Note: Page numbers of article titles are in boldface type. A Abdomen, surgery of, abdominal pain and, 163 vascular anatomy of, 253 255 Abdominal aortic aneurysm, 264 266 Abdominal emergencies, vascular, 253 272 Abdominal hernias. See Hernia(s), abdominal. Abdominal pain, acute, analgesia in, 168 approach to, 159 173 diagnostic imaging in, 176 179 diagnostic studies in, 169 170 imaging and laboratory testing in, 175 193 integration based on pain location and disease process, 179 190 in older adult, 429 448 in unstable patient, 168 169 laboratory testing in, 175 176 assessment of patient s pain in, 160 162 epigastric, evaluation of, 184 extra-abdominal and systemic causes of, 196 197 functional, in children, 418 419 generalized, evaluation of, 179 181 hematologic causes of, 200 history taking in, 159 163 imflammatory causes of, 200 202 in children, diagnosis of, 403 420 differential diagnosis of, 403, 404 due to infections, 202 203 functional, 418 419 history taking in, 401 physical examination in, 402 403 in older adults. See Adult(s), older, abdominal pain in. in right upper quadrant, evaluation of, 182 183 in special populations, 449 458 infectious causes of, 202 203 left lower quadrant, evaluation of, 188 189 left upper quadrant, evaluation of, 187 188 metabolic/endocrine causes of, 197 199 neurogenic causes of, 205 right lower quadrant, evaluation of, 184 187 suprapubic, evaluation of, 189 190 symptoms associated with, abdominal examination in, 164 166 Emerg Med Clin N Am 29 (2011) 459 467 doi:10.1016/s0733-8627(11)00026-5 0733-8627/11/$ see front matter ª 2011 Elsevier Inc. All rights reserved. emed.theclinics.com
460 Abdominal (continued) assessment of, 162 163 physical examination in, 164 168 vital signs in, 164 systemic causes of, 195 209 toxin-related or drug-related causes of, 203 204 Abscesses, anorectal, 388 389 Achalasia, 274 277 Adrenal insufficiency, abdominal pain in, 197 198 Adult(s), older, abdominal pain in, acute, 429 448 extra-abdominal causes of, 441 442 inflammatory causes of, 431 434 obstructive causes of, 434 437 vascular causes of, 437 440 appendicitis in, 433 434 diagnostic obstacles in, 430 442 diarrhea in, 218 pathophysiologic changes in, 429 430 Adynamic ileus, 329 330 Alcoholic hepatitis, 297 298 Alcoholic liver disease, 296 298 Anal fissures, 387 388 Aneurysms, vascular, 264 268 Angiography, in gastrointestinal bleeding, 248 Anorectal abscesses, 388 389 Anorectal emergencies, 384 392 foreign bodies in gastrointestinal tract and, 369 400 Anorectum, anatomy of, 384 385 Anorexia, and appendicitis, 162 Aortic aneurysm, abdominal, ruptured, in older adult, 439 440 Aortic dissection, in older adult, 440 Aortic thrombosis, 255 Appendicitis, and anorexia, 162 clinical presentation of, 348 diagnosis of, 349 352 in children, 403 406 diverticulitis, and colitis, 347 368 in older adults, 433 434 in special populations, 348 349 overview and epidemiology of, 347 pathophysiology of, 347 348 treatment of, 352 353 B Biliary disease, in older adults, 433 Biliary drains, percutaneous, abdominal pain folowing insertion of, 455 Biliary tract disease, 300 301 Body packer syndrome, 381 Bougienage, for extraction of esophageal foreign bodies, 378 Bowel, large, obstruction of, background of, 327 clinical features of, 328
