Advertisement

What Imaging Strategies Are Effective for Rapid and Accurate Diagnosis of Abdominal Pain Etiologies?

  • Lindley E. Folkerson
  • Adeola A. Kosoko
Chapter

Abstract

Abdominal pain is a common presenting complaint in the emergency department (ED). A thorough history, physical examination, and knowledge of current guidelines can help the clinician select the most accurate, appropriate diagnostic imaging. Separating the abdomen into quadrants is useful in understanding the common etiologies that lead to abdominal pain. Right upper quadrant (RUQ) pain generally derives from a hepatobiliary source, while epigastric and left upper quadrant (LUQ) most commonly are gastric, pancreatic, or associated with other etiologies. Lower abdominal pain, both on the right and left side, is associated most commonly with intestinal or genitourinary problems. By understanding the locations of abdominal pain in relation to differential diagnosis, the most accurate and clinically validated imaging modalities can be obtained.

Keywords

Abdominal pain Abdominal quadrants Abdominal aortic aneurysm Bedside ultrasound Cholecystitis Computed tomography scan Diverticulitis Emergency department Pancreatitis 

References

  1. 1.
    Mattson B, Dulaimy K. The 4 quadrants: acute pathology in the abdomen and current imaging guidelines. Semin Ultrasound CT MR. 2017;38(4):414–23.CrossRefGoogle Scholar
  2. 2.
    Hastings RS, Powers RD. Abdominal pain in the ED: a 35-year retrospective. Am J Emerg Med. 2011;29(7):711–6.CrossRefGoogle Scholar
  3. 3.
    McNamara R, Dean AJ. Approach to acute abdominal pain. Emerg Med Clin North Am. 2011;29(2):159–73.CrossRefGoogle Scholar
  4. 4.
    Natesan S, Lee J, Volkamer H, Thoureen T. Evidence-based medicine approach to abdominal pain. Emerg Med Clin North Am. 2016;34(2):165–90.CrossRefGoogle Scholar
  5. 5.
    Nagurney JT, Brown DF, Chang Y, Sane S, Wang AC, Weiner JB. Use of diagnostic testing in the emergency department for patients presenting with non-traumatic abdominal pain. J Emerg Med. 2003;25(4):363–71.CrossRefGoogle Scholar
  6. 6.
    Gans SL, Pols MA, Stoker J, Boermeester MA. Experts steering group. Guideline for the diagnostic pathway in patients with acute abdominal pain. Dig Surg. 2015;32(1):23–31.CrossRefGoogle Scholar
  7. 7.
    Lameris W, van Randen A, van Es HW, van Heesewijk JP, van Ramshorst B, Bouma WH, et al. Imaging strategies for detection of urgent conditions in patients with acute abdominal pain: diagnostic accuracy study. BMJ. 2009;338:b2431.CrossRefGoogle Scholar
  8. 8.
    Millet I, Sebbane M, Molinari N, Pages-Bouic E, Curros-Doyon F, Riou B, et al. Systematic unenhanced CT for acute abdominal symptoms in the elderly patients improves both emergency department diagnosis and prompt clinical management. Eur Radiol. 2017;27(2):868–77.CrossRefGoogle Scholar
  9. 9.
    Bektas F, Eken C, Soyuncu S, Kusoglu L, Cete Y. Contribution of goal-directed ultrasonography to clinical decision-making for emergency physicians. Emerg Med J. 2009;26(3):169–72.CrossRefGoogle Scholar
  10. 10.
    Stoker J, van Randen A, Lameris W, Boermeester MA. Imaging patients with acute abdominal pain. Radiology. 2009;253(1):31–46.CrossRefGoogle Scholar
  11. 11.
    Summers SM, Scruggs W, Menchine MD, Lahham S, Anderson C, Amr O, et al. A prospective evaluation of emergency department bedside ultrasonography for the detection of acute cholecystitis. Ann Emerg Med. 2010;56(2):114–22.CrossRefGoogle Scholar
  12. 12.
    Kendall JL, Shimp RJ. Performance and interpretation of focused right upper quadrant ultrasound by emergency physicians. J Emerg Med. 2001;21(7):7–13.CrossRefGoogle Scholar
  13. 13.
    Taylor MR, Lalani N. Adult small bowel obstruction. Acad Emerg Med. 2013;20(6):528–44.CrossRefGoogle Scholar
  14. 14.
    Smith JE, Hall EJ. The use of plain abdominal x-rays in the emergency department. Emerg Med J. 2009;26(3):160–3.CrossRefGoogle Scholar
  15. 15.
    Rubano E, Mehta N, Caputo W, Paladino L, Sinert R. Systematic review: emergency department bedside ultrasonography for diagnosing a suspected abdominal aortic aneurysm. Acad Emerg Med. 2013;20(2):128–38.CrossRefGoogle Scholar
  16. 16.
    Rao PM, Rhea JT, Novelline RA, Mostafavi AA, McCabe CJ. Effect of computed tomography of the appendix on treatment of patients and use of hospital resources. N Engl J Med. 1998;338(3):141–6.CrossRefGoogle Scholar
  17. 17.
    Tremblay E, Therasse E, Thomassin-Naggara I, Trop I. Quality initiatives: guidelines for use of medical imaging during pregnancy and lactation. Radiographics. 2012;32(3):897–911.CrossRefGoogle Scholar
  18. 18.
    Graif M, Itzchak Y. Sonographic evaluation of ovarian torsion in childhood and adolescence. AJR Am J Roentgenol. 1988;150(3):647–9.CrossRefGoogle Scholar
  19. 19.
    Destigter KK, Keating DP. Imaging update: acute colonic diverticulitis. Clin Colon Rectal Surg. 2009;22(3):147–55.CrossRefGoogle Scholar
  20. 20.
    Anderson SW, Soto JA. Multi-detector row CT of acute non-traumatic abdominal pain: contrast and protocol considerations. Radiol Clin N Am. 2012;50(1):137–47.CrossRefGoogle Scholar
  21. 21.
    Rekant EM, Gibert CL, Counselman FL. Emergency department time for evaluation of patient discharged with a diagnosis of renal colic: unenhanced helical computed tomography versus intravenous urography. J Emerg Med. 2001;21(4):371–4.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Lindley E. Folkerson
    • 1
  • Adeola A. Kosoko
    • 1
  1. 1.Department of Emergency MedicineMcGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)HoustonUSA

Personalised recommendations