Abstract: |
This article explains how physicians can use an 11 question analysis to get an immediate bearing on the source of a patient's abdominal pain. The authors focus on acute abdominal pain in the elderly. Clues to diagnosis include location and characteristics of the pain, as well as patterns of radiation; color, content, and volume of vomitus; stool consistency, frequency, and color. Every abdominal examination should be followed by a rectal examination and, in women, a vaginal examination. Laboratory studies usually include serum electrolyes, glucose and amylase levels, liver and kidney function tests, and a complete blood count with differential analysis. Guidelines are available to help determine the need for hospitalization based on test results. Radiographic films and ultrasonography (now available at bedside) are often enough to confirm diagnoses, but CT scan and MRI (magnetic resonance imaging) also play important roles. The authors review cost effective approaches for suspected appendicitis, bowel obstruction, diverticulitis, peptic ulcer disease, mesenteric ischemia, pancreatitis, and biliary disease. 5 figures. 4 tables. 15 references. |