461 imaging in, 328 329 in older adult, 436 437 laboratory studies in, 328 management and disposition in, 329 pathophysiology of, 328 normal, and mesentary position, 411 small, obstruction of, 319 327 background of, 319 clinical features of, 320 321 imaging in, 321 326 in older adult, 435 436 laboratory tests in, 321 management and disposition in, 326 327 pathophysiology of, 320 Bowel infarction, 261, 262 Bowel obstruction, 319 and hernia, 319 345 Bowel symptoms, abdominal pain and, 162 163 Button batteries, in esophagus, 376 377 in stomach, 380 C C1 inhibitor deficiency, abdominal pain in, 199 Carnett sign, 166 Caustic ingestions, esophageal emergency in, 283 284 Caustics, abdominal pain due to, 204 Children, abdominal pain in. See Abdominal pain, in children. diarrhea in, 217 218 extraabdominal pain in, 419 420 infections in, abdominal pain in, 202 203 ovarian torsion in, 413 414 vomiting in, 214 215 Cholecystectomy, 307 308 Cholecystitis, 301 laboratory evaluation in, 303 304 treatment of, 307 308 Cholescintigraphy, radionuclide, 306 307 Closed eyes sign, 166 167 Coins, in esophagus, 373, 377 378 Colitis, 355 360 C difficile, clinical presentation of, 360 361 diagnosis of, 361 overview and epidemiology of, 360 pathophysiology of, 360 treatment of, and disposition in, 361 362 in older adults, 434 ischemic, clinical presentation of, 362 diagnosis of, 362 363 overview and epidemiology of, 362 pathophysiology of, 362 treatment of, and disposition in, 363
462 Colonic pseudo-obstruction, acute, 330 332 and ileus, in older adult, 437 Colonoscopy, in gastrointestinal bleeding, 247 248 Computed tomography, abdominal, in acute abdominal pain, 177 179 in appendicitis, 350 352 in biliary disease, 306 in esophageal foreign bodies, 375 Constipation, 219 223 diagnostic evaluation of, 221 etiology of, 219 221 in children, 417 418 in older adult, 440 441 management and treatment of, 221 223 presenting signs and symptoms of, 221 Cough test, 166 Crohn disease, 355, 356, 357 complications of, 359 D Diarrhea, 215 219 differential diagnosis of, 216 217 in elderly patients, 218 in pediatric patients, 217 218 prevention of, 219 treatment of, 218 219 Diverticula, esophageal, as cause of dysphagia, 279 Diverticulitis, clinical presentation of, 353 354 diagnosis of, 354 in older adults, 434 overview and epidemiology of, 353 pathophysiology of, 353 treatment of, 354 355 Dopamine receptor antagonists, in vomiting, 212 214 Drug ingestion, illicit, 380 381 Duodenum, foreign bodies in, 380 381 Dysphagia, 274 280 emergency department evaluation and management of, 280 281 mechanical causes of, 278 280 neuromuscular causes of, 274 278 E Endoscopy, upper, in gastrointestinal bleeding, 247 Enterocolitis, neutropenic, abdominal pain in, 451 Epilepsy, abdominal, abdominal pain due to, 205 Esophageal and gastric emergencies, 273 291 Esophageal dysphagia, 274 Esophageal neoplasms, 279 280 Esophageal perforation, 286 287 Esophageal spasm, diffuse, 277 278
463 Esophageal strictures, benign, 278 279 Esophagitis, 282 283 Esophagoscopy, in esophageal foreign bodies, 375 376 Esophagus, anatomy and physiology of, 273, 372, 373 foreign bodies in. See Foreign bodies, esophageal. F Familial Mediterranean fever, abdominal pain in, 200 201 Fluoroscopic-guided enema, in intussusception in children, 409, 410 Foley catheter, for extraction of esophageal foreign bodies, 377, 378 for extraction of rectal foreign bodies, 382 383 Food allergy, abdominal pain in, 202 Foreign bodies, esophageal, 284 285 complications of, 374 epidemiology of, 372 374 evaluation of, 373, 374 375 management