Pemmerl Sylvia, Hüfner Andreas
Dtsch Med Wochenschr. 2020 Oct;145(21):1535-1543. doi: 10.1055/a-1007-4174. Epub 2020 Oct 20.
Abdominal pain is one of the most common complaints that lead to an emergency department visit. Depending on the interpretation of the definition, 20-40 % of these patients present with an acute abdomen. This term summarizes a variety of diseases that often occur in the abdominal cavity, mostly acute, and can be accompanied by symptoms such as nausea and vomiting. The challenge for the physician is to differentiate a whole range of vital diseases from less urgent causes of complaints. Extra-abdominal differential diagnoses should also be considered. Initial diagnosis often requires a great deal of clinical experience.The targeted medical history and clinical assessment together with the selection of the appropriate technical investigation play a central role. The goal must be to move from symptom-based to causal therapy as quickly as possible and to clarify whether a patient needs to be referred to an emergency operation or whether there is time for further differential diagnostic measures. The prognosis of the acute abdomen often depends on the time latency until the definitive therapy is initiated. Rapid and determined action by the experienced initial examiner are important prerequisites for a favorable course of the disease process.
腹痛是导致患者前往急诊科就诊的最常见主诉之一。根据对定义的解读,这些患者中有20% - 40%表现为急腹症。该术语概括了多种常发生于腹腔的疾病,大多为急性,且可能伴有恶心、呕吐等症状。对医生而言,挑战在于区分一系列危及生命的疾病与不太紧急的主诉病因。还应考虑腹外疾病的鉴别诊断。初步诊断通常需要大量临床经验。有针对性的病史采集、临床评估以及选择合适的技术检查起着核心作用。目标必须是尽快从基于症状的治疗转向病因治疗,并明确患者是否需要紧急手术,或者是否有时间采取进一步的鉴别诊断措施。急腹症的预后通常取决于开始确定性治疗前的时间延迟。经验丰富的初诊医生迅速而果断的行动是疾病进程良好发展的重要前提。