Karın Ağrıları
Özet
Karın ağrısı, mekanik ve kimyasal uyarılara bağlı olarak gelişen ve acil servis başvurularında sık karşılaşılan, basit nedenlerden yaşamı tehdit eden durumlara kadar geniş bir yelpazeye yayılan klinik bir şikayettir. Tanı sürecinde ağrının yeri, süresi, oluş mekanizması ve eşlik eden semptomlar titizlikle değerlendirilerek fizik muayene ve laboratuvar tetkikleriyle desteklenmelidir. Özellikle yaşlılar, bağışıklığı baskılanmış bireyler ve kadınlar gibi özel gruplarda atipik belirtiler görülebileceğinden, bu popülasyonlarda radyolojik görüntüleme yöntemlerinden de faydalanılarak multidisipliner bir yaklaşım sergilenmesi kritiktir.
Abdominal pain is a frequent clinical complaint caused by mechanical and chemical stimuli, ranging from simple causes to life-threatening conditions, and is a leading reason for emergency department visits. The diagnostic process requires a thorough evaluation of the pain's location, duration, and mechanism, alongside physical examination and laboratory tests. A multidisciplinary approach is critical, especially in special populations such as the elderly, immunocompromised, and women, where atypical symptoms may necessitate the use of radiological imaging.
Referanslar
Graff IV LG, Robinson D. Abdominal pain and emergency department evaluation. Emergency medicine clinics of North America. 2001;19(1):123-136.
Van Geloven A, Biesheuvel T, Luitse J, et al. Hospital admissions of patients aged over 80 with acute abdominal complaints. European Journal of Surgery. 2000;166(11):866-871.
Hustey FM, Meldon SW, Banet GA, et al. The use of abdominal computed tomography in older ED patients with acute abdominal pain. Am J Emerg Med. 2005;23(3):259-265.
Cooper GS, Shlaes DM, Salata RA. Intraabdominal infection: differences in presentation and outcome between younger patients and the elderly. Clin Infect Dis. 1994;19(1):146-148.
Huether SE, Defriez C. Pain, temperature regulation, sleep, and sensory function. Pathophysiology: The Biologic Basis for Disease in Adults and Children 4th ed St Louis, MO: Mosby. 2002:401-437.
Doherty GM BJ. The acute abdomen. In: Way L DG, eds. , editor. Current Surgical Diagnosis and Treatment, 11th ed Lange Medical Books. McGraw-Hill, New York, 2003. p. 503-516.
Guyton. A. Pain, headache, and thermal sensations. In: Guyton AC HJ, eds., editor. Human Physiology and Mechanisms of Disease, 6th.
Bloomfield AL, Polland WS. Experimental Referred Pain From The Gastrointestinal Tract. Part II. Stomach, Duodenum And Colon. J Clin Invest. 1931;10(3):453-473.
Cline DM, Ma OJ. Tintinalli's emergency medicine: Just the facts: McGraw Hill Professional; 2012.
O’Brien MC. Acute abdominal pain. Tintinalli JE, Stapczynski JS, Ma OJ, Cline DM, Cydulka RK, Meckler GD. 2011:481-489.
Laméris W, van Randen A, Dijkgraaf MG, et al. Optimization of diagnostic imaging use in patients with acute abdominal pain (OPTIMA): Design and rationale. BMC emergency medicine. 2007;7(1):1-6.
Kamin RA, Nowicki TA, Courtney DS, et al. Pearls and pitfalls in the emergency department evaluation of abdominal pain. Emergency Medicine Clinics. 2003;21(1):61-72.
Dworken HJ, Biel FJ, Machella TE. Supradiaphragmatic reference of pain from the colon. Gastroenterology. 1952;22(2):222-243.
Cartwright SL, Knudson MP. Evaluation of acute abdominal pain in adults. American family physician. 2008;77(7):971-9778.
Karakuş A, Kaya E, Kuvandık G. Acil serviste karın ağrısına yaklaşım. The Journal of Turkish Family Physician. 2018;9(2):59-67.
Tekin F, İlter T. Birinci basamakta akut karın ağrısı olan hastaya yaklaşım. Güncel Gastroenteroloji. 2015;19(3):161-170.
Martina B, Bucheli B, Stotz M, et al. First clinical judgment by primary care physicians distinguishes well between nonorganic and organic causes of abdominal or chest pain. Journal of general internal medicine. 1997;12(8):459-465.
Peterson MC, Holbrook JH, Von Hales D, et al. Contributions of the history, physical examination, and laboratory investigation in making medical diagnoses. Western Journal of Medicine. 1992;156(2):163.
Thomas SA. Spinal stenosis: history and physical examination. Phys Med Rehabil Clin N Am. 2003;14(1):29-39.
Trowbridge RL, Rutkowski NK, Shojania KG. Does this patient have acute cholecystitis? Jama. 2003;289(1):80-86.
Fraser A, Ali M, McCullough S, et al. Diagnostic tests for Helicobacter pylori--can they help select patients for endoscopy? The New Zealand medical journal. 1996;109(1018):95-98.
Cudnik MT, Darbha S, Jones J, et al. The diagnosis of acute mesenteric ischemia: a systematic review and meta‐analysis. Academic Emergency Medicine. 2013;20(11):1087-1100.
Girman C, Kou T, Cai B, et al. Patients with type 2 diabetes mellitus have higher risk for acute pancreatitis compared with those without diabetes. Diabetes, Obesity and Metabolism. 2010;12(9):766-771.
