September 2, 2010

Non-surgical causes of abdominal pain

I have come to the conclusion that emergency medicine surely must be one of the most difficult specialties in medicine. We are the the only gate-keepers to the hospital and it is our decision if the person walking in to the ER is sick or not and then if there actually is anything with that symptom that needs follow-up. Amal Mattu in his excellent ECG course has often pointed this out with regards to ECG interpretation - it is the emergency physician, not the cardiologist, who will pick up the pathologic pattern before disaster happens. Take Brugada and Wellens as an example. Treating the patient is not the difficult part, ruling in and ruling out is.

So every now and then I like to read about the not-so-common diseases which just might pass through my ER and I am responsible for reacting on. Abdominal pain is one of those traps where delay in diagnosis can cause misery to the patient. If it isn't appendicitis, cholecystitis or diverticulitis I try to strain my brain cells and think twice before deciding what to do with the patient. Often it's just back to basics and so it was a joy to stumble upon this great article from BMJs medical student journal:

Non-surgical causes of abdominal pain
It will help you think broader next time you have that abdominalia that simply doesn't fit into the common disease patterns. Tabes dorsalis, lead toxicity, porphyria... oh common don't tell me you already had these on your ddx list!