Skip to Main Content

++

Abdominal pain is one of the most common complaints encountered in the acute care setting. Undifferentiated abdominal pain can be one of the most challenging conditions that a physician encounters on a daily basis. The decision regarding which labs or radiological tests to order can be frustrating and often unrevealing. Particularly in elderly patients, a difficult history and often inaccurate and changing physical examination can complicate the decision-making process.

++

There are many conditions that cause abdominal pain, but not all of them are best evaluated with ultrasound. However, there are certain situations in which bedside ultrasound is ideal. In any patient who presents with undifferentiated abdominal pain and is hemodynamically unstable, a quick bedside ultrasound can help to rule out free fluid or possible surgical causes of the pain, such as an abdominal aortic aneurysm. Other etiologies that bedside ultrasound can be useful for are biliary colic or acute cholecystitis, renal colic, bowel obstruction, and appendicitis.

++

The first distinction that should be made is whether or not the pain is diffuse or focal. This guides the physician in which abdominal areas should be evaluated first. The bedside ultrasound should begin with the evaluation of the most likely organ system to be causing the pain.

++

Diffuse Abdominal Pain

++

If the pain is diffuse, it is not always easy to pinpoint which organ system first became affected. Abdominal pain that is generalized is usually of higher concern for the physician as it indicates the progression of the disease. The concerning causes for diffuse abdominal pain include a perforated viscous, a bowel obstruction, the presence of new free fluid from a ruptured structure, or peritonitis in a patient with known ascites.

++

Perforated Viscous

++

There are multiple causes of a perforated viscous, including a ruptured appendix, a diverticulitis, a perforated ulcer, a prolonged bowel obstruction, or a ruptured esophagus from excessive vomiting. The presence of fluid in the abdomen in a patient without liver disease or known ascites should raise the suspicion of an abdominal catastrophe, including perforated viscous. Free air is a specific finding for a perforated viscous, and ultrasound may be able to detect free air. When present, free air is best seen at the edge of the liver and will be seen as hyperechoic areas with dirty comet tails that are not within the bowel. Plain radiographs may also detect free air, but a CT scan is much more sensitive than either ultrasound or x-ray.

++

Free Fluid

++

If a moderate to large amount of fluid is seen with a cirrhotic-looking liver (shrunken, irregular-shaped), then spontaneous bacterial peritonitis should be considered. Free fluid in a female with abdominal pain should lead to a search for gynecologic origin, such as a ruptured ovarian cyst, ectopic pregnancy with bleeding, or the extension of a pelvic infection. An elderly patient with diffuse abdominal pain and ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessAnesthesiology Full Site: One-Year Subscription

Connect to the full suite of AccessAnesthesiology content and resources including procedural videos, interactive self-assessment, real-life cases, 20+ textbooks, and more

$995 USD
Buy Now

Pay Per View: Timed Access to all of AccessAnesthesiology

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.