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

Abstract

KEYWORDSUltrasonography; Abdomen; Abdominal pain; Internal medicine.Abstract Introduction: US (US) examination of the abdomen has acquired a growing role in the investigation of abdominal pain; however its role in the diagnosis of some important causes of abdominal pain is still under investigation. The aim of this study was to evaluate the role of US of the abdomen in the diagnosis of abdominal pain in patients referred to a department of internal medicine. Materials and methods: A retrospective analysis was carried out on 248 US examinations performed in our department due to abdominal pain. For each examination the data written on the request form were registered as well as US findings which could be correlated with abdominal pain. Results: In 105 patients (42%), US examination of the abdomen resulted in a relevant clinical finding and was thus considered positive. A high percentage of patients were elderly (>65 years; 52%) and very elderly (>80 years; 24%); these patients showed a significantly higher percentage of positive US scans. The proportion of positive scans was not significantly different between localized and non-localized pain. Specific pain location was associated with US findings such as hepatic masses, ovarian masses and renal stones, whereas nonlocalized pain was associated with abdominal free fluid and fluid-distended bowel loops. Discussion: A high percentage of US examinations identified conditions that could possibly cause abdominal pain. Diagnostic yield of abdominal US was higher in elderly and very elderly patients. When a US examination is requested, it should always be evaluated within the clinical context. The physician should be aware of the great value of abdominal US in the diagnosis of the various causes of abdominal pain, but also of its possible limitations.Sommario Introduzione: L'ecografia dell'addome sta acquistando un ruolo sempre maggiore nell'iter diagnostico del dolore addominale, tuttavia il suo ruolo nella diagnosi di alcuni importanti quadri di dolore addominale è ancora in corso di studio. Scopo del nostro studio è stato valutare il ruolo dell'ecografia nella diagnosi differenziale di dolore addominale in un reparto di medicina interna. Materiali e metodi: Abbiamo condotto un'analisi retrospettiva di 248 ecografie addominali eseguite per dolore addominale nel nostro centro. Per ogni esame, sono stati registrati i dati inseriti nel modulo di richiesta e i reperti ecografici che potevano essere considerati correlati a dolore addominale. Risultati: In 105 pazienti (42%) l'ecografia dell'addome ha rilevato un reperto ecografico rilevante ed è stata quindi considerata positiva. Un'alta percentuale di pazienti era anziana (>65 anni, 52%) e grande anziana (>80 anni, 24%): questi soggetti avevano percentuale significativamente maggiore di esami ecografici positivi. La percentuale di indagini positive non è risultata significativamente diversa tra quelle eseguite per dolore addominale localizzato e non localizzato. Specifiche localizzazioni di dolore addominale erano associat...

Do We Really Need Additional Contrast-Enhanced Abdominal Computed Tomography for Differential Diagnosis in Triage of Middle-Aged Subjects With Suspected Biliary Pain

“…The proverb “the abdomen is the physician's grave,” quoted in one study, vividly explains how challenging it is to make an accurate diagnosis in patients complaining of abdominal pain. 1 In fact, abdominal pain is a common complaint, accounting for 6.5% of causes for visits to the emergency department (ED). 2 Among myriad of differential diagnosis considered in such patients, stone-related biliary diseases manifest with a comparatively typical nature.…”