kent KC. Clinical practice. Abdominal aortic aneurysms. N Engl J Med. 2014;371(22):2101-8.
13. Rubarth LB, Van Woudenberg CD. Development of the Gastrointestinal System: An Embryonic and Fetal Review. Neonatal Netw. 2016;35(3):156-8.
14. Rami Reddy SR, Cappell MS. A Systematic Review of the Clinical Presentation, Diagnosis, and Treatment of Small Bowel Obstruction. Curr Gastroenterol Rep. 2017;19(6):28.
15. Shabanzadeh DM, Sorensen LT, Jorgensen T. Which Abdominal Symptoms are Associated with Clinical Events in a Population Unaware of Their Gallstones? a Cohort Study. J Gastrointest Surg. 2017;21(5):831-9.
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17. Petroianu A. Diagnosis of acute appendicitis. Inter J Surg. 2012;10(3):115-9.
18. Flasar MH, Goldberg E. Acute abdominal pain. Med Clin North Am. 2006;90(3):481-503.
19. Wyers MC, editor Acute mesenteric ischemia: diagnostic approach and surgical treatment. Seminars in vascular surgery; 2010: Elsevier.
20. Ford AC, Lacy BE, Talley NJ. Irritable Bowel Syndrome. N Engl J Med. 2017;376(26):2566-78.
21. Lanas A, Chan FKL. Peptic ulcer disease. Lancet. 2017;390(10094):613-24.
22. Enck P, Azpiroz F, Boeckxstaens G, Elsenbruch S, Feinle-Bisset C, Holtmann G, et al. Functional dyspepsia. Nat Rev Dis Primers. 2017;3:17081.
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41. Bundy DG, Byerley JS, Liles EA, Perrin EM, Katznelson J, Rice HE. Does this child have appendicitis? JAMA. 2007;298(4):438-51.
42. Felder S, Margel D, Murrell Z, Fleshner P. Usefulness of bowel sound auscultation: a prospective evaluation. J Surg Educ. 2014;71(5):768-73.
43. Quaas J, Lanigan M, Newman D, McOsker J, Babayev R, Mason C. Utility of the digital rectal examination in the evaluation of undifferentiated abdominal pain. Am J Emerg Med. 2009;27(9):1125-9.
44. Gans SL, Pols MA, Stoker J, Boermeester MA. Guideline for the diagnostic pathway in patients with acute abdominal pain. Dig Surg. 2015;32(1):23-31.
45. Markogiannakis H, Memos N, Messaris E, Dardamanis D, Larentzakis A, Papanikolaou D, et al. Predictive value of procalcitonin for bowel ischemia and necrosis in bowel obstruction. Surgery. 2011;149(3):394-403.
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49. Kurt Y, Akin ML, Demirbas S, Uluutku AH, Gulderen M, Avsar K, et al. D-dimer in the early diagnosis of acute mesenteric ischemia secondary to arterial occlusion in rats. Eur Surg Res. 2005;37(4):216-9.
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53. Cucher D, Kulvatunyou N, Green DJ, Jie T, Ong ES. Gallstone pancreatitis: a review. Surg Clin North Am. 2014;94(2):257-80.
54. Panebianco NL, Jahnes K, Mills AM. Imaging and laboratory testing in acute abdominal pain. Emerg Med Clin North Am. 2011;29(2):175-93, vii.
55. Laurell H, Hansson LE, Gunnarsson U. Diagnostic pitfalls and accuracy of diagnosis in acute abdominal pain. Scand J Gastroenterol. 2006;41(10):1126-31.
56. Toorenvliet BR, Bakker RF, Flu HC, Merkus JW, Hamming JF, Breslau PJ. Standard outpatient re-evaluation for patients not admitted to the hospital after emergency department evaluation for acute abdominal pain. World J Surg. 2010;34(3):480-6.
57. Broder J, Warshauer DM. Increasing utilization of computed tomography in the adult emergency department, 2000-2005. Emerg Radiol. 2006;13(1):25-30.
