Respond to other students responses with substantive comments.

Respond to other student’s responses with substantive comments. he postings should be at least one paragraph (approximately 100 words) and include at least references.

1. References and citations should conform to the APA 6th edition.
2. Remember: Please respect the opinions of others, even if their views differ. In other words, disagree professionally and respectfully.Plagiarism is never acceptable – give credit when credit is due – cite your sources.

Sandra’s Response

Acute abdominal pain is one of the most common patient presentations in the emergency department ranging from simple to complex or from physiological to psychological in nature. A comprehensive assessment that utilizes inspection, palpation, auscultation and percussion can help the practitioner further determine what underlying issues the patient may be experiencing. For example, positive findings such as bruits, Boas, Rovsing, Dunphy’s, Cullen, and Murphy signs can all indicate possible abdominal issues as well as distention, tympany, discoloration, and tenderness. Dependent on the noninvasive findings, the practitioner can further investigate to find the cause of the patient’s ailment. The American College of Radiology provide guidelines for referring practitioners to help them making efficient use of radiology use if there are diagnostic needs. The guidelines are developed by expert panels in diagnostic imaging, and appropriateness criteria are presented per clinical condition, thereby enabling the treating practitioner to request the most appropriate imaging modality for that specific clinical condition (Van Randen, Laméris, Luitse, Gorzeman, Hesselink, Dolmans, &Boermeester, 2011).

When it comes to diagnostics among expectant mothers, there are precautions and considerations to be taken due to gravidity. As a woman’s body changes during pregnancy organs tend to shift to accommodate the growing fetus which can make assessments challenging at times. The discomfort of stretching and weight gain can cause distress or pain related to the anatomical fluctuations taking place. Disorders of the abdomen may involve one or more organs within the abdominal cavity which contains the stomach, spleen, liver, gall bladder, pancreas, kidneys, small intestine and large intestine. Additionally, some abdominal organs are contained within the pelvis such as the bladder, cecum, appendix, sigmoid colon, rectum and female reproductive organs. Understanding what prompts the discomfort or the characteristics, aggravating factors, and other accompanying symptoms are important for the practitioner to use as differentiation (Cole, Lynch, & Cugnoni, 2013). Treatment is guided by the presence of a fetus therefore certain tests and medications are to be excluded or used very cautiously in order to protect the unborn child.

Furthermore, pediatric patients assimilate discomfort differently from adults making assessments and diagnosis difficult. The fact that children are vulnerable makes for a more complicated approach. Children fear pain and therefore are reluctant to allow examination let alone by a stranger. Due to developmental age it may be more difficult to understand pain characteristics as well. Obtaining information from the parents or nonverbal clues can pinpoint some associated signs and symptoms that aide in diagnosis.

As for patients with acute abdominal pain and fever in the emergency department, the American College of Radiology considers abdominal X-rays equally appropriate as unenhanced computed tomography (CT) scan and ultrasound. Only a CT scan with intravenous contrast is considered more appropriate although in the presence of some medical conditions or medications it is contraindicated. When fever is present, a complete metabolic panel, complete blood count, and lactic acid are commonly ordered as well as urine, blood or wound cultures. Knowing the serum differential levels can help the practitioner identify the severity of the infection and may help detect some autoimmune conditions, or other conditions as well. For example, in patients suspected with urinary tract calculi, perforation bowel obstruction, and radio-opaque intestinal foreign bodies X-rays are presumably diagnostically preferred (Van Randen et al., 2011). Whereas, CT scans, MRI’s, and US are preferred for other suspected conditions involving muscle tissue or other organs.

References

Cole, E., Lynch, A., & Cugnoni, H. (2013). Assessment of the patient with acute abdominal pain. Nursing Standard, 20(39), 67-75. Retrieved from https://prx-herzing.lirn.net/login?url=https://search-proquest-com.prx-herzing.lirn.net/docview/219841789?accountid=167104

The American College of Radiology (2018) Retrieved from https://www.acr.org/Clinical-Resources/ACR-Appropr…

Van Randen, A., Laméris, W., Luitse, J. S., Gorzeman, M., Hesselink, E. J., Dolmans, D., Boermeester, M. A. (2011). The role of plain radiographs in patients with acute abdominal pain at the ED. The American Journal of Emergency Medicine, 29(6), 582-589.e2. doi: http://dx.doi.org.prx-herzing.lirn.net/10.1016/j.a…

Brooke’s initial post

In the adult patient, abdominal pain may be indicative of a serious condition and cannot be discounted. When the practitioner is assessing for pain, it is important to examine the pain subjectively. Asking the patient about the nature of the pain to obtain whether it is visceral or parietal is often helpful to tell where the pain is coming from. In addition, noting the patient’s posture, demeanor, pallor, and mental status can also provide useful clues during the examination. Next, examine the abdomen for Cullen’s sign (bruising around the umbilicus) or Turner’s sign (flank bruising) to help pinpoint causes of the pain (Mistovich, Krost, Limmer, 2008). A basic metabolic panel, a hemogram, urinalysis, and a cat scan of the abdomen can rule out pathologic causes of abdominal pain. Constipation, ovarian cyst, appendicitis, irritable bowel disease, Crohn’s, kidney stones, diverticulitis, and gastroenteritis are all causes of abdominal pain (Dains, Baumann, & Scheibel, 2016).

In the pregnant population, abdominal pain usually occurs from the displacement of the bowel by the uterus or the stretching of ligaments. Even though these are both benign conditions, serious medical conditions must still be ruled out. Magnetic resonance imaging (MRI) is a helpful tool to use to safely diagnose a handful of conditions on a gravida patient while keeping her fetus safe. Intravenous dyes should not be used as they are pregnancy category C. However, oral contrast is not systemically absorbed and is appropriate in this patient population, as they are category B. Appendicitis, inflamed bowel, obstructed bowel, diverticulitis, cholecystitis, uterine fibroids, endometriosis, ovarian masses, ectopic pregnancy, cystitis, pyelonephritis, and urinary obstruction are all conditions that can be diagnosed using this method (Bailey, Pedrosa, Twickler, & Rofsky, 2012).

In the pediatric population, thirty percent of abdominal pain is functional, but serious medical conditions must be ruled out before this diagnosis can be made. Often times during the workup, practitioners may find some abnormality in the child’s diagnostics. This is not necessarily a stopping point because it is not what is causing the patient’s pain and further investigation is needed. Using the ROMEIII diagnostic criteria, a practitioner can begin to narrow down the cause of the child’s abdominal pain, thereby helping the child and lessening the parent’s anxiety, as well. A detailed history and exam along with a stool for occult blood are usually sufficient to rule out pathology in most pediatric cases. Peppermint oil and probiotics have been known to provide effective over-the-counter treatment and may have a positive placebo effect when given to children (Almadhoun, 2012).

References

Almadhoun, O. (2012). Managing Chronic Abdominal Pain In Children: Understanding Physical

and Behavioral Components of Functional Abdominal Pain. Contemporary Pediatrics,

29(3), 18-23 6p.

Bailey, A. A., Pedrosa, I., Twickler, D. M., & Rofsky, N. M. (2012). MR imaging of abdominal

and pelvic pain in pregnancy. Applied Radiology, 41(9), 16-24 9p.

Dains, J. E., Baumann, L. C., & Scheibel, P. (2016). Advanced health assessment and clinical

diagnosis in primary care (5^th ed.). St. Louis, MO: Elsevier.

Mistovich, J., Krost, W., & Limmer, D. (2008). Beyond the basics: acute abdominal pain. EMS

Magazine, 37(7), 63-73 10p