Assessing Abdominal Pain in Adults: A Rational, Cost-Effective, and Evidence-Based Strategy

Assessing Abdominal Pain in Adults: A Rational, Cost-Effective, and Evidence-Based Strategy is organized by EB Medicine.

Date of Original Release: June 1, 2019. 
Date of most recent review: May 10, 2019.
Termination date: June 1, 2022.
CME Expiration Date: June 30, 2022

Target Audience: This enduring material is designed for emergency medicine physicians, physician assistants, nurse practitioners, and residents.

CME Credits: 
4 AMA PRA Category 1 Credits™, 4 ACEP Category I credits, 4 AAFP Prescribed credits, and 4 AOA Category 2-A or 2-B CME credits. CME expires 06/01/2022.

Goals: Upon completion of this activity, you should be able to: (1) demonstrate medical decision-making based on the strongest clinical evidence; (2) cost-effectively diagnose and treat the most critical presentations; and (3) describe the most common medicolegal pitfalls for each topic covered.

About This Issue:
Patients with abdominal pain are common in the ED, but you need a strategy for quickly identifying patients who are at high risk for life-threatening causes of pain, and you need to order testing and consultation that improves the accuracy of your clinical assessment.
• What are the 4 groups of patients with abdominal pain who are frequently misdiagnosed?
• Why do elderly patients with appendicitis often have little or no abdominal pain?
• In women of childbearing age, is there a realistic algorithm to distinguish gastroenteritis from appendicitis, ectopic pregnancy, and PID?
• What role should prior abdominal surgeries have in assessing abdominal pain?
• What are the 18 high-yield historical questions to ask patients who present with abdominal pain?
• Fever, high WBC, low blood pressure, tachycardia: how reliable are these in pointing to a cause for abdominal pain?
• Pain location, migration, tenderness, and guarding: what each one can (and can’t) tell you about what is going on.
• When pelvic and testicular exams are must-dos.
• What are the highest-yield lab tests? CBC? Lipase or amylase? CRP?
• When x-ray is all you need, and when CT is a must.
• Will opioids make diagnosis more difficult?

Objectives:
Upon completion of this article, you should be able to:
• Describe the life-threatening etiologies of abdominal pain and how they present.
• Identify the most commonly missed diagnoses in abdominal pain.
• Identify the “high-risk” patient with abdominal pain.
• Order imaging and laboratory testing that is most appropriate according to history and clinical presentation.