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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
- If concerned for biliary pathology
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)