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Original Research

RMJ. 2010; 35(2): 160-164


Threatening signals in acute abdomen

Essa Mayyas, Ahmad S Sbaihat, Firas khori.


Abstract

ABSTRACT
Objective
To determine the most significant factors in clinical and laboratory investigations that can help in pointing presence or absence of serious surgical condition.
Methods
It’s a retrospective analysis of 210 patients who were admitted to Prince Rashid Ben Al-Hassan hospital, Irbid, Jordan as a case of acute abdominal pain from January 2008 to January 2009.
Results
Out of 210 patients, 127 were female and 83 male. The ages ranged from 15 to 65 year. One hundred and four patients (49.5% of total) were diagnosed to have acute surgical pathology. Of these, 49 (47.1%) had acute appendicitis where appendectomy done. Seventy one (33.8% of total) were labeled to have acute non specific abdominal pain. Nausea and vomiting presented in 72.1% of patients who have acute surgical pathology followed by localized tenderness or guarding in (70.2%), leukocytosis (62.5%) and tachycardia in 54.8% of patients.
Conclusion
Nausea and vomiting, localized tenderness or guarding, leukocytosis, and tachycardia were associated with significant pathology. Patients without these variables were unlikely to have significant pathology requiring further active medical or surgical intervention. (Rawal Med J 2010;35: ).
Key words
Acute abdomin, nausea, vomiting, abdominal pain.

INTRODUCTION
Acute abdominal pain is a common presentation to the emergency room leading to hospital admission.1 Right iliac fossa pain accounts for one third to half of all such admissions, with appendicitis being the most common cause.2 However, the signs and symptoms can mimic any other acute abdominal condition.3 Decision making in patients with abdominal pain on the basis of clinical and laboratory evaluation alone can result in unnecessary interventions or in delayed treatment of urgent conditions. Several forms of imaging, of which ultrasonography and computed tomography (CT) are the most often used, can assist in clinical decision making.4 Imaging has been shown to have a positive effect on the accuracy of the clinical diagnosis.5 Despite the advance in diagnostic modalities; the diagnosis is still doubtful in 30%-40% of cases. 6,7
Acute non specific abdominal pain, generally defined as acute abdominal pain of under seven days duration and for which there is no diagnosis after examination and baseline investigations, is a common cause of emergency admissions, many of these patients have persistence symptoms and are difficult to discharge, undergo multiple, often costly investigations and have repeated admissions.8 Hospitalization followed by active clinical observation, traditionally defined as “wait and see,” has been the most widely used method of clinical management of patients with nontypical clinical signs. The predictive value of clinical diagnosis reached with this method, which varies with the underlying cause, has been estimated between 68% and 92%.9 Acute abdominal pain includes many diseases that range from self limited conditi

Key words: Acute abdomin, nausea, vomiting, abdominal pain.






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