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

Abstract

The epigastrium is the site where pain coming from both abdominal and extra-abdominal 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).

US in the evaluation of abdominal pain in a department of internal medicine

“…The proportion of positive examinations was similar to that of previous studies conducted in a general hospital setting (45% in a study by Raman et al) [2] and in emergency departments (42% in a study by Testa et al) [4]. Other studies conducted in emergency department settings reported a higher percentage of positive US findings (66% in a study by Nural et al) [5].…”

Abdominal and thoracic focused assessment with sonography for trauma, triage, and monitoring in small animals

“…The ‘T’ in ‘FAST’ could be considered representative within the veterinary community of not only ‘Trauma,’ but also ‘Triage’ and ‘Tracking’ for nontrauma and monitoring applications, respectively. By recognizing that the ‘T’ in FAST may represent these additional applications, it may help avoid the need for a host of additional acronyms such as extended FAST, HHFAST, FAFF, FFAST, INBU, SLOH, ‘$ Approach,’ BOAST which can be found in the human literature 23,32,61–65 …”

Retrospective cohort study on clinical predictors for acute abnormalities on CT scan in adult patients with abdominal pain

“…Among the patients included in this study, only 8 out of 31 patients with epigastric tenderness had an abnormal CT scan, and of those, only 4 were surgical. Since epigastric pain is a common presenting complaint, with data showing that it can account for up to 25 % of NTAP presentations to the ED [17], unnecessary CT scans for such presentations can be of concern. Epigastric pain has a broad differential diagnosis that commonly includes pathologies of the stomach, gallbladder, and pancreas, many of which can be diganosed by imaging modalities other than CT scans.…”