Abdominal Pain - Life Threatening Causes And Two Diagnostic Schemas From The Clinical Problem Solver With Additional Resources From The ACR

In this post I’m reviewing the Abdominal Pain Diagnostic Schemas from The Clinical Problem Solvers as well as including a link to the American College of Radiology imaging recommendations for the imaging of gastrointestinal problems.

The Life Threatening Causes of Abdominal Pain from CPS:

Obstruction
Perforation
Vascular Catastrophe
- e.g. acute mesenteric ischemia
- rupture of an abdominal aortic aneurysm
- aortic dissection
- or an inferior MI manifesting as abdominal pain
Ectopic Pregnancy

The Two Diagnostic Schema of Abdominal Pain [Link is to the video reviews of the two schema – Be sure and watch both videos – great reviews] from CPS

Abdominal Pain
- “One third of the patients who present with abdominal pain in the inpatient or outpatient setting never receive a diagnosis. They are labeled as undifferentiated abdominal pain; and these patients typically do fine.
- “In diabetics, the immunocompromised, and the elderly the mortality rate associated with abdominal pain is increased
Imaging Negative Abdominal Pain
- “What I mean by that is that you obtain a CT scan and the following list of diagnoses may not show any abnormalities on the CT scan
  - Metabolic
  - Meds/Toxins
  - Functional
  - Other

The American College Of Radiology Appropriateness Criteria [This foregoing link is for the entire list of covered diagnoses] for Gastrointestinal Disease:

Acute Nonlocalized Abdominal Pain	Narrative & Rating Table	Evidence Table	Lit Search	Appendix		Patient Summary
Acute Pancreatitis	Narrative & Rating Table	Evidence Table	Lit Search	Appendix
Chronic Liver Disease	Narrative & Rating Table	Evidence Table	Lit Search	Appendix
Colorectal Cancer Screening	Narrative & Rating Table	Evidence Table	Lit Search	Appendix		Patient Summary
Crohn Disease	Narrative & Rating Table	Evidence Table	Lit Search	Appendix
Dysphagia	Narrative & Rating Table	Evidence Table	Lit Search	Appendix
Imaging of Mesenteric Ischemia	Narrative & Rating Table	Evidence Table	Lit Search	Appendix		Patient Summary
Jaundice	Narrative & Rating Table	Evidence Table	Lit Search	Appendix
Left Lower Quadrant Pain-Suspected Diverticulitis	Narrative & Rating Table	Evidence Table	Lit Search	Appendix
Liver Lesion — Initial Characterization	Narrative & Rating Table	Evidence Table		Appendix
Nonvariceal Upper Gastrointestinal Bleeding	Narrative & Rating Table	Evidence Table	Lit Search
Palpable Abdominal Mass-Suspected Neoplasm	Narrative & Rating Table	Evidence Table	Lit Search	Appendix
Pancreatic Cyst	Narrative & Rating Table	Evidence Table	Lit Search	Appendix
Pretreatment Staging of Colorectal Cancer	Narrative & Rating Table	Evidence Table	Lit Search	Appendix
Right Lower Quadrant Pain-Suspected Appendicitis	Narrative & Rating Table	Evidence Table	Lit Search	Appendix
Right Upper Quadrant Pain	Narrative & Rating Table	Evidence Table	Lit Search	Appendix	Patient Summary
Staging of Pancreatic Ductal Adenocarcinoma	Narrative & Rating Table	Evidence Table	Lit Search	Appendix	Patient Summary
Suspected Small-Bowel Obstruction	Narrative & Rating Table	Evidence Table	Lit Search	Appendix