Acute abdominal pain among elderly patients3 years, 831 casesNon-specific 22-24%Misdiagnosis (52% VS 45%), high mortality (2.8% VS 0.1%)less peritoneal signs Laurell H, Hansson LE, Gunnarsson U. Gerontology. 2006;52(6): 339-44
Emergency department diagnosis of acute abdominalpain in elderly patients 1 year retrospective review, 378 cases Non-specific (35.2%), acute gastritis/gastroenteritis (10.6%), and biliary tract dis. (8.2%) Non-specific; 90% dissolved, 5.4% Sx. Othong R, Wuthisuthimethawee P, Vasinanukorn P Songkla Med J vol. 28 No 1 Jan-Feb 2010
Predictor for an intensive care or specific treatment inthe elderly patients with acute abdominal pain 1 year retrospective review, 386 cases Dyspepsia (21.8%), non-specific (17.6%) and acute gastroenteritis (8.8%) Male, BT < 38, PR >90, abnormal abd contour, and Localize tenderness or guarding Worapraatya P, Wuthisuthimethawee P, Vasinanukorn P
Analgesia on abdominal examination Effect on diagnostic efficiency of analgesia for undifferentiated abdominal pain Analgesia is safe in abdominal pain Br J Surg. 2003 Jan;90(1):5-9
Analgesia on abdominal examinationEffects of morphine analgesia on diagnostic accuracy inEmergency Department patients with abdominal pain:a prospective, randomized trial Prospective, double-blind clinical trial Reexam in 60 minutes No differences with respect to changes in physical examination or diagnostic accuracy J Am Coll Surg. 2003 Jan;196(1):18-31
Analgesia on abdominal examination Analgesia in patients with acute abdominal pain Opioid improve patients comfort and does not retard decision to treat Cochrane Database Syst Rev. 2007 Jul 18;(3): CD005660
Analgesia on abdominal examinationEfficacy and impact of intravenous morphine before surgicalconsultation in children with right lower quadrant painsuggestive of appendicitis: a randomized controlled trial Randomized double-blind placebo-controlled trial 8-18 years old, 90 patients Morphine did not delay surgical decision, not more effective than placebo to diminishing pain Ann Emerg Med. 2007 Oct;50(4):371-8. Epub 2007 Jun 27
Medication on abdominal examination Buscopan ?
High-Yield historical questions How old are you ? Which came first-pain or vomiting ? How long have you had the pain ? Have you ever had abdominal surgery ?
High-Yield historical questions Is the pain constant or intermittent ? Have you ever had this before ? Do you have a history of cancer diverticulosis ? Do you have HIV ?
High-Yield historical questions How much alcohol do you drink per day ? Are you pregnant ? Are you taking antibiotic or steroid ? Did the pain start centrally and migrate ? Do you have a history of CAD, HT, AF ?
Etiology and clinical course of abdominal painIn senior patients; a prospective, multicenter study3 years, 831 casesNon-specific 22-24%Misdiagnosis (52% VS 45%), high mortality (2.8% VS 0.1%)less peritoneal signs Lewis LM, Banet GA, Blenda M, et al. J Gerontol A Biol Sci Med Sci. 2005