Peripheral neuropathic mimics of visceral abdominal pain: Can physical examination limit diagnostic testing?
| Autor: | Kenneth Frumkin, Liam F. Delahanty |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
Abdominal pain medicine.drug_class Physical examination Intercostal nerves Diagnosis Differential Abdominal wall 03 medical and health sciences 0302 clinical medicine medicine Humans Pain Management 030212 general & internal medicine Physical Examination medicine.diagnostic_test business.industry Local anesthetic Peripheral Nervous System Diseases 030208 emergency & critical care medicine General Medicine Emergency department medicine.disease Abdominal Pain Surgery medicine.anatomical_structure Emergency Medicine Etiology Neuralgia Intercostal Nerves medicine.symptom Emergency Service Hospital business |
| Zdroj: | The American Journal of Emergency Medicine. 36:2279-2285 |
| ISSN: | 0735-6757 |
| DOI: | 10.1016/j.ajem.2018.08.042 |
| Popis: | Background The emergency department evaluation of patients with abdominal pain is most appropriately directed at identifying acute inflammation, infection, obstruction, or surgical disease. Doing so commonly involves “routine” (and often extensive) diagnostic imaging and laboratory testing. Benign mimics of serious visceral abdominal pain that can be diagnosed by physical exam and confirmed with local anesthetic injections have been identified over the last century. These syndromes derive from painful irritation of the intercostal nerves by a mobile rib below, or from impingement of the cutaneous branches of those same intercostal nerves as they penetrate the abdominal wall. These peripheral neuropathic mimics of visceral abdominal pain continue to go unrecognized and underdiagnosed. Methods Our purpose is to review the affirmative diagnosis of non-visceral abdominal pain by physical examination. Results The consequences of failure to identify these conditions are considerable. In the search for a diagnosis that is literally at the provider's fingertips, patients frequently undergo months to years of fruitless and often invasive diagnostic tests, not uncommonly including unsuccessful surgeries. Conclusions With proper consideration of and appropriate testing for visceral etiologies, a carefully directed physical examination may yield an affirmative diagnosis in a percentage of these common emergency department patients. |
| Databáze: | OpenAIRE |
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