58. Mitka M. Costly surge in diagnostic imaging spurs debate. JAMA. 2005;293(6):665-7.
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2. Macaluso CR, McNamara RM. Evaluation and management of acute abdominal pain in the emergency department. Int J Gen Med. 2012;5:789-97.
3. de Burlet K, Lam A, Larsen P, Dennett E. Acute abdominal pain-changes in the way we assess it over a decade. N Z Med J. 2017;130(1463):39-44.
4. Kachalia A, Gandhi TK, Puopolo AL, Yoon C, Thomas EJ, Griffey R, et al. Missed and delayed diagnoses in the emergency department: a study of closed malpractice claims from 4 liability insurers. Ann Emerg Med. 2007;49(2):196-205.
5. Selbst SM, Friedman MJ, Singh SB. Epidemiology and etiology of malpractice lawsuits involving children in US emergency departments and urgent care centers. Pediatr Emerg Care. 2005;21(3):165-9.
6. Natesan S, Lee J, Volkamer H, Thoureen TJEmcoNA. Evidence-Based Medicine Approach to Abdominal Pain. Emerg Med Clin North Am. 2016;34(2):165-90.
7. Rittenhouse DW, Chojnacki KA. Massive portal venous air and pneumatosis intestinalis associated with cocaine-induced mesenteric ischemia. J Gastrointest Surg. 2012;16(1):223-5.
8. Lacy BE, Spangler CC. Acute, Recurrent, and Chronic Abdominal Pain. Problem-based Approach to Gastroenterology and Hepatology. 2012:44.
9. Utzolino S, Kousoulas L. The patient with acute abdomen in a critical care setting. Anasthesiol Intensivmed Notfallmed Schmerzther. 2018;59:640-53.
10. Riccardello GJ, Jr., Barr LK, Bassani L. Bowel perforation presenting with acute abdominal pain and subcutaneous emphysema in a 14-year-old girl with an abandoned distal peritoneal shunt catheter: case report. J Neurosurg Pediatr. 2016;18(3):325-8.
11. Aggarwal S, Qamar A, Sharma V, Sharma A. Abdominal aortic aneurysm: A comprehensive review. Exp Clin Cardiol. 2011;16(1):11-5.
12. Kent KC. Clinical practice. Abdominal aortic aneurysms. N Engl J Med. 2014;371(22):2101-8.
13. Rubarth LB, Van Woudenberg CD. Development of the Gastrointestinal System: An Embryonic and Fetal Review. Neonatal Netw. 2016;35(3):156-8.
14. Rami Reddy SR, Cappell MS. A Systematic Review of the Clinical Presentation, Diagnosis, and Treatment of Small Bowel Obstruction. Curr Gastroenterol Rep. 2017;19(6):28.
15. Shabanzadeh DM, Sorensen LT, Jorgensen T. Which Abdominal Symptoms are Associated with Clinical Events in a Population Unaware of Their Gallstones? a Cohort Study. J Gastrointest Surg. 2017;21(5):831-9.
16. Liu L. Essentials of Chinese medicine: Springer Science & Business Media; 2009.
17. Petroianu A. Diagnosis of acute appendicitis. Inter J Surg. 2012;10(3):115-9.
18. Flasar MH, Goldberg E. Acute abdominal pain. Med Clin North Am. 2006;90(3):481-503.
19. Wyers MC, editor Acute mesenteric ischemia: diagnostic approach and surgical treatment. Seminars in vascular surgery; 2010: Elsevier.
20. Ford AC, Lacy BE, Talley NJ. Irritable Bowel Syndrome. N Engl J Med. 2017;376(26):2566-78.
21. Lanas A, Chan FKL. Peptic ulcer disease. Lancet. 2017;390(10094):613-24.
22. Enck P, Azpiroz F, Boeckxstaens G, Elsenbruch S, Feinle-Bisset C, Holtmann G, et al. Functional dyspepsia. Nat Rev Dis Primers. 2017;3:17081.
