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Query: UMLS:C0740577 (acute abdominal pain)
 1,982 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The ability to improve surgical decision-making in the acute abdomen using selective laparoscopy is now established. When the decision to operate is uncertain laparoscopy not only identifies those patients who do not require laparotomy, but also reveals those who need surgery which might otherwise have been delayed. Furthermore, the high error rates in diagnosing acute appendicitis in young women provides overwhelming support to the current view that all women with suspected appendicitis should undergo laparoscopy before appendicectomy, irrespective of clinical 'certainty'. Improvements in the management of the acute abdomen can also be achieved by other techniques such as computer-assisted diagnosis (McAdam et al, 1990) and peritoneal cytology (Stewart et al, 1988), and a combination of these with selective laparotomy would be appropriate. Initial patient assessment using a structured proforma would appear to be one of the most significant factors in the improvement of diagnostic accuracy associated with the use of computers (Gunn, 1976), and their combination with a policy of selective laparoscopy has been shown to be beneficial (Paterson-Brown et al, 1989). The ability to detect which patients are likely to benefit from laparoscopy by performing peritoneal cytology first (Vipond et al, 1990) has been shown to be helpful in reducing the number of patients who undergo a 'negative laparoscopy' (Baigrie et al, 1990). It is now time for laparoscopy to return to the bosom of general surgery from where it was conceived almost a century ago. When it does, as the developments in laparoscopic cholecystectomy would predict it will, so surgeons in training must take the earliest opportunity to become as familiar and proficient with the technique as their gynaecological colleagues have done, even if this means attending the gynaecological operating lists to do so. It is only then that the undoubted benefits of laparoscopy will be spread more widely in general surgery and particularly for the patient with acute abdominal pain.
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PMID:The acute abdomen: the role of laparoscopy. 183 86

We report on 8 patients who presented with acute abdominal pain, palpable mass and a rapid decrease in hemoglobin. Intravenous pyelogram, ultrasound and computed tomography had been performed but the underlying cause of the perirenal hematoma couldn't be detected. Surgical exploration was decided and 6 total and 2 partial nephrectomies were performed. The pathological report revealed 4 adenocarcinomas and 4 angiomyolipomas. The possibility of spontaneous rupture of the kidney in the evaluation of cases of acute abdomen is particularly stressed.
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PMID:Diagnostic and therapeutic dilemmas in nontraumatic spontaneous perirenal hemorrhage. 185 27

In a prospective study 152 consecutive patients presenting with acute abdominal pain were assessed clinically and an ultrasonographic examination was performed immediately. Of these, 16 (11 per cent) patients would normally have had an immediate ultrasonographic scan requested; routine (within 24 h of admission) ultrasonographic examination would have been requested in a further 66 (43 per cent) patients. In 70 (46 per cent) patients an ultrasonographic examination would not have been requested. Ultrasonography altered the diagnosis in one patient from probable appendicitis to cholecystitis. Ultrasonography missed one abdominal aortic aneurysm and one empyema of the gallbladder. Ultrasonography had a sensitivity of 96 per cent, a specificity of 94 per cent, a positive predictive value of 96 per cent, a negative predictive value of 94 per cent and an accuracy of 95 per cent in diagnosing appendicitis. Exactly the same values were found for the clinical diagnosis of appendicitis. The study shows that routine immediate ultrasonographic examination of the acute abdomen is rarely helpful, with the possible exception of appendicitis. Where an urgent ultrasonographic scan is necessary on clinical grounds the expertise of a radiologist is probably required, whereas in specific areas, for example in the diagnosis of right iliac fossa pain, there may be a place for training the surgical trainee.
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PMID:Ultrasonography in the acute abdomen. 195 78

Acute abdominal pain continues to provide not only a large workload for the general surgeon but also many diagnostic and management problems. Many different techniques have been introduced over the past two decades to help in the management of the acute abdomen and this review considers their relative claims to become incorporated into the process of clinical decision-making. The evidence in support of formally structured patient interview pathways with or without computer-aided diagnostic programs is now overwhelming and should become routine. Both laparoscopy and peritoneal cytology have an important role to play in the management of patients in whom the decision to operate is in doubt, and a combination of the two would be complementary. Ultrasonography has become increasingly popular for investigating the acute abdomen, and results from specialist centres are impressive. However, the problems of operator variation and the difficulties in providing a 24-h service will probably prevent it from becoming a first-line investigation in most hospitals. Although plain radiography has been available for many years, its routine use in the management of the acute abdomen remains controversial. Recent studies have confirmed that contrast radiography is an important adjunct to decision-making, particularly in the management of large bowel obstruction, and there is increasing evidence to support its use in suspected small bowel obstruction, perforated peptic ulcer and acute diverticular disease.
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PMID:Modern aids to clinical decision-making in the acute abdomen. 238 63