of, 375 380 overview of, 371 372 presentation of, 374 in gastrointestinal tract, 369 and anorectal emergencies, 369 400 in small and large intestine, 381 382 in stomach, 380 381 oropharyngeal, 370 371 rectal, 382 384 G Gallbladder, anatomy and pathophysiology of, 301 302 emergency diseases of, 300 309 Gallstones, 301 302 clinical presentation of, 302 303 complications and special considerations in, 308 309 diagnostic imaging evaluation in, 304 307 risk factors for, 302 Gas-forming agents, in esophageal obstruction, 379 380 Gastric and esophageal emergencies, 273 291 Gastroenteritis, acute, in children, 414 416 assessment and diagnostic evaluation in, 227 Campylobacter jejuni as cause of, 225 eosinophilic, abdominal pain in, 201 Escherichia coli as cause of, 226 etiology of, 224 management of, 227 228 Norwalk virus as cause of, 223 224 rotavirus as cause of, 224 225 Salmonella infection as cause of, 225 Shigella infection as cause of, 226 Vibrio parahaemolyticus as cause of, 225 226 Yersinia infection as cause of, 226
464 Gastrointestinal bleeding, 239 252 angiography in, 248 clinical features of, 243 244 colonoscopy in, 247 248 consultation in, 247 emergency department management in, 245 epidemiology of, 239 240 fluid resuscitation and blood transfusion in, 245 246 initial diagnostic testing in, 244 initial evaluation in, 242 lower, etiology of, 241 242 medical therapies in, 246 247 nasogastric aspiration in, 245 nature of bleed in, 242 243 nuclear scintigraphy in, 248 upper, etiology of, 240 241, 245 upper endoscopy in, 247 Gastrointestinal tract, foreign bodies in, and anorectal emergencies, 369 400 Gastrostomy tubes, percutaneous, abdominal pain following insertion of, 453 Genitourinary system, disorders of, in older adult, 440 GERD(gastroesophageal reflux disease), 281 282 Glucagon, in esophageal obstruction, 379 H Heavy metals exposure, abdominal pain in, 203 Hemorrhoids, 385 387 Henoch-Schönlein purpura, abdominal pain in, 201 202 in children, 416 417 Hepatic artery aneurysm, 267 268 Hepatic encephalopathy, 299 300 Hepatitis, alcoholic, 297 298 viral, 296 Hepatorenal syndrome, 298 Hernia(s), abdominal, 332 337 background of, 333 clinical features of, 334 335 imaging of, 335 336 management and disposition in, 336 337 pathophysiology of, 333 334 bowel obstruction and, 319 345 incarcerated, in children, 414 internal, 338 ventral, 337 338 Human immunodeficiency virus/aids, abdominal pain in, 449 450 Hypercalcemia, abdominal pain in, 199 I Iliac artery aneurysm, 266 267 Immunocompromised patient, abdominal pain in, 449 452 emergency department management of, 456
465 Infections, pediatric, abdominal pain in, 202 203 Inflammatory bowel disease, clinical presentation of, 356 diagnosis of, 357 extraintestinal manifestations of, 359 360 overview and epidemiology of, 355 pathophysiology of, 355 356 serious complications of, 358 359 treatment of, 357 358 Intestines, small and large, foreign bodies in, 381 382 Intussusception, in children, 406 410 Irritable bowel syndrome, 220 221 abdominal pain due to, 205 Ischemic bowel, 258 264 L Lactrodectus mactans (black widow spider) envenomation, abdominal pain due to, 204 Liver, emergency diseases of, 293 294 gallbladder, and pancreas, emergencies of, 293 317 laboratory tests of, 294 295 Liver disease, alcoholic, 296 298 chronic, complications of, 298 300 M Magnetic resonance imaging, in appendicitis, 352 Malignancy, abdominal pain in, 450 452 in