Month: August 2016

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Elderly people die from abdominal pain

Step 1: Risk Stratify

• Certain patient groups have VERY high mortality when having abdominal pain
  • Geriatrics
  • Immunocompromised
  • Diabetics

Step 2: Consider Genitourinary Causes

• Be especially cautious with lower abdominal/flank pain
  • Mention that you performed or considered performing GU exam during presentation!
• Common GU causes of abdominal pain
  • Testicular/ovarian torsion
  • Prostatitis/pelvic inflammatory disease
  • Ectopic pregnancy

Step 3: High-Yield Tests to Consider

• CBC and Electrolytes
• EKG and Troponin
• Liver Panel and Lipase
• Urinalysis and Urine pregnancy

Step 4: Order Appropriate Imaging

• CT scan is most useful test with abdominal pain in adults
  • Need to give IV contrast if concerned for vascular pathology
  • Usually performs just as well as ultrasound (even in cases where ultrasound is the classic, initial test)
• 3 “exceptions” to the CT first rule
  • If concerned for biliary pathology
    • RUQ ultrasound
  • If concerned for genitourinary pathology
    • Testicular/Pelvic ultrasound
    • Renal ultrasound (kidney stone)
  • If concerned for Abdominal Aortic Aneurysm
    • Bedside Aorta ultrasound

Step 5: Disposition

• Classic teaching is that patients discharged with undifferentiated abdominal pain need follow up in 12-24 hours
• It’s ok to have them come back to the ED if necessary

Additional Reading

• Abdominal Pain History (EM Clerkship)
• Abdominal Pain Exam, Plan, and Disposition (EM Clerkship)