Pitfalls

Pitfalls in assessing ED patients with abdominal pain include the following:

• Do not forget to examine the hernial orifices so as not to miss an incarcerated hernia.
• Do not rely too heavily on inflammatory markers – these are non-specific.
• Failure to perform an hCG in all females of child-bearing age may mean missing an ectopic pregnancy.
• Beware discharging the patient who has experienced severe pain (eg. requiring strong opiates) as this pain may return and these patients often need a period of observation.
• Do not forget that medical conditions can present with abdominal pain. It is important not to miss an inferior MI or DKA.
• Ruptured AAA can present with a variety of different patterns of pain. Have a high degree of suspicion especially in patients with risk factors (e.g. male, age >50, smoker, hypertensive, positive family history).
• Be aware that pregnancy distorts normal anatomy and clinical presentation may be atypical.
• The elderly patient with abdominal pain is more likely to have serious pathology and can be harder to diagnose.