Emergency medicine clinics of North America
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The chief complaint of abdominal pain accounts for 5% to 10% of all presentations in the emergency department. With such broad differential and diagnostic modalities available, this article focuses on a systematic approach to evaluating abdominal pain, essential to providing patients with efficient and accurate care.
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Abdominal vascular catastrophes are among the most challenging and time sensitive for emergency practitioners to recognize. Mesenteric ischemia remains a highly lethal entity for which the history and physical examination can be misleading. Laboratory tests are often unhelpful, and appropriate imaging must be quickly obtained. ⋯ Ruptured abdominal aortic aneurysm likewise may present in a cryptic fashion. A specific type of ruptured aneurysm, the aortoenteric fistula, often masquerades as the more common routine gastrointestinal bleed. The astute clinician recognizes that this is a more lethal variant of gastrointestinal hemorrhage.
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Abdominal pain in the elderly can be a challenging and difficult condition to diagnose and treat. The geriatric population has significant comorbidities and often takes polypharmacy that can mask symptoms. The presentation of common conditions can be different than that in the younger population, often lacking the traditional indicators of disease, making it of pivotal importance for the clinician to consider a wide differential during their workup. It is also important to consider extra-abdominal abnormality that may manifest as abdominal pain.
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Although most frequently presenting with lower abdominal pain, appendicitis, colitis, and diverticulitis can cause pain throughout the abdomen and can cause peritoneal and retroperitoneal symptoms. Evaluation and management of lower intestinal disease requires a nuanced approach by the emergency physician, sometimes requiring computed tomography, ultrasonography, MRI, layered imaging, shared decision making, serial examination, and/or close follow-up. ⋯ Appendicitis patients should be admitted. Diverticulitis and inflammatory bowel disease can frequently be managed on an outpatient basis, but may require admission and surgical consultation.
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Emerg. Med. Clin. North Am. · May 2016
ReviewDiarrhea: Initial Evaluation and Treatment in the Emergency Department.
Diarrhea generates a wide range of diagnostic considerations and has profound individual and public health significance. The setting and circumstances under which a patient presents with diarrhea drastically influences the concern brought to the encounter. ⋯ In resource-poor countries, the significance of diarrhea is even greater. This review focuses on diarrhea and its initial evaluation and management in the emergency department.