23. Cartwright SL, Knudson MP. Evaluation of acute abdominal pain in adults. Am Fam Physician. 2008;77(7):971-8.
24. Kruszka PS, Kruszka SJ. Evaluation of acute pelvic pain in women. Am Fam Physician. 2010;82(2):141-7.
25. Linzay CD, Pandit S. Acute Diverticulitis. StatPearls [Internet]: StatPearls Publishing; 2018.
26. Cafasso DE, Smith RR. Symptomatic cholelithiasis and functional disorders of the biliary tract. Surg Clin North Am. 2014;94(2):233-56.
27. Khan SR, Pearle MS, Robertson WG, Gambaro G, Canales BK, Doizi S, et al. Kidney stones. Nat Rev Dis Primers. 2016;2:16008.
28. Patterson JW, Dominique E. Acute Abdomen. StatPearls [Internet]: StatPearls Publishing; 2018.
29. Girman CJ, Kou TD, Cai B, Alexander CM, O'Neill EA, Williams-Herman DE, et al. Patients with type 2 diabetes mellitus have higher risk for acute pancreatitis compared with those without diabetes. Diabetes Obes Metab. 2010;12(9):766-71.
30. Cudnik MT, Darbha S, Jones J, Macedo J, Stockton SW, Hiestand BC. The diagnosis of acute mesenteric ischemia: A systematic review and meta-analysis. Acad Emerg. 2013;20(11):1087-100.
31. Lanas A, Carrera-Lasfuentes P, Arguedas Y, Garcia S, Bujanda L, Calvet X, et al. Risk of upper and lower gastrointestinal bleeding in patients taking nonsteroidal anti-inflammatory drugs, antiplatelet agents, or anticoagulants. Clin Gastroenterol Hepatol. 2015;13(5):906-12.e2.
32. ten Broek RP, Issa Y, van Santbrink EJ, Bouvy ND, Kruitwagen RF, Jeekel J, et al. Burden of adhesions in abdominal and pelvic surgery: systematic review and met-analysis. BMJ. 2013;347:f5588.
33. Lindquist Liljeqvist M, Hultgren R, Siika A, Gasser TC, Roy J. Gender, smoking, body size, and aneurysm geometry influence the biomechanical rupture risk of abdominal aortic aneurysms as estimated by finite element analysis. J Vasc Surg. 2017;65(4):1014-21.e4.
34. Li C, Zhao WH, Zhu Q, Cao SJ, Ping H, Xi X, et al. Risk factors for ectopic pregnancy: a multi-center case-control study. BMC Pregnancy Childbirth. 2015;15:187.
35. Worcester EM, Coe FL. Nephrolithiasis. Primary Care. 2008;35(2):369-vii.
36. Wong F. Management of ascites in cirrhosis. J Gastroenterol Hepatol. 2012;27(1):11-20.
37. Taylor S, Watt M. Emergency department assessment of abdominal pain: clinical indicator tests for detecting peritonism. Eur J Emerg Med. 2005;12(6):275-7.
38. Benabbas R, Hanna M, Shah J, Sinert R. Diagnostic Accuracy of History, Physical Examination, Laboratory Tests, and Point-of-care Ultrasound for Pediatric Acute Appendicitis in the Emergency Department: A Systematic Review and Meta-analysis. Acad Emerg Med. 2017;24(5):523-51.
39. Kharbanda AB, Dudley NC, Bajaj L, Stevenson MD, Macias CG, Mittal MK, et al. Validation and refinement of a prediction rule to identify children at low risk for acute appendicitis. Arch Pediatr Adolesc Med. 2012;166(8):738-44.
40. Ahn S, Lee H, Choi W, Ahn R, Hong JS, Sohn CH, et al. Clinical Importance of the Heel Drop Test and a New Clinical Score for Adult Appendicitis. PloS One. 2016;11(10):e0164574.
41. Bundy DG, Byerley JS, Liles EA, Perrin EM, Katznelson J, Rice HE. Does this child have appendicitis? JAMA. 2007;298(4):438-51.
42. Felder S, Margel D, Murrell Z, Fleshner P. Usefulness of bowel sound auscultation: a prospective evaluation. J Surg Educ. 2014;71(5):768-73.