Harward TR, Green D, Bergan JJ, et al. Mesenteric venous thrombosis. Journal of vascular surgery. 1989;9(2):328-333.
Griffin MR, Ray WA, Schaffner W. Nonsteroidal anti-inflammatory drug use and death from peptic ulcer in elderly persons. Annals of Internal Medicine. 1988;109(5):359-363.
Macaluso CR, McNamara RM. Evaluation and management of acute abdominal pain in the emergency department. International journal of general medicine. 2012;5:789.
E David Bryan M. Abdominal Pain in Elderly Persons Clinical Presentation 2018 [Available from: https://emedicine.medscape.com/article/776663-clinical#b2.
Adedeji O, McAdam W. Murphy's sign, acute cholecystitis and elderly people. Journal of the Royal College of Surgeons of Edinburgh. 1996;41(2):88-89.
Wagner JM, McKinney WP, Carpenter JL. Does this patient have appendicitis? Jama. 1996;276(19):1589-1594.
Cartwright SL, Knudson MP. Evaluation of acute abdominal pain in adults. Am Fam Physician. 2008;77(7):971-978.
Medina-Bombardó D, Jover-Palmer A. Does clinical examination aid in the diagnosis of urinary tract infections in women? A systematic review and meta-analysis. BMC Fam Pract. 2011;12:111.
Mody L, Juthani-Mehta M. Urinary tract infections in older women: a clinical review. Jama. 2014;311(8):844-854.
Panebianco NL, Jahnes K, Mills AM. Imaging and laboratory testing in acute abdominal pain. Emerg Med Clin North Am. 2011;29(2):175-193, vii.
Kafetzis DA, Velissariou IM, Nikolaides P, et al. Procalcitonin as a predictor of severe appendicitis in children. Eur J Clin Microbiol Infect Dis. 2005;24(7):484-487.
Sand M, Trullen XV, Bechara FG, et al. A prospective bicenter study investigating the diagnostic value of procalcitonin in patients with acute appendicitis. Eur Surg Res. 2009;43(3):291-297.
Anielski R, Kuśnierz-Cabala B, Szafraniec K. An evaluation of the utility of additional tests in the preoperative diagnostics of acute appendicitis. Langenbecks Arch Surg. 2010;395(8):1061-1068.
Taylor MR, Lalani N. Adult small bowel obstruction. Acad Emerg Med. 2013;20(6):528-544.
Allemann F, Cassina P, Röthlin M, et al. Ultrasound scans done by surgeons for patients with acute abdominal pain: a prospective study. Eur J Surg. 1999;165(10):966-970.
Lindelius A, Törngren S, Pettersson H, et al. Role of surgeon-performed ultrasound on further management of patients with acute abdominal pain: a randomised controlled clinical trial. Emerg Med J. 2009;26(8):561-566.
Mayumi T, Yoshida M, Tazuma S, et al. The practice guidelines for primary care of acute abdomen 2015. Journal of General and Family Medicine. 2016;17(1):5-52.
Garcia EM, Camacho MA, Karolyi DR, et al. ACR Appropriateness Criteria(®) Right Lower Quadrant Pain-Suspected Appendicitis. J Am Coll Radiol. 2018;15(11s):S373-s387.
Galgano SJ, McNamara MM, Peterson CM, et al. ACR Appropriateness Criteria(®) Left Lower Quadrant Pain-Suspected Diverticulitis. J Am Coll Radiol. 2019;16(5s):S141-s149.
Gerhardt RT, Nelson BK, Keenan S, et al. Derivation of a clinical guideline for the assessment of nonspecific abdominal pain: the Guideline for Abdominal Pain in the ED Setting (GAPEDS) Phase 1 Study. The American journal of emergency medicine. 2005;23(6):709-717.
Bhavsar AK, Gelner EJ, Shorma T. Common questions about the evaluation of acute pelvic pain. American family physician. 2016;93(1):41-48.
Vilke GM, Jin A, Davis DP, et al. Prospective randomized study of viscous lidocaine versus benzocaine in a GI cocktail for dyspepsia. The Journal of emergency medicine. 2004;27(1):7-9.
Wrenn K, Slovis CM, Gongaware J. Using the" GI cocktail": a descriptive study. Annals of emergency medicine. 1995;26(6):687-690.
Chan S, Maurice AP, Davies SR, et al. The use of gastrointestinal cocktail for differentiating gastro-oesophageal reflux disease and acute coronary syndrome in the emergency setting: a systematic review. Heart, Lung and Circulation. 2014;23(10):913-923.
Patanwala AE, Amini R, Hays DP, et al. Antiemetic therapy for nausea and vomiting in the emergency department. The Journal of emergency medicine. 2010;39(3):330-336.
Braude D, Crandall C. Ondansetron versus promethazine to treat acute undifferentiated nausea in the emergency department: a randomized, double‐blind, noninferiority trial. Academic Emergency Medicine. 2008;15(3):209-215.
Thomas SH, Silen W, Cheema F, et al. Effects of morphine analgesia on diagnostic accuracy in emergency department patients with abdominal pain: a prospective, randomized trial. Journal of the American College of Surgeons. 2003;196(1):18-31.
Emet M, Eroğlu M, Aslan Ş, et al. Karın ağrısı olan hastaya yaklaşım. Eurasian J Med. 2007;39:136-141.
Robert M Penner B, MD, FRCPC, MScMary B Fishman, MD. Evaluation of the adult with abdominal pain uptodate2022 [Available from: https://www.uptodate.com/contents/evaluation-of-the-adult-with-abdominal-pain?search=chronic-abdominal-pain&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2.
