Nonspesifik Karın Ağrısı: Gerçek Bir Tanı Mı, Yoksa Kon(A) Mayan Tanı Mı?
Özet
Nonspesifik karın ağrısı (NSKA), acil servis başvurularının en sık nedenlerinden biri olup tanısal belirsizliklerle karakterizedir. NSKA, özgül bir hastalıktan ziyade, yeterli klinik değerlendirme sonrası ulaşılan geçici ve güvenlik temelli bir klinik sonuç olarak kabul edilmelidir. Gelişmiş görüntüleme yöntemlerine rağmen NSKA oranlarında anlamlı bir azalma sağlanamamış; seri klinik muayene ve gözlem güvenli yaklaşımın temelini oluşturmaya devam etmiştir. Karın duvarı ağrısı ve özellikle Anterior Kutanöz Sinir Tuzaklanma Sendromu (ACNES), NSKA ile sık karışan ancak tanınabilir ve tedavi edilebilir önemli nedenler arasındadır. Çoğu hastada prognoz benign olmakla birlikte, ileri yaş grubunda altta yatan ciddi patolojiler açısından dikkatli izlem gereklidir.
Referanslar
Hastings RS, Powers RD. Abdominal pain in the ED: a 35-year retrospective. Am J Emerg Med. 2011;29(7):711–716.
Cervellin G, Mora R, Ticinesi A, Meschi T, Comelli I, Catena F, et al. Epidemiology and outcomes of acute abdominal pain in a large urban Emergency Department: retrospective analysis of 5,340 cases. Ann Transl Med. 2016;4(19):362. doi:10.21037/atm.2016.09.10.
de Burlet K, Lam A, Larsen P, Dennett E. Changes in our assessment of acute abdominal pain over ten years. N Z Med J. 2017 Oct 6;130(1463):39–44.
Laurell H, Hansson LE, Gunnarsson U. Diagnostic pitfalls and accuracy of diagnosis in acute abdominal pain. Scand J Gastroenterol. 2006;41(10):1126–1131. doi:10.1080/00365520600587485.
Fagerström A, Paajanen P, Saarelainen H, Ahonen-Siirtola M, Ukkonen M, Miettinen P, et al. Non-specific abdominal pain remains as the most common reason for acute abdomen: 26-year retrospective audit in one emergency unit. Scand J Gastroenterol. 2017;52(10):1072–1077. doi:10.1080/00365521.2017.1342140.
Cartwright SL, Knudson MP.Evaluation of acute abdominal pain in adults.
American Family Physician. 2008;77(7):971–978.
Dang C, Aguilera P, Dang A, Salem L. Acute abdominal pain. Four classifications can guide assessment and management. Geriatrics. 2002;57(3):30-42.
Townsend CM, Beauchamp RD, Evers BM, Mattox KL.Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice.
21st ed. Elsevier; 2022
Powers RD, Guertler AT.Abdominal pain in the emergency department: stability and change over time.
Annals of Emergency Medicine. 1995;26(6):703–713.
Drossman DA, Hasler WL.Rome IV—Functional GI disorders: disorders of gut–brain interaction.Gastroenterology. 2016;150(6):1257–1261.doi:10.1053/j.gastro.2016.03.035
Clouse RE, Mayer EA. Functional abdominal pain syndrome.Gastroenterology. 2002;123(3):660–668.
Wolfe C, Halsey-Nichols M, Ritter K, McCoin N. Abdominal Pain in the Emergency Department: How to Select the Correct Imaging for Diagnosis. Open Access Emerg Med. 2022;14:335-345. Published 2022 Jul 20. doi:10.2147/OAEM.S342724
Gray DW, Dixon JM, Collin J. The closed eyes sign: an aid to diagnosing non-specific abdominal pain. BMJ. 1988;297(6652):837. doi:10.1136/bmj.297.6652.837.
De Dombal FT. Diagnosis of acute abdominal pain. Edinburgh: Churchill Livingstone; 1980. p. 74.