43. Quaas J, Lanigan M, Newman D, McOsker J, Babayev R, Mason C. Utility of the digital rectal examination in the evaluation of undifferentiated abdominal pain. Am J Emerg Med. 2009;27(9):1125-9.
44. Gans SL, Pols MA, Stoker J, Boermeester MA. Guideline for the diagnostic pathway in patients with acute abdominal pain. Dig Surg. 2015;32(1):23-31.
45. Markogiannakis H, Memos N, Messaris E, Dardamanis D, Larentzakis A, Papanikolaou D, et al. Predictive value of procalcitonin for bowel ischemia and necrosis in bowel obstruction. Surgery. 2011;149(3):394-403.
46. Yu CW, Juan LI, Wu MH, Shen CJ, Wu JY, Lee CC. Systematic review and meta-analysis of the diagnostic accuracy of procalcitonin, C-reactive protein and white blood cell count for suspected acute appendicitis. Br J Surg. 2013;100(3):322-9.
47. Cosse C, Sabbagh C, Kamel S, Galmiche A, Regimbeau JM. Procalcitonin and intestinal ischemia: a review of the literature. World J gastroenterol. 2014;20(47):17773-8.
48. Mentes O, Eryilmaz M, Harlak A, Ozer T, Balkan M, Kozak O, et al. Can D-dimer become a new diagnostic parameter for acute appendicitis? Am J Emerg Med. 2009;27(7):765-9.
49. Kurt Y, Akin ML, Demirbas S, Uluutku AH, Gulderen M, Avsar K, et al. D-dimer in the early diagnosis of acute mesenteric ischemia secondary to arterial occlusion in rats. Eur Surg Res. 2005;37(4):216-9.
50. Thuijls G, van Wijck K, Grootjans J, Derikx JP, van Bijnen AA, Heineman E, et al. Early diagnosis of intestinal ischemia using urinary and plasma fatty acid binding proteins. Ann Surg. 2011;253(2):303-8.
51. Kanda T, Tsukahara A, Ueki K, Sakai Y, Tani T, Nishimura A, et al. Diagnosis of ischemic small bowel disease by measurement of serum intestinal fatty acid-binding protein in patients with acute abdomen: a multicenter, observer-blinded validation study. J Gastroenterol. 2011;46(4):492-500.
52. Kittaka H, Akimoto H, Takeshita H, Funaoka H, Hazui H, Okamoto M, et al. Usefulness of intestinal fatty acid-binding protein in predicting strangulated small bowel obstruction. PloS One. 2014;9(6):e99915.
53. Cucher D, Kulvatunyou N, Green DJ, Jie T, Ong ES. Gallstone pancreatitis: a review. Surg Clin North Am. 2014;94(2):257-80.
54. Panebianco NL, Jahnes K, Mills AM. Imaging and laboratory testing in acute abdominal pain. Emerg Med Clin North Am. 2011;29(2):175-93, vii.
55. Laurell H, Hansson LE, Gunnarsson U. Diagnostic pitfalls and accuracy of diagnosis in acute abdominal pain. Scand J Gastroenterol. 2006;41(10):1126-31.
56. Toorenvliet BR, Bakker RF, Flu HC, Merkus JW, Hamming JF, Breslau PJ. Standard outpatient re-evaluation for patients not admitted to the hospital after emergency department evaluation for acute abdominal pain. World J Surg. 2010;34(3):480-6.
57. Broder J, Warshauer DM. Increasing utilization of computed tomography in the adult emergency department, 2000-2005. Emerg Radiol. 2006;13(1):25-30.
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| Files | ||
| Issue | Vol 3 No 4 (2019): Autumn (October) | |
| Section | Review article | |
| PMCID | PMC6789065 | |
| PMID | 31633098 | |
| Keywords | ||
| Abdominal Pain Diagnosis, Differential Emergency Service, Hospital Ultrasonography | ||
| Rights and permissions | |
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Abdolrazaghnejad A, Rajabpour-Sanati A, Rastegari-Najafabadi H, Ziaei M, Pakniyat A. The Role of Ultrasonography in Patients Referring to the Emergency Department with Acute Abdominal Pain. Front Emerg Med. 2019;3(4):e43.
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