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Assessing Abdominal Pain In Adults: A Rational, Cost-Effective, And Evidence-Based Strategy

June 1999

Abstract

An experienced emergency physician might compare the painful abdomen to the dark side of the moon—a terrain both indistinct and enigmatic. The patient’s history is frequently mutable, the physical examination misleading. And to further complicate the issue, “textbook” presentations of serious disease seem to occur only in print. Patients with severe pain may prove to have gastroenteritis after an expensive work-up, while those with a seemingly benign belly are hiding a surgical catastrophe.

This issue of Emergency Medicine Practice will address the dilemma of abdominal pain and provide a structured approach to this complaint. The central principles include recognizing the high-risk patient, selecting appropriate tests, and using flexible clinical pathways.

This article emphasizes disposition over diagnosis. It’s not so important to identify a cause of abdominal pain as to recognize a surgical abdomen. In patients with pain of uncertain significance, the diagnosis may be clarified by a re-examination in 6-8 hours.
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