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  • • Nonspecific abdominal pain is a diagnosis of exclusion characterized by abdominal pain without identifiable organic pathology

    • Mild, fleeting abdominal pain

    • Abdominal pain short-lived (< 6hrs)

    • Improvement or no change in abdominal pain since onset of symptoms

    • Patients frequently complain of nausea and/or diarrhea

    • Lack of associated serious signs or symptoms

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Epidemiology

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  • • Most common diagnosis among children complaining of abdominal pain

    • -Accounts for up to 33% of all cases

    • Adults with the symptoms of nonspecific abdominal pain are often diagnosed with irritable bowel syndrome

    • Nonspecific abdominal pain is a diagnosis of exclusion

    • -Extreme care should be taken before diagnosing this disorder in the very young or old and immunocompromised

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Symptoms and Signs

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  • • Patient appears comfortable

    • No documented fever

    • Vital signs normal

    • No evidence of peritoneal irritation

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Laboratory Findings

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  • • Normal WBC count

    • Normal serum chemistries, amylase, lipase, and UA

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Imaging Findings

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  • Abdominal x-ray: Reveal no free air and a normal bowel gas distribution

    CT scan: Although expensive, it is quite specific in ruling out surgical etiologies of abdominal pain

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  • • Irritable bowel syndrome

    • Viral gastroenteritis

    • Dysmenorrhea

    • Psychosomatic pain

    • Abdominal wall pain

    • Causalgia

    • Acute hip bursitis

    • Hip joint dislocation

    • Thoracolumbar spinal nerve root compression

    • Constipation

    • Mesenteric adenitis

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Rule Out

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  • • Surgical etiology of abdominal pain

    • -Acute appendicitis

      -Acute cholecystitis

      -Bowel obstruction

      -Perforated peptic ulcer

      -Incarcerated hernia

      -Diverticulitis

    • Inflammatory bowel disease

    • Acute salpingitis/pelvic inflammatory disease

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  • • CBC

    • Basic chemistries

    • UA

    • Amylase and lipase

    • Abdominal x-ray

    • Abdominal/pelvic CT may be indicated when diagnosis is in doubt

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When to Admit

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  • • Admission for 24-hour observation may be indicated if a surgical etiology is contemplated (most commonly "rule out appendicitis")

    • Most patients can be sent home and asked to come to the emergency department if their symptoms recur or worsen

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When to Refer

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  • • Patients with recurrent abdominal symptoms may benefit from a gastroenterology consult

    • Young female patients with cyclical pain that correlates with their menstrual cycle benefit from a thorough gynecologic evaluation

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  • • Educate patients regarding significant signs and symptoms that should prompt them to return to the emergency department

    • Arrange outpatient follow-up as indicated

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Surgery

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Indications

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  • • None

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Medications

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  • • Avoid narcotics

    • NSAIDs may be beneficial and nonaddictive

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Complications

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  • • Misdiagnosis

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Prognosis

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  • • Excellent

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References

Kilpatrick CC, Monga M: Approach to the acute abdomen in pregnancy. Obstet Gynecol Clin North Am 2007;34:389. ...

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