Acute abdomen: Difference between revisions

Line 309:

=== History and physical examination ===

The patient’s history and physical examination should be taken. Characterisation of the timing and features of the pain is especially important. It’s important to recognise features suggestive of severe disease, like severe, opioid-refractory pain, haemodynamic instability, sudden onset pain, and signs of peritonitis. Care should be made in elderly, where typical signs of the specific diseases may be absent, and severe disease may present without findings of severe disease.

=== Imaging ===

If there is suspicion of serious pathology, including [[abdominal aortic aneurysm]] rupture, [[Gastrointestintal perforation|gastrointestinal perforation]] or [[ileus]], an urgent [[CT]] with contrast is indicated. CT is also the preferred modality if [[diverticulitis]] or [[nephrolithiasis]] is suspected. In case of biliary disease like [[Acute calculous cholecystitis|cholecystitis]] or [[Gallstone disease|gallstone]], or [[Acute pancreatitis|pancreatitis]] or [[appendicitis]] is suspected, [[ultrasound]] is usually the first choice. For PID and ectopic pregnancy, [[transvaginal ultrasound]] is the first choice.

eFAST is a rapid (a few minutes) ultrasound protocol used in the context of trauma which can be used to identify free fluid in the peritoneum, which is presumably blood, as well as [[pneumothorax]], [[haemothorax]], or [[pleural effusion]].

Ultrasound cannot visualise a retrocoecal appendix, and is therefore not completely sensitive for acute appendicitis. The presence of bowel gas also reduces visibility.

== References ==

<noinclude>[[Category:Gastrointestinal surgery]]</noinclude>

[[Category:Gastrointestinal surgery]]

</noinclude>

@@ Line 309: / Line 309: @@
 === History and physical examination ===
 The patient’s history and physical examination should be taken. Characterisation of the timing and features of the pain is especially important. It’s important to recognise features suggestive of severe disease, like severe, opioid-refractory pain, haemodynamic instability, sudden onset pain, and signs of peritonitis. Care should be made in elderly, where typical signs of the specific diseases may be absent, and severe disease may present without findings of severe disease.
+=== Imaging ===
+If there is suspicion of serious pathology, including [[abdominal aortic aneurysm]] rupture, [[Gastrointestintal perforation|gastrointestinal perforation]] or [[ileus]], an urgent [[CT]] with contrast is indicated. CT is also the preferred modality if [[diverticulitis]] or [[nephrolithiasis]] is suspected. In case of biliary disease like [[Acute calculous cholecystitis|cholecystitis]] or [[Gallstone disease|gallstone]], or [[Acute pancreatitis|pancreatitis]] or [[appendicitis]] is suspected, [[ultrasound]] is usually the first choice. For PID and ectopic pregnancy, [[transvaginal ultrasound]] is the first choice.
+eFAST is a rapid (a few minutes) ultrasound protocol used in the context of trauma which can be used to identify free fluid in the peritoneum, which is presumably blood, as well as [[pneumothorax]], [[haemothorax]], or [[pleural effusion]].
+Ultrasound cannot visualise a retrocoecal appendix, and is therefore not completely sensitive for acute appendicitis. The presence of bowel gas also reduces visibility.
 == References ==
-<noinclude>[[Category:Gastrointestinal surgery]]</noinclude>
+<noinclude>
+[[Category:Gastrointestinal surgery]]
+</noinclude>