Aanvullende diagnostiek bij volwassenen met acute buikpijn

In order to provide an accurate diagnosis and management strategy for adult patients with acute abdominal pain and peritoneal irritation, it is important to understand the value of various forms of diagnostics modalities. History, physical examination and laboratory results can generally differentiate between an acutely serious and a less serious abdominal problem. Patients with acute abdominal pain and no increase in either the leukocyte count or the concentration of C-reactive protein should be re-evaluated after 12 hours. If laboratory values are increased, then diagnostic imaging is necessary. For patients with diffuse abdominal pain and for patients with signs of shock or respiratory insufficiency, a CT-scan is the imaging method of choice. If symptoms are located in the left upper quadrant, an upright chest radiograph or a plain abdominal film are recommended. If symptoms are located in the right upper quadrant, ultrasonography will be preferred. If the diagnosis is still uncertain, a CT-scan will be performed. A CT-scan is indicated for lower abdominal pain in women with increased inflammatory parameters and in men aged 50 years or older with increased inflammatory parameters. If the cause of the abdominal pain is still unclear following a CT-scan, then diagnostic laparoscopy may be considered for fertile women of childbearing age and for men aged less than 50 years with signs of appendicitis