Acute Abdomen (Overview)
Pathway Home
Population Covered By The Guidance
This pathway provides guidance for imaging adult patients with non-traumatic acute abdominal pain. An approach is used based on categorization of symptoms with associated links to more specific pathways.
Date reviewed: January 2012
Date of next review: July 2023
Published: January 2012
Quick User Guide
Move the mouse cursor over the PINK text boxes inside the flow chart to bring up a pop up box with salient points.
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The relative radiation level (RRL) of each imaging investigation is displayed in the pop up box.
SYMBOL | RRL | EFFECTIVE DOSE RANGE |
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None | 0 |
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Minimal | < 1 millisieverts |
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Low | 1-5 mSv |
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Medium | 5-10 mSv |
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High | >10 mSv |
Images
Teaching Points
Teaching Points
- An acute abdomen can be defined as severe, persistent abdominal pain of sudden onset that requires immediate surgical or medical review
- Plain Film Radiography (PFR) has limited efficacy in an unselected population with acute abdominal pain, as it rarely alters clinical management
- Utilising PFR for the assessment of 'non-specific abdominal pain' is unlikely to yield a positive finding. Significantly, unrelated or incidental pathology can be identified and alter clinical management erroneously
- Evidence and consensus indications for plain film radiography in the investigation of 'non-traumatic acute abdominal pain' include
- Suspected bowel obstruction or ileus
- Suspected bowel perforation
- Ingested foreign body
- Severe abdominal pain/tenderness of unknown origin requiring opiate analgesia
References
References
References are graded from Level I to V according to the Oxford Centre for Evidence-Based Medicine, Levels of Evidence. Download the document
- Anyanwu A, Moalypour S. Are abdominal radiographs still over-utilised in the assessment of acute abdominal pain? A district general hospital audit. J R Coll Surg Edin. 1998;43:267-70. (Level IV evidence)
- Morris-Stiff G, Stiff R, Morris-Stiff H. Abdominal radiograph requesting in the setting of acute abdominal pain: temporal trends and appropriateness of requesting. Ann R Coll Surg Eng. 2006;88:270-4. (Level IV evidence)
- Boleslawski E, Panis Y, Benoist S et al. Plain Abdominal radiography as a routine procedure for acute abdominal pain of the right lower quadrant: Prospective Evaluation. World J Surg. 1999;23:262-4. (Level II evidence). View the reference
- Stower M, Amar S, Mikulin J et al. Evaluation of the plain abdominal X-ray in the acute abdomen. J Royal Soc of Med. 1985;75:630-3. (Level II evidence). View the reference
- Campbell J, Gunn A. Plain abdominal radiographs and acute abdominal pain. Br J Surg. 1988;75:554-6. (Level IV evidence)
- Hayward M, Hayward C, Ennis W et al. A pilot evaluation of radiography of the acute abdomen. Clin Radiol. 1984;35:289-91. (Level IV evidence)
- Lacey G, Wignall B, Bradbrooke S et al. Rationalising abdominal radiography in the accident and Emergency Department. Clin Radiol. 1980;31:453-5. (Level III evidence)
- Eisenberg R, Heineken P, Hedgcock M et al. Evaluation of plain abdominal radiographs in the diagnosis of abdominal pain. Ann Surg. 1983;197:464-9. (Level II evidence). View the reference
Information for Consumers
Information for Consumers
Information from this website |
Information from the Royal Australian and New Zealand College of Radiologists’ website |
Radiation Risks of X-rays and Scans |
Contrast Medium (Gadolinium versus Iodine) Iodine-Containing Contrast Medium Radiation Risk of Medical Imaging During Pregnancy Radiation Risk of Medical Imaging for Adults and Children |
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