Karın Ağrısının Karın Dışı Nedenleri
Özet
Karın ağrısı, acil servise başvuruların en sık nedenlerinden biri olmakla birlikte etiyolojisi yalnızca intraabdominal patolojilerle sınırlı değildir. Kardiyovasküler, pulmoner, vasküler, metabolik, endokrin, toksikolojik, enfeksiyöz, kas-iskelet sistemi ve genitoüriner kaynaklı çok sayıda karın dışı neden, nonspesifik bulgularla prezente olarak tanısal gecikmelere ve mortalitesi yüksek tabloların atlanmasına yol açabilmektedir. Bu derlemenin amacı, karın ağrısının karın dışı nedenlerini sistematik bir çerçevede sunarak acil serviste erken tanıyı destekleyen klinik ipuçlarını vurgulamaktır.
Abdominal pain is one of the most common reasons for emergency department admissions; however, its etiology is not limited to intra-abdominal pathologies. Numerous extra-abdominal causes originating from cardiovascular, pulmonary, vascular, metabolic, endocrine, toxicological, infectious, musculoskeletal, and genitourinary systems may present with nonspecific findings, leading to diagnostic delays and missed life-threatening conditions. The aim of this review is to present the extra-abdominal causes of abdominal pain within a systematic framework and to emphasize clinical clues that support early diagnosis in the emergency department.
Referanslar
Melzer AC, Pines JM, Richards LM, et al. US emergency department visits for adults with abdominal and pelvic pain (2007-2011): trends in demographics, resource utilization and opioid usage. American Journal of Emergency Medicine. 2017;35(9): 1286-1291. doi: 10.1016/j.ajem.2017.06.019.
Tintinalli JE. Abdominal pain. In: Tintinalli JE, Stapczynski JS, Ma OJ, Yealy DM, Meckler GD, Cline DM (eds.) Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. 9th ed. New York: McGraw-Hill; 2020.
Walls RM. Abdominal pain. In: Walls RM, Hockberger RS, Gausche-Hill M (eds.) Rosen’s Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia: Elsevier; 2022.
May P, Smith A, Rosenberg M, et al. Extra-abdominal causes of abdominal pain in the emergency department. Emergency Medicine Clinics of North America. 2022;40(3): 487-503. doi: 10.1016/S0733-8627(20)30518-6.
UpToDate. Causes of abdominal pain in adults. Available from: https://www.uptodate.com/contents/causes-of-abdominal-pain-in-adults [Accessed 04 May 2025].
Hatjipetrou A, Anyfantakis D, Kastanakis M. Rectus sheath hematoma: a review of the literature. International Journal of Surgery. 2015;13: 267-271. doi: 10.1016/j.ijsu.2014.12.015.
Kasotakis G. Retroperitoneal and rectus sheath hematomas. Surgical Clinics of North America. 2014;94: 71-76. doi: 10.1016/j.suc.2013.10.007.
Schneiderman H, Lopetegui-Lia N, Nichols J. The enduring and practical power of physical examination: Carnett sign. The American Journal of Medicine. 2020;133: 682-686. doi: 10.1016/j.amjmed.2019.09.027.
Yamaguchi H, Kobayashi H, Nagasaki K. Abdominal wall cellulitis presenting as acute abdomen. Internal Medicine. 2020;59: 595-598. doi: 10.2169/internalmedicine.3643-19.
Dworkin RH, Johnson RW, Breuer J, et al. Recommendations for the management of herpes zoster. Clinical Infectious Diseases. 2007;44(Suppl 1): S1-S26. doi: 10.1086/510206.
Kitabchi AE, Umpierrez GE, Miles JM, et al. Hyperglycemic crises in adult patients with diabetes. In: Feingold KR, Anawalt B, Boyce A (eds.) Endotext. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: http://www.endotext.org [Accessed 30 January 2013].
Zheng T, Camilleri M. Management of gastroparesis. Gastroenterol Hepatol (N Y). 2021 Nov;17(11):515–525. PMID: 35466306; PMCID: PMC9021159. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9021159/
Feldman RD, Gros R. Vascular effects of aldosterone: sorting out the receptors and ligands. Clinical and Experimental Pharmacology and Physiology. 2013;40: 916-921. doi: 10.1111/1440-1681.12157.
Sibai BM, Ramadan MK, Usta I, et al. Maternal morbidity and mortality in 442 pregnancies with hemolysis, elevated liver enzymes, and low platelets (HELLP syndrome). American Journal of Obstetrics and Gynecology. 1993;169: 1000-1006. doi: 10.1016/0002-9378(93)90043-i.
Platt OS, Thorington BD, Brambilla DJ, et al. Pain in sickle cell disease: rates and risk factors. New England Journal of Medicine. 1991;325: 11-16. doi: 10.1056/NEJM199107043250103.
Agency for Toxic Substances and Disease Registry. Toxicological profile for lead. Atlanta (GA): US Department of Health and Human Services; 2020. Available from: https://www.atsdr.cdc.gov/toxprofiles/tp13.pdf [Accessed 04 May 2025].
Bush SP. Black widow spider envenomation mimicking cholecystitis. American Journal of Emergency Medicine. 1999;17: 315-317. doi: 10.1016/s0735-6757(99)90137-7.
Valavi E, Amuri P, Ahmadzadeh A, et al. Acute kidney injury in children with Hemiscorpius lepturus scorpion sting: risk factors and clinical features. Saudi Journal of Kidney Diseases and Transplantation. 2016;27: 936-942. doi: 10.4103/1319-2442.190841.
Radmanesh M. Cutaneous manifestations of Hemiscorpius lepturus sting: a clinical study. International Journal of Dermatology. 1998;37: 500-507. doi: 10.1046/j.1365-4362.1998.00386.x.