We evaluated the diagnostic value of serum amylase, isoamylase, and lipase for the diagnosis of acute pancreatitis from sera of patients with acute abdominal pain. Comparison was first made in condition A between 32 patients with image-proven pancreatitis and 414 patients with nonpancreatic acute abdomen (the control group), then in condition B, between 62 pancreatitis patients with or without image proof and the control group. We found (a) that patients with image-proven pancreatitis suffer a more severe clinical course than those without; (b) that the sensitivity, positive predictive value, and accuracy in condition B are higher than in condition A at any cutoff level; (c) that none of the enzyme assays is specific at the upper reference limit, but their diagnostic yields are much improved by raising cutoff levels to about three or four times the upper limit; and (d) that at these selected cutoff levels, amylase had a diagnostic value similar to p-isoamylase or lipase in both conditions (sensitivity 84% and 92% for amylase in conditions A and B, respectively; specificity 98% and 98%; positive predictive value 75% and 90%; negative predictive value 99% and 99%; accuracy 91% and 97%). In conclusion, at an appropriately selected cutoff level, amylase can be effectively used as the first-line test and isoamylase or lipase as adjunct tests for acute abdominal conditions.
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PMID:Serum amylase, isoamylase, and lipase in the acute abdomen. Their diagnostic value for acute pancreatitis. 168 29

A prospective study has been undertaken of 321 patients with acute abdominal pain admitted to hospital under one surgical firm over a period of 21 months. During the first 10 months patients were classified on admission according to the perceived need for operation, with laparoscopy being performed on all those in whom the need for operation was uncertain. In addition, all women with suspected appendicitis underwent laparoscopy because previous studies by us and others have demonstrated a high error rate in this group. During the second 11 months of the study a similar system of classification and procedure was used but the patient's initial assessment was entered on a structured data sheet. After the patient had been discharged home this information was entered into a computer-aided diagnosis program. Hypothetical retrospective computer-aided decisions were then made about patient management. The final management error rate (correct decision to operate or not) was compared with the actual error rate using the clinical system. The final overall error rate in the first 10 months was 11 out of 163 patients and this was improved to 3 out of 158 in the second 11 months of the study by the addition of the structured data sheet to selective laparoscopy. A management policy based entirely on diagnostic probabilities taken from the computer-aided diagnosis program would have produced an error rate of 26 out of 158. We conclude that in the management of the acute abdomen a policy based on clinical decision combined with selective laparoscopy may be superior to one based on diagnostic probabilities alone. Further improvement in results follows the introduction of a structured data sheet for initial data collection.
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PMID:Clinical decision making and laparoscopy versus computer prediction in the management of the acute abdomen. 253 48

This paper describes the management consequences of the use of a microcomputer as a special investigation in patients with an acute abdomen. Results in 812 patients seen by 42 junior doctors are compared six monthly and with baseline data from 295 cases from the preceding 2 years. Improvement in diagnostic ability from 48.5% to 71.8% (X2 = 25.8, P less than 0.001) resulted in a fall in negative appendicectomy from 37.5% to 9.71% (X2 = 16.2, P = less than 0.001). Bad management errors were also reduced from 22% to 10% (P = less than 0.01). The number of emergency investigation fell from 4 to 2 and inpatient stay of patients with non-surgical abdominal pain was reduced from 3 to 2 days. These results demonstrate that the use of microcomputers as investigative tools improves the surgical management of patients with acute abdominal pain.
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PMID:The acute abdomen: management with microcomputer aid. 353 84

Acute suppurative infection of the sacroiliac joint can mimic the acute abdomen. Experience with a patient who had exploratory laparotomy for acute appendicitis prompted a review of the literature, which indicated that 12.6% of patients with pyogenic sacroiliitis have acute abdominal pain. A high index of suspicion is necessary to establish this diagnosis.
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PMID:Pyogenic sacroiliitis: another imitator of the acute abdomen. 372 68

Two hundred and fifty-two patients with acute abdominal pain were admitted to Wellington Hospital during three consecutive months in 1982. The prevalence of the surgical acute abdomen in these patients was 35%. There was no significant difference in performance between the peripheral blood white cell count (WCC) and neutrophil count (NC) when used as diagnostic tests of surgical acute abdomen. Neither test is sufficiently sensitive or specific to be a good predictor of surgical acute abdomen. It is recommended that the WCC be used sparingly and interpreted as a continuously distributed rather than dichotomous diagnostic test. There is no advantage in using the NC.
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PMID:Patients with acute abdominal pain: white cell and neutrophil counts as predictors of the surgical acute abdomen. 385 15

This paper presents the clinical features of 600 patients suffering from abdominal pain of acute onset and admitted to either the General Infirmary or St. James's Hospital, Leeds. The survey was initially retrospective, but later put on a prospective basis. Roughly two-thirds of these 600 patients presented a "typical" picture of the disease with which they presented, while the remaining third presented one or more atypical features. Since other prospective studies have indicated that the diagnostic accuracy of a group of clinicians in respect of the acute abdomen is roughly 65% it is tentatively suggested (a) that clinical diagnosis contains a large element of "pattern-matching," and (b) that such a policy can be expected to be ineffective in roughly one-third of all cases of acute abdominal pain.
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PMID:Clinical presentation of acute abdomen: study of 600 patients. 450 71


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