Emergency Department, A. Gemelli University Hospital, Rome, Italy.
Intern Emerg Med. 2010 Oct;5(5):401-9. doi: 10.1007/s11739-010-0395-4. Epub 2010 May 18.
The epigastrium is the site where pain coming from both abdominal and extra-abdominal organs is frequently referred. Although acute or chronic diseases of the stomach, duodenum, liver, pancreas and biliary tree are the most common causes of acute epigastric pain, several other entities, potentially more severe, should also be suspected and investigated. Clinical bedside ultrasonography (US) is actually the first-line imaging in acute epigastric pain patients presenting to the hospital Emergency Department (ED) because it is rapid, noninvasive, relatively inexpensive and focused, repeatable and reliable. Moreover, the systematic use of emergency US as a complement to routine management might save economic resources by avoiding further costs for complications and substantially reducing the time for making an accurate diagnosis. The purpose of this paper is to review the US spectrum of the most common diseases responsible for acute epigastric pain onset. We also propose a focused, well codified US protocol, that we call the "$ approach", based on our clinical experience and the current literature for acute non-traumatic epigastric pain evaluation in an emergency setting. Its systematic application by the emergency physician may reduce the wait for diagnosis and the over-usage of second-line radiological techniques, including computed tomography, as well as to increase the diagnostic accuracy with potential benefits for patient (safety), physician (efficacy) and the institution (efficiency).
上腹部是疼痛经常牵涉的部位，这些疼痛既可以来自腹部器官，也可以来自腹部以外的器官。尽管胃、十二指肠、肝脏、胰腺和胆道系统的急性或慢性疾病是引起急性上腹痛的最常见原因，但也应怀疑和检查几种其他可能更严重的病症。临床床旁超声（US）实际上是因急性上腹痛而到医院急诊科（ED）就诊的患者的一线影像学检查方法，因为它快速、无创、相对廉价且具有针对性，可重复且可靠。此外，将急诊 US 作为常规管理的补充系统使用，可能通过避免并发症的进一步费用并大大缩短做出准确诊断的时间来节省经济资源。本文旨在回顾引起急性上腹痛发作的最常见疾病的 US 表现。我们还根据我们的临床经验和当前有关在急诊环境中评估急性非创伤性上腹痛的文献，提出了一种针对性强且规范的 US 方案，我们称之为“$ 方法”。急诊医师系统应用该方案可能会减少诊断等待时间和二线影像学技术（包括 CT）的过度使用，从而提高诊断准确性，为患者（安全）、医生（疗效）和医疗机构（效率）带来潜在益处。