Jain A, Mehta N, Secko M, Schechter J, Papanagnou D, Pandya S, et al. History, Physical Examination, Laboratory Testing, and Emergency Department Ultrasonography for the Diagnosis of Acute Cholecystitis. Acad Emerg Med. 2017;24(3):281-297. doi:10.1111/acem.13132
Doshi M, Heaton KW. Irritable bowel syndrome in patients discharged from surgical wards with non-specific abdominal pain. Br J Surg. 1994;81(8):1216–1218. doi:10.1002/bjs.1800810848.
de Dombal FT, Matharu SS, Staniland JR, Wilson DH, MacAdam DA, Gunn AA, et al. Presentation of cancer to hospital as ‘acute abdominal pain’. Br J Surg. 1980;67(6):413–416. doi:10.1002/bjs.1800670610.
Laurell H, Hansson LE, Gunnarsson U. Acute abdominal pain among elderly patients.
Gerontology. 2006;52(6):339–344.
Paajanen P, Lehtimäki TT, Fagerström A, Paajanen H. Diagnostic potential of magnetic resonance imaging in chronic abdominal pain. Dig Surg. 2020;37(3):258–264. doi: 10.1159/000502797.
Kijima T, Hyakudomi R, Hashimoto T, Kusaka A, Nakatani T, Ishibashi Y. Adhesion-induced chronic abdominal pain: a case report on the diagnostic value of Carnett’s test. J Med Case Rep. 2019;13:93. doi:10.1186/s13256-019-2026-7.
Shian B, Larson ST. Abdominal Wall Pain: Clinical Evaluation, Differential Diagnosis, and Treatment. Am Fam Physician. 2018 Oct 1;98(7):429-436. PMID: 30252418.
Lukens TW, Emerman C, Effron D. The natural history and clinical findings in undifferentiated abdominal pain. Ann Emerg Med. 1993;22(4):690–696. doi:10.1016/S0196-0644(05)81849-9.
Jess P, Bjerregaard B, Brynitz S, Holst-Christensen J, Kalaja E, Lund-Kristensen J, et al. Prognosis of acute nonspecific abdominal pain: a prospective study. Am J Surg. 1982;144(3):338–340. doi:10.1016/0002-9610(82)90015-0.
Pennel DJ, Goergen N, Driver CP. Nonspecific abdominal pain is a safe diagnosis. J Pediatr Surg. 2014;49(11):1602–1604. doi:10.1016/j.jpedsurg.2014.06.014.
Referanslar
Hastings RS, Powers RD. Abdominal pain in the ED: a 35-year retrospective. Am J Emerg Med. 2011;29(7):711–716.
Cervellin G, Mora R, Ticinesi A, Meschi T, Comelli I, Catena F, et al. Epidemiology and outcomes of acute abdominal pain in a large urban Emergency Department: retrospective analysis of 5,340 cases. Ann Transl Med. 2016;4(19):362. doi:10.21037/atm.2016.09.10.
de Burlet K, Lam A, Larsen P, Dennett E. Changes in our assessment of acute abdominal pain over ten years. N Z Med J. 2017 Oct 6;130(1463):39–44.
Laurell H, Hansson LE, Gunnarsson U. Diagnostic pitfalls and accuracy of diagnosis in acute abdominal pain. Scand J Gastroenterol. 2006;41(10):1126–1131. doi:10.1080/00365520600587485.
Fagerström A, Paajanen P, Saarelainen H, Ahonen-Siirtola M, Ukkonen M, Miettinen P, et al. Non-specific abdominal pain remains as the most common reason for acute abdomen: 26-year retrospective audit in one emergency unit. Scand J Gastroenterol. 2017;52(10):1072–1077. doi:10.1080/00365521.2017.1342140.
Cartwright SL, Knudson MP.Evaluation of acute abdominal pain in adults.
American Family Physician. 2008;77(7):971–978.
