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Query: UMLS:C0162871 (abdominal aortic aneurysm)
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Acute low back pain is a common complaint heard in the emergency room and in a physiatrist's practice. It is important to rule out occult pathology in patients with an atypical presentation. In the case presented here, the patient was elderly, developed back pain without preceding trauma or lifting, had a history of easy bruisability, had a large ecchymosis, and had worsening back pain with bedrest. An abdominal aortic aneurysm was ruled out and the patient was discovered to have a large retroperitoneal hemorrhage. He was diagnosed with acquired hemophilia secondary to factor VIII inhibitors. This has implications for physicians who treat patients with acute low back pain. They must be alert to potentially life-threatening causes of low back pain.
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PMID:Acute low back pain secondary to retroperitoneal hemorrhage in an elderly man. 919 76

Two important goals in treating acute low back pain are to return the patient to regular activity as quickly as possible and to do so in a manner that is cost-effective. By following a logical treatment protocol, the clinician is often able to provide the treatment necessary to provide the patient with relief. Referral to an orthopedist or neurosurgeon may be appropriate in only a minority of cases. Thus, after the initial history and physical examination, ruling out (or in) conditions that require urgent or emergent care is essential. These conditions include cauda equina syndrome, circulatory collapse due to expanding abdominal aortic aneurysm, and tumor, infection, and other underlying disorders as a cause of low back pain. Patients without these conditions can be started on conservative therapy-without radiographic or laboratory tests-regardless of the specific diagnosis. Conservative therapy consists of passage of time, controlled physical activity, physical modalities (e.g., cryotherapy or thermotherapy), local injections, nonsteroidal anti-inflammatory drugs, and muscle relaxants. Because low back pain is so common, even the small proportion of patients who do not improve after 6 weeks of conservative therapy represents a sizable number. The location and radiation of pain are used as initial guides to classifying these patients into four groups: those with localized pain, sciatica, anterior thigh pain, or posterior thigh pain. Each follows a different diagnostic path, which will be described herein.
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PMID:A clinician's approach to acute low back pain. 921 55

Acute low back pain is one of the most frequent reason for an emergency or primary care physician visit. Up to 90% of all adults will experience an episode of back pain at some point during their lifetime. Although the majority of patients have uncomplicated benign presentation and 80-90% recover within 4 to 6 weeks, there is a small subset who has an underlying potential life-threatening etiology. Among them are aortic dissection, ruptured abdominal aortic aneurysm, vertebral osteomyelitis, spinal epidural abscess and the cauda equina syndrome (CES). The latter entails a compression of the nerve roots of the cauda equina. These patients usually present post-traumatically with the clinical triad of saddle anesthesia, bowel or bladder dysfunction and muscular weakness of the lower extremeties. A delayed diagnosis can result in a significantly increased morbidity. Therefore, early diagnosis and the initiation of the appropriate therapeutic steps are essential. A thourough anamnesis and physical examination are leading to the suspected diagosis. Below, clinical presentation, diagnosis and relevant treatment of the CES are discussed.
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PMID:[Emergency scenario: cauda equina syndrome--assessment and management]. 1854 37