| Abstract: |
This chapter on abdominal pain is from a reference book for practicing physicians who are providing information for their patients over the telephone. The author notes that abdominal pain is one of the more challenging medical complaints to evaluate over the telephone. The chapter summarizes key points, then outlines an approach to acute abdominal pain and to chronic abdominal pain that has acutely changed in the adult patient. Topics include epidemiology, utility of early diagnosis, early diagnosis in the elderly, the general approach to the telephone evaluation, determining whether the patient requires emergency evaluation, small bowel obstruction, acute appendicitis, acute cholecystitis (gallbladder infection, often due to gallstones), ectopic pregnancy, dyspepsia, biliary colic, what to tell the patient, and what to document. The author stresses that the telephone physician should have a lower threshold for in-person evaluation of elderly patients with any acute abdominal pain because older patients are more likely to present late in the course of their illness and to have a poor clinical outcome. Abdominal pain in the setting of significant bleeding, trauma, or recent abdominal surgery should prompt a referral to the emergency room without delay. For patients in whom the disposition is not clear, the physician should consider calling back within a few hours to reassess the symptoms for resolution or progression. A patient care diagnostic algorithm is provided. 1 figure. 38 references. |