UMEM Educational Pearls

Category: Med-Legal

Title: Abdominal Pain Pitfalls

Keywords: abdominal pain, exam, legal, pitfall, missed (PubMed Search)

Posted: 11/23/2007 by Dan Lemkin, MD (Emailed: 11/26/2007) (Updated: 10/14/2019)
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Abdominal pain can be very confusing. Occasionally, serious etiologies may masquarade as benign complaints. Always consider the following pitfalls when addressing abdominal complaints.

  • Be aware of extra-abdominal disease processes presenting as abdominal pain
    • AMI, pneumonia, pelvic diesases
  • If you suspect appendicitis - than pursue the diagnosis
    • Do not delay notification of surgeon, and request consultation early
      • It is reasonable for them to examine the patient without CT results
      • It is not reasonable to withhold pain medications until they see the patient
    • Time all calls, and document all discussions with consultant name
  • UTI and gastroenteritis should be considered diagnoses of exclusion. Be wary of using, if any red flags exist
    • fever, hypotension, blood in stool, weight loss, abdominal tenderness
  • Unless the diagnosis/etiology is clearly not pelvic in origin, always do a pelvic exam in a women
  • Always consider, and document your consideration of testicular and ovarian torsion
  • In a septic patient with UTI, consider obstructing pyelonephritis.
    • Patients with a kidney stone and obstructing pyelo will not get better unless the stone is removed. CT for stones, prior to dispo.
  • Consider vascular etiologies in high risk populations: elderly, diabetic, hypertensive
    • AAA - pain to back, tearing sensation
    • Dissection - pain, decreased pulses, neuro findings
    • Mesenteric Ischemia / schemic Colitis - pain out of proportion to exam findings
    • Torsion - radiating pain to abdomen - document a genital exam

Disclaimer: This information does not constitute legal advice, is general in nature, and because individual circumstances differ it should not be interpreted as legal advice. The speaker provides this information only for Continuing Medical Education purposes.

Content abstracted from: Nguyen Anh, Nguyen Dung. Learning from Medical Errors. Radcliffe Publishing, UK. 2005. P 11-13.