American College of Emergency Physicians (ACEP). Clinical Policy: Critical Issues in the Management of Adult Patients Presenting to the Emergency Department With Acute Pain. Annals Emergency Medicine. 2019;74(4):e41–e74. doi:10.1016/j.annemergmed.2019.08.429
European Association of Urology (EAU). Guidelines on Urolithiasis. 2023.
Ranji SR, Goldman LE, Simel DL, Shojania KG. Analgesia for acute abdominal pain. Cochrane Database of Systematic Reviews. 2018; doi:10.1002/14651858.CD005660.pub4
Referanslar
Melzer AC, Pines JM, Richards LM, et al. US emergency department visits for adults with abdominal and pelvic pain (2007-2011): trends in demographics, resource utilization and opioid usage. American Journal of Emergency Medicine. 2017;35(9): 1286-1291. doi: 10.1016/j.ajem.2017.06.019.
Tintinalli JE. Abdominal pain. In: Tintinalli JE, Stapczynski JS, Ma OJ, Yealy DM, Meckler GD, Cline DM (eds.) Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. 9th ed. New York: McGraw-Hill; 2020.
Walls RM. Abdominal pain. In: Walls RM, Hockberger RS, Gausche-Hill M (eds.) Rosen’s Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia: Elsevier; 2022.
May P, Smith A, Rosenberg M, et al. Extra-abdominal causes of abdominal pain in the emergency department. Emergency Medicine Clinics of North America. 2022;40(3): 487-503. doi: 10.1016/S0733-8627(20)30518-6.
UpToDate. Causes of abdominal pain in adults. Available from: https://www.uptodate.com/contents/causes-of-abdominal-pain-in-adults [Accessed 04 May 2025].
Hatjipetrou A, Anyfantakis D, Kastanakis M. Rectus sheath hematoma: a review of the literature. International Journal of Surgery. 2015;13: 267-271. doi: 10.1016/j.ijsu.2014.12.015.
Kasotakis G. Retroperitoneal and rectus sheath hematomas. Surgical Clinics of North America. 2014;94: 71-76. doi: 10.1016/j.suc.2013.10.007.
Schneiderman H, Lopetegui-Lia N, Nichols J. The enduring and practical power of physical examination: Carnett sign. The American Journal of Medicine. 2020;133: 682-686. doi: 10.1016/j.amjmed.2019.09.027.
Yamaguchi H, Kobayashi H, Nagasaki K. Abdominal wall cellulitis presenting as acute abdomen. Internal Medicine. 2020;59: 595-598. doi: 10.2169/internalmedicine.3643-19.
Dworkin RH, Johnson RW, Breuer J, et al. Recommendations for the management of herpes zoster. Clinical Infectious Diseases. 2007;44(Suppl 1): S1-S26. doi: 10.1086/510206.
Kitabchi AE, Umpierrez GE, Miles JM, et al. Hyperglycemic crises in adult patients with diabetes. In: Feingold KR, Anawalt B, Boyce A (eds.) Endotext. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: http://www.endotext.org [Accessed 30 January 2013].
Zheng T, Camilleri M. Management of gastroparesis. Gastroenterol Hepatol (N Y). 2021 Nov;17(11):515–525. PMID: 35466306; PMCID: PMC9021159. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9021159/
Feldman RD, Gros R. Vascular effects of aldosterone: sorting out the receptors and ligands. Clinical and Experimental Pharmacology and Physiology. 2013;40: 916-921. doi: 10.1111/1440-1681.12157.
Sibai BM, Ramadan MK, Usta I, et al. Maternal morbidity and mortality in 442 pregnancies with hemolysis, elevated liver enzymes, and low platelets (HELLP syndrome). American Journal of Obstetrics and Gynecology. 1993;169: 1000-1006. doi: 10.1016/0002-9378(93)90043-i.
Platt OS, Thorington BD, Brambilla DJ, et al. Pain in sickle cell disease: rates and risk factors. New England Journal of Medicine. 1991;325: 11-16. doi: 10.1056/NEJM199107043250103.
Agency for Toxic Substances and Disease Registry. Toxicological profile for lead. Atlanta (GA): US Department of Health and Human Services; 2020. Available from: https://www.atsdr.cdc.gov/toxprofiles/tp13.pdf [Accessed 04 May 2025].
Bush SP. Black widow spider envenomation mimicking cholecystitis. American Journal of Emergency Medicine. 1999;17: 315-317. doi: 10.1016/s0735-6757(99)90137-7.
Valavi E, Amuri P, Ahmadzadeh A, et al. Acute kidney injury in children with Hemiscorpius lepturus scorpion sting: risk factors and clinical features. Saudi Journal of Kidney Diseases and Transplantation. 2016;27: 936-942. doi: 10.4103/1319-2442.190841.
Radmanesh M. Cutaneous manifestations of Hemiscorpius lepturus sting: a clinical study. International Journal of Dermatology. 1998;37: 500-507. doi: 10.1046/j.1365-4362.1998.00386.x.
American College of Emergency Physicians (ACEP). Clinical Policy: Critical Issues in the Management of Adult Patients Presenting to the Emergency Department With Acute Pain. Annals Emergency Medicine. 2019;74(4):e41–e74. doi:10.1016/j.annemergmed.2019.08.429
European Association of Urology (EAU). Guidelines on Urolithiasis. 2023.
Ranji SR, Goldman LE, Simel DL, Shojania KG. Analgesia for acute abdominal pain. Cochrane Database of Systematic Reviews. 2018; doi:10.1002/14651858.CD005660.pub4
