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Suitable diagnostic testing of abdominal pain varies depending on the clinical condition. A complete blood count is recommended if blood loss or infection is suspected. In patients with epigastric pain, lipase measurements and simultaneous amylase are recommended. Determining of the source of abdominal pain in a pregnant patient requires a timely and accurate diagnosis. In this case, the source of the abdominal pain is mostly clinically confounded. Therefore, an accurate imaging diagnosis is crucial because medical and surgical management decisions depend on the imaging results. On the other hand, the physiologic and anatomic changes related to pregnancy present a number of challenges to the radiologist interpreting the results (Bailey, Pedrosa, Twickler & Rofsky, 2012).
Initial evaluation of the pregnant patient should involve ultrasound since it is widely available and does not have ionizing radiation. Since ultrasound assessment is limited or equivocal, cross-sectional imaging is regularly requested and is normally conducted using the computed tomography (CT). Imaging technology will keep on providing critical diagnostic information or data. Since sonographic assessment single-handedly is not adequate to guide management in pregnant patients, the use of magnetic resonance imaging (MRI) technology is growing. MRI is considered to be safe during pregnancy and is recommended to be used when the imaging results will impact on clinical management of the mother or fetus during the pregnancy (Bailey et al. 2012). The greatest advantage of MRI is that it lacks ionizing radiation features. MR techniques used for pregnant patients with abdominal pain involve “T1-weighted GRE, intensive T2-weighted images, axial 2D TOF, single shot fast spin echo (SSFSE) or HASTE, and fat-saturated SSFSE images in the axial plane” (Bailey et al. 2012, p. 17).
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Management of abdominal pain in a pediatric patient can be frustrating and time-consuming despite the fact that most of the symptoms normally indicate a benign problem. In most of the children, the pain is usually functional, but it always advisable to consider organic causes. In other words, it does not show evidence of a pathologic condition, such as inflammatory, infectious, metabolic, anatomic, or neoplastic disorder (Almadhoun, 2012). Clinical assessment is often conducted to help identify organic and nonorganic causes of abdominal pain in a pediatric patient. Presence of alarm or red flags symptoms, clinical evaluation, and medical history assist to discriminate between nonorganic and organic causes of the abdominal pain in children and provide indication for additional testing (Almadhoun, 2012). For children with functional abdominal pain without red flag symptoms, a stool testing for occult blood is recommended. Additional diagnostic tests can be carried out at the will of the physician depending on the patient’s predominant symptoms and intensity of functional deterioration as well as parental anxiety (Almadhoun, 2012). In most cases, trial and error is the only way to determine the cause of abdominal pain in a pediatric patient (Almadhoun, 2012).
An abdominal assessment for the adult in the Emergency Room (ER) abides by the usual medical assessment layout that involves the following steps: scene size-up, initial assessment, focused physical and history evaluation, and continuing evaluation (Mistovich, Krost & Limmer, 2008). Scene size-up evaluation is performed to look for evidence that may provide information concerning the patient prior to getting physical examination results. It is particularly useful for patients with altered mental state. A patient medical history provides important information in identifying the causes of the pain. The history information that should be collected during the assessment include signs and symptoms, allergies, medications, past medical history, last oral intake, events prior to the episode, onset, provocation or palliation, quality, radiation, time, and severity of the pain (Mistovich, Krost & Limmer, 2008). Vital signs such as blood pressure, temperature and condition, skin color, respirations, and heart rate ought to be assessed as part of the initial assessment. The procedure of assessment of the orthostatic vital signs has to be performed as well. Apart from taking into account vital signs, perfusion signs need to be considered when assessing for shock (Mistovich, Krost & Limmer, 2008).
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