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      Comparative study between clinical diagnosis, plain radiography and sonography for the diagnosis of nontraumatic acute abdomen

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          A BSTRACT

          Background:

          Acute abdomen is the most commonly attended surgical emergency. It can be caused by intra-abdominal, extra-abdominal and metabolic causes. A few imaging modalities are at disposal of primary care physicians like plain x-ray and ultrasonography.

          Materials and Methods:

          This study has been done to compare the efficacy of clinical diagnosis, plain radiography and sonography in diagnosis of non-traumatic acute abdomen. Every patient under study admitted in the Department of General Surgery underwent thorough clinical evaluation, biochemical investigations, X-rays and sonography. Findings of clinical evaluation, X-Rays and sonography were compared to the final diagnosis found intraoperatively.

          Results:

          Clinical diagnosis was made in 47 (94%) out of 50 patients. X-rays were able to diagnose in 20 patients (40%) whereas sonography diagnosed 26 patients (52%).

          Conclusion:

          The present study showed that clinical evaluation, x-rays or Ultrasound alone are not sufficient to diagnose cause of non-traumatic acute abdomen in all cases. Clinical evaluation combined with x-rays and ultrasound increases the number and accuracy of pre-operative diagnosis in non-traumatic acute abdomen.

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          Most cited references19

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          Evaluation and management of acute abdominal pain in the emergency department

          Evaluation of the emergency department patient with acute abdominal pain is sometimes difficult. Various factors can obscure the presentation, delaying or preventing the correct diagnosis, with subsequent adverse patient outcomes. Clinicians must consider multiple diagnoses, especially those life-threatening conditions that require timely intervention to limit morbidity and mortality. This article will review general information on abdominal pain and discuss the clinical approach by review of the history and the physical examination. Additionally, this article will discuss the approach to unstable patients with abdominal pain.
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            Guideline for the Diagnostic Pathway in Patients with Acute Abdominal Pain

            Introduction: Diagnostic practice for acute abdominal pain at the Emergency Department varies widely and is mostly based on doctor's preferences. We aimed at developing an evidence-based guideline for the diagnostic pathway of patients with abdominal pain of non-traumatic origin. Methods: All available international literature on patients with acute abdominal pain was identified and graded according to their methodological quality by members of the multidisciplinary steering group. A guideline was synthetized, providing evidence-based recommendations together with considerations based on expertise of group members, patient preferences, costs, availability of facilities, and organizational aspects. Conclusions and Recommendations: Definition: Uniform terminology is needed in patients with acute abdominal pain to avoid difficulty in interpretation and ease comparison of findings between studies. We propose the use of the following definition for acute abdominal pain: pain of nontraumatic origin with a maximum duration of 5 days. Clinical diagnosis: Clinical evaluation is advised to differentiate between urgent and nonurgent causes. The diagnostic accuracy of clinical assessment is insufficient to identify the correct diagnosis but can discriminate between urgent and nonurgent causes. Patients suspected of nonurgent diagnoses can safely be reevaluated the next day. Based on current literature, no conclusions can be drawn on the differences in accuracy between residents and specialists. No conclusions can be drawn on the influence of a gynecological consultation. In patients suspected of an urgent condition, additional imaging is justified. CRP and WBC count alone are insufficient to discriminate urgent from nonurgent diagnoses. Diagnostic imaging: There is no place for conventional radiography in the work-up of patients with acute abdominal pain due to the lack of added value on top of clinical assessment. Computed tomography leads to the highest sensitivity and specificity in patients with acute abdominal pain. Positive predictive value of ultrasound is comparable with CT and therefore preferred as the first imaging modality due to the downsides of computed tomography; negative or inconclusive ultrasound is followed by CT. Based on current literature, no conclusions can be drawn on the added value of a diagnostic laparoscopy in the work-up of patients with acute abdominal pain. Antibiotic treatment should be started within the first hour after recognition of sepsis. Administration of opioids (analgesics) decreases the intensity of the pain and does not affect the accuracy of physical examination.
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              Ultrasound scans done by surgeons for patients with acute abdominal pain: a prospective study.

              To evaluate the routine use of abdominal ultrasonography (US) in patients admitted to the surgical emergency unit with acute abdominal pain. Prospective study with a three-step evaluation of patients over a 12-month period. University hospital, Switzerland. 496 patients (male/female = 234/262; mean age 45 years) who presented with acute abdominal pain. Every patient underwent routine investigations and had an abdominal US by the attending surgeon. Clinical diagnosis, post-ultrasonography diagnosis and final diagnosis. US improved the correct diagnostic rate from 348 (70%) to 414 (83%). The diagnostic accuracy for acute appendicitis and biliary tract disease improved after US from 455 (92%) to 488 (98%) and from 463 (93%) to 490 (99%), respectively; the corresponding sensitivities and specificities were 91% and 99% and 94% and 99%. Ultrasonography should be part of routine surgical investigation and should be mastered and used by surgeons.
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                Author and article information

                Journal
                J Family Med Prim Care
                J Family Med Prim Care
                JFMPC
                J Family Med Prim Care
                Journal of Family Medicine and Primary Care
                Wolters Kluwer - Medknow (India )
                2249-4863
                2278-7135
                December 2022
                17 January 2023
                : 11
                : 12
                : 7686-7690
                Affiliations
                [1 ] Department of General Surgery, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
                [2 ] Department of General Surgery, MM Medical College and Hospital, Kumarhatti-Solan, Himachal Pradesh, India
                [3 ] Department of General Surgery, Dr. Yashwant Singh Parmar Govt. Medical College and Hospital, Nahan, Himachal Pradesh, India
                Author notes
                Address for correspondence: Dr. Mukul Sharma, Assistant Professor, Department of General Surgery, Dr. Yashwant Singh Parmar Government Medical College and Hospital, Nahan, Himachal Pradesh - 173 001, India. E-mail: mukulmuki@ 123456gmail.com

                Work Affiliated to: Indira Gandhi Medical College, Shimla, Himachal Pradesh, India

                Article
                JFMPC-11-7686
                10.4103/jfmpc.jfmpc_624_22
                10041025
                490cd085-1754-4931-8f89-88cf5efc6440
                Copyright: © 2023 Journal of Family Medicine and Primary Care

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                : 15 March 2022
                : 30 July 2022
                : 01 August 2022
                Categories
                Original Article

                acute abdomen,clinical diagnosis,sonography,x-ray
                acute abdomen, clinical diagnosis, sonography, x-ray

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