Workup

Acute abdomen

What are the 4 common causes of acute abdominal pain, in patients over 50 years old?

• Biliary tract disease (21%)
• Nonspecific abdominal pain (16%)
• Appendicitis (15%)
• Bowel obstruction (12%)

Note that vascular disease, such as abdominal aortic aneurysm or mesenteric ischemia, only accounts for 2% of cases.

What are the common causes of acute abdominal pain, in patients under 50 years old?

• Nonspecific abdominal pain (40%)
• Appendicitis (32%)

Which is the imaging procedure of choice in a suspected case of acute abdomen?

• Working diagnosis based on history and physical will dictate which imaging procedure should be ordered.
  • In general abdomen CT provides the most diagnostic information in patients with an acute abdomen.
  • Plain abdominal radiographs can serve as preliminary imaging study to CT.
  • For biliary disease, US is the initial choice.
  • HIDA scan (nuclear medicine study) is used to evaluate acalculus cholecystitis.

Which is the imaging procedure of choice in patients with acute abdomen suggestive of biliary disease?

Ultrasound

Diagnostic with following findings

• Thickened GB wall >3 mm
• Gall stones
• Tenderness over Gall bladder area while scanning
• Dilated biliary ducts and calculi

Non diagnostic Ultrasound should be followed by HIDA scan

• HIDA scan will demonstrate bile ducts and patent cystic duct if it is not GB disease.