Assessing Abdominal Pain in Adults: A Rational, Cost-Effective, and Evidence-Based Strategy -
Publication Date: June 2019 (Volume 21, Number 6)
CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I credits, 4 AAFP Prescribed credits, and 4 AOA Category 2-A or 2-B CME credits. CME expires 06/01/2022.
Stephen Colucciello, MD, FACEP
Professor of Emergency Medicine, University of North Carolina School of Medicine, Charlotte Campus, Charlotte, NC
Todd Taylor, MD
Assistant Professor, Assistant Residency Director, Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA
Nadia Maria Shaukat, MD, RDMS, FACEP
Director, Emergency and Critical Care Ultrasound, Department of Emergency Medicine, Coney Island Hospital, Brooklyn, NY
The management of abdominal pain has changed significantly in the past 20 years, with increasing emphasis on identifying patients who are at high risk for occult pathology and worse outcomes. Emphasizing safe disposition over diagnosis, this issue identifies the important aspects of the history and physical examination, explores strengths and weaknesses of laboratory evaluations, and summarizes the pros and cons of the many types of imaging now available. With abdominal pain still the most common chief complaint seen in the emergency department, a new look at the evolution of assessment strategies is in order, such as new recommendations on the use of oral contrast, managing HIV patients on highly active antiretroviral therapy, maximizing use of bedside ultrasound, when and how to offer pain relief, and the value of serial examinations and observation to reduce costs and improve care.
Excerpt From This Issue
As you begin your shift, a 68-year-old woman presents with severe abdominal pain. She requires 4 mg of morphine before you can even talk to her. Surprisingly, her abdomen is soft, and not particularly tender. She is tachycardic to the 120s, and her pulse feels irregular. Her blood pressure is 100/50 mm Hg. It seems strange that her pain is so incongruent with her exam, and you wonder: What is the best imaging study to help clarify things?
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