Dang C, Aguilera P, Dang A, Salem L. Acute abdominal pain. Four classifications can guide assessment and management. Geriatrics. 2002;57(3):30-42.
Townsend CM, Beauchamp RD, Evers BM, Mattox KL.Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice.
21st ed. Elsevier; 2022
Powers RD, Guertler AT.Abdominal pain in the emergency department: stability and change over time.
Annals of Emergency Medicine. 1995;26(6):703–713.
Drossman DA, Hasler WL.Rome IV—Functional GI disorders: disorders of gut–brain interaction.Gastroenterology. 2016;150(6):1257–1261.doi:10.1053/j.gastro.2016.03.035
Clouse RE, Mayer EA. Functional abdominal pain syndrome.Gastroenterology. 2002;123(3):660–668.
Wolfe C, Halsey-Nichols M, Ritter K, McCoin N. Abdominal Pain in the Emergency Department: How to Select the Correct Imaging for Diagnosis. Open Access Emerg Med. 2022;14:335-345. Published 2022 Jul 20. doi:10.2147/OAEM.S342724
Gray DW, Dixon JM, Collin J. The closed eyes sign: an aid to diagnosing non-specific abdominal pain. BMJ. 1988;297(6652):837. doi:10.1136/bmj.297.6652.837.
De Dombal FT. Diagnosis of acute abdominal pain. Edinburgh: Churchill Livingstone; 1980. p. 74.
Jain A, Mehta N, Secko M, Schechter J, Papanagnou D, Pandya S, et al. History, Physical Examination, Laboratory Testing, and Emergency Department Ultrasonography for the Diagnosis of Acute Cholecystitis. Acad Emerg Med. 2017;24(3):281-297. doi:10.1111/acem.13132
Doshi M, Heaton KW. Irritable bowel syndrome in patients discharged from surgical wards with non-specific abdominal pain. Br J Surg. 1994;81(8):1216–1218. doi:10.1002/bjs.1800810848.
de Dombal FT, Matharu SS, Staniland JR, Wilson DH, MacAdam DA, Gunn AA, et al. Presentation of cancer to hospital as ‘acute abdominal pain’. Br J Surg. 1980;67(6):413–416. doi:10.1002/bjs.1800670610.
Laurell H, Hansson LE, Gunnarsson U. Acute abdominal pain among elderly patients.
Gerontology. 2006;52(6):339–344.
Paajanen P, Lehtimäki TT, Fagerström A, Paajanen H. Diagnostic potential of magnetic resonance imaging in chronic abdominal pain. Dig Surg. 2020;37(3):258–264. doi: 10.1159/000502797.
Kijima T, Hyakudomi R, Hashimoto T, Kusaka A, Nakatani T, Ishibashi Y. Adhesion-induced chronic abdominal pain: a case report on the diagnostic value of Carnett’s test. J Med Case Rep. 2019;13:93. doi:10.1186/s13256-019-2026-7.
Shian B, Larson ST. Abdominal Wall Pain: Clinical Evaluation, Differential Diagnosis, and Treatment. Am Fam Physician. 2018 Oct 1;98(7):429-436. PMID: 30252418.
Lukens TW, Emerman C, Effron D. The natural history and clinical findings in undifferentiated abdominal pain. Ann Emerg Med. 1993;22(4):690–696. doi:10.1016/S0196-0644(05)81849-9.
Jess P, Bjerregaard B, Brynitz S, Holst-Christensen J, Kalaja E, Lund-Kristensen J, et al. Prognosis of acute nonspecific abdominal pain: a prospective study. Am J Surg. 1982;144(3):338–340. doi:10.1016/0002-9610(82)90015-0.
Pennel DJ, Goergen N, Driver CP. Nonspecific abdominal pain is a safe diagnosis. J Pediatr Surg. 2014;49(11):1602–1604. doi:10.1016/j.jpedsurg.2014.06.014.
