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The role of emergency ultrasound in the diagnosis of acute non-traumatic epigastric pain

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Abstract

The epigastrium is the site where pain coming from both abdominal and extraabdominal organs is frequently referred. Although acute or chronic diseases of the stomach, duodenum, liver, pancreas and biliary tree are the most common causes of acute epigastric pain, several other entities, potentially more severe, should also be suspected and investigated. Clinical bedside ultrasonography (US) is actually the first-line imaging in acute epigastric pain patients presenting to the hospital Emergency Department (ED) because it is rapid, noninvasive, relatively inexpensive and focused, repeatable and reliable. Moreover, the systematic use of emergency US as a complement to routine management might save economic resources by avoiding further costs for complications and substantially reducing the time for making an accurate diagnosis. The purpose of this paper is to review the US spectrum of the most common diseases responsible for acute epigastric pain onset. We also propose a focused, well codified US protocol, that we call the “$ approach”, based on our clinical experience and the current literature for acute non-traumatic epigastric pain evaluation in an emergency setting. Its systematic application by the emergency physician may reduce the wait for diagnosis and the over-usage of second-line radiological techniques, including computed tomography, as well as to increase the diagnostic accuracy with potential benefits for patient (safety), physician (efficacy) and the institution (efficiency).

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Authors and Affiliations

  1. Emergency Department, A. Gemelli University Hospital, Rome, Italy

    Americo Testa, Rosangela Giannuzzi, Giulia Pignataro & Nicolò Gentiloni Silveri

  2. Emergency Department, SS. Antonio e Biagio e C. Arrigo Hospital, Alessandria, Italy

    Ernesto Cristiano Lauritano & Ivo Casagranda

  3. A. Gemelli University Hospital, Largo A. Gemelli, 8, 00168, Rome, Italy

    Americo Testa

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  1. Americo Testa
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  2. Ernesto Cristiano Lauritano
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  4. Giulia Pignataro
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  6. Nicolò Gentiloni Silveri
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Correspondence to Americo Testa.

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Testa, A., Lauritano, E.C., Giannuzzi, R. et al. The role of emergency ultrasound in the diagnosis of acute non-traumatic epigastric pain. Intern Emerg Med 5, 401–409 (2010). https://doi.org/10.1007/s11739-010-0395-4

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  • DOI: https://doi.org/10.1007/s11739-010-0395-4

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