older adult, abdominal pain in, 441 Meckel s diverticulum, 412 413 Mesenteric artery, superior, occlusion of, 260, 261 thrombotic occlusion of, 258 259 Mesenteric ischemia, acute, in older adult, 437 439 clinical findings in, 260 diagnostic imaging in, 260 261 laboratory evaluation in, 260 risk management in, 263 264 treatment of, 261 263 Mesenteric vein, thrombotic occlusion of, 259 Migraine, abdominal, abdominal pain due to, 204 205 Mirizzi syndrome, 303 Murphy sign, 167 N Neutropenia, abdominal pain in, 200 Nitroglycerin and nifedipine, in esophageal obstruction, 379 NOMI, 259 260, 263 Nuclear medicine hepatobiliary evaluation, 306, 307 Nuclear scintigraphy, in gastrointestinal bleeding, 248 Nutcracker esophagus, 278 O Obturator sign, 167 Ogilvie syndrome, in older adult, 437
466 Opiates, abdominal pain due to, 204 Organ transplant, solid, abdominal pain following, 452 Oropharyngeal dysphagia, 274 Oropharynx, foreign bodies in, 370 371 Ovarian torsion, in children, 413 414 P Pain, abdominal. See Abdominal pain. extraabdominal, in children, 419 420 Pancreas, anatomy of, 309 clinical findings in, 310 311 diagnostc testing and imaging of, 311 312 emergency diseases of, 309 313 epidemiology of, 309 pathophysiology of, 310 risk factors for, 309 310 Pancreatitis, abdominal pain in, 184 in older adults, 432 433 mortality associated with, 312 treatment of, 312 Peptic ulcer disease, 240 241, 287 288 in older adults, 431 432 Peritonitis, detection of, in abdominal pain, 165 166 spontaneous bacterial, 298 299 Pharmacologic therapies, in esophageal obstruction, 378 379 Pilonidal disease, 389 390 Pneumonia, pediatric abdominal pain in, 419 Polyarteritis nodosa, abdominal pain in, 201 Porphyria, abdominal pain in, 198 199 Portal vein thrombosis, 257 258 Proctocolitis, radiation, 363 Pruritis ani, 390 Psoas sign, 167 R Radiography, plain abdominal, in acute abdominal pain, 177 plain film, in biliary disease, 306 Rectal examination, in abdominal pain, 166 Rectal prolapse, 390 392 Rectum, foreign bodies in, 382 384 Renal artery aneurysm, 268 Renal artery thrombosis, 255 256 Renal vein thrombosis, 256 257 Rovsing sign, 167 S Serotonin 5-HT 3 antagonists, in vomiting, 214 Sickle cell disease, abdominal pain in, 200 Sigmoid volvulus, 329 in older adult, 436 Splenic artery aneurysm, 267
467 Stomach, foreign bodies in, 380 381 Streptococcal pharyngitis, group A &beta-hemolytic, in children, 419 420 Systemic lupus erythematosus, abdominal pain in, 202 T Thyrotoxicosis, abdominal pain in, 198 Transjugular intrahepatic portosystemic shunts, abdominal pain following insertion of, 454 455 Transvenous biopsies, abdominal pain following, 454 Traveler s diarrhea, 216 217 Tuberculosis, abdominal pain in, 202 U Ultrasound, in acute abdominal pain, 179 in appendicitis, 350, 351 in gallstones, 304 305, 306 in intussusception in children, 408, 410 Uterine artery embolization, abdominal pain following, 455 V Vascular abdominal emergencies, 253 272 Vascular thromboses, abdominal, 255 258 Vena cava filters, abdominal pain following insertion of, 452 453 Ventral hernias, 337 338 Viral hepatitis, 296 Visceral artery aneurysms, 267 Volvulus, midgut, 411 412 Vomiting, abdominal pain and, 162 antiemetics in, 212 214 diarrhea, constipation, and gastroenteritis, 211 237 differential diagnosis of, 211 212 in pediatric patients, 214 215 Vomiting syndrome, cyclic, abdominal pain due to, 204 205 W W.A.S.H. regimen, 386, 388