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Diagnostic imaging plays a key role
in the management of patients with acute abdominal pain. A precise
diagnosis based on clinical findings alone is usually not possible,
and diagnostic imaging should therefore be used liberally, especially
if surgical treatment might be necessary. In elderly or debilitated
patients, the clinical presentations of serious abdominal conditions
can be muted, so a low threshold for ordering radiography and especially
CT should be maintained (Esses et al. 2004). However, when a patient
is unstable or an imaging study would delay emergency surgery, diagnostic
imaging should be omitted.
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In the past, abdominal radiography was the primary imaging modality
even though its diagnostic accuracy for most disorders is limited.
With the introduction of CT and ultrasonography, the scope of imaging
diagnosis has expanded greatly. Other imaging modalities include
nuclear scintigraphy, enteric contrast studies, and angiography.
The choice of imaging study is based on the diagnoses suspected
(Table 1).
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CT has the greatest diagnostic
capabilities and is the test of choice in most patients presenting
with significant abdominal pain. CT has high sensitivity for many
abdominal disorders and can often detect alternative diagnoses when
the primary disorder is not present.
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Radiography is indicated in patients
with suspected peptic ulcer perforation and small or large bowel
obstruction. Because emergency clinicians are often called upon
to interpret radiographs, conventional radiography is the focus
of the cases in this section. In addition, knowledge about the radiographic manifestations
of these disorders is important in understanding the radiologist’s
report.
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Three radiographic views should be obtained in an abdominal series:
supine and upright abdominal views and ...