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| The Subtleties of the Acute Abdomen: Information for Physician Assistants and Nurse Practitioners |
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by Bob Blumm, MA, PA-C, DFAAPA - August 12, 2010
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The Washington DC first summer annual conference is going to be held in the next ten days in our nation’s capital. What a wonderful opportunity in which PAs and NPs, as well as other clinicians, can have the opportunity to have excellent continued education; a plethora of workshops that would make any clinician turn their head . Simultaneously there will be all of the attractions that have always made the capital a great family opportunity to learn yet close enough to water parks and family parks galore. This CME opportunity can be a grand slam home run for your family. Go to AFPPA.com and look at the exciting four-colored brochure. But now for my dilemma. I’m giving lectures and two workshops, and I’ll be luxuriating with a cold Pepsi in the 68 degree conference rooms. I’ll have plenty of time to network and meet new friends and to share on subjects that are burning in my heart, but the contemplation really starts now. Can I decide to make a six week series for AdvancedPracticeJobs.com on the Acute Abdomen, or should I call my favorite editor and have this in a peer reviewed journal? I’ll write an introduction and then make my decision tomorrow, and, in the meantime, I will make some important introductory thoughts.
Much has been written on the acute abdomen, and many have spoken on this subject; however, my goal is to maintain depth in the lecture that I give at AFPPA in Washington and to simultaneously add clarity, simplicity and some statistics that are extremely relevant.
My fist comment would be to seek out the most important book on this subject, one which was initially written over 100 years ago, “Copes treatise on the Early Diagnosis of the Acute Abdomen,” reviewed by William Silen. The second tool that would demonstrate enhanced knowledge may be apprehended from the Internet and is called “Bristol’s Stool Form Scale.” I have found both of these references to be great resources and to serve as a nice foundation for a lengthy subject.
This subject has been a source of study by Medical physicians and Surgical physicians, as well as their counterparts in pathology, radiology, laboratory science and physician assistants and nurse practitioners. I might add that this is an important subject for corpsman and medics who must diagnose and sometimes operate on these patients in standards that would be a nightmare for the average doctor.
Where do we hope to travel on this study of the acute abdomen? We realize that, in most cases, this is a surgical disease; therefore, there will be a surgical slant to my approach whereas I will definitely not fail to consider the student of medicine. The outline for this lecture contains: definition of the acute abdomen, we will review the Pathophysiology of pain, followed by the usual signs and symptoms of the acute abdomen. The workup will be described starting with basic labs to more invasive modalities and modern enhancements in aids to diagnose. Finally, common diseases, both surgical and non-surgical, will be discussed including H&Ps, Lab findings, as well as radiological exams.
I will close this article with the definition. An acute abdomen is defined as severe abdominal pain that has a sudden onset of only a few hours. Because of the nature of the pain and the diseases that may have caused it, a management decision must be made without delay. A definitive diagnosis is less important making a correct or right decision. What is the big question; does that patient need an operation? In cases such as mesenteric ischemia, failure to make the correct decision has a mortality rate of 100%. I look forward to seeing you at the conference in Washington!
Robert M. Blumm has received national recognition as a distinguished fellow of the American Academy of Physician Assistants (AAPA). He is the past president of the Association of Plastic Surgery Physician Assistants, and was past-president of the American Association of Surgical Physician Assistants, past president of the American College of Clinicians and NYSSPA, as well as Chairman of the Surgical Congress of the AAPA. In addition, Bob received the John Kirklin MD Award for Professional Excellence from the American Association of Surgical Physician Assistants. Along with his associate, Dr. Acker, Bob was the first recipient of the AAPA PAragon Physician-PA Partnership Award. He has been a contributing author of three textbooks, written 150 plus articles and is a sought out conference speaker throughout the United States.
The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.
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