Abrupt onset of abdominal pain
What was causing this patient’s epigastric abdominal pain, which began several days after he’d been hospitalized for acute pericarditis?
The differential diagnosis of epigastric abdominal pain includes: pancreatitis, gastritis, gastric/duodenal ulcer, and obstruction. Elevated serum lipase levels or CT findings of pancreatic inflammation assist in the diagnosis of pancreatitis. Upper endoscopy is key to identifying cases of gastritis and ulcers in the GI tract. And an abdominal radiograph that shows dilated loops of bowel will confirm suspicions of obstruction.
Stabilize the patientAcute management of GI perforation begins with stabilizing the patient and determining the need for surgical intervention or medical management. Should a patient have a persistent air leak, surgery is the mainstay of treatment.3 If the perforation has healed, the patient should be medically managed.
Therapy may require placing a nasogastric tube and holding any oral intake until abdominal pain and perforation resolves. Medications in the acute treatment should include proton pump inhibitors (PPIs) and antibiotics. Antibiotics should cover for gram-negative enteric bacteria and anaerobes.
How to prevent NSAID-induced injury.
PPIs used with nonselective NSAIDs appear to reduce the likelihood of gastric ulceration.4 Similarly, H2-receptor antagonists (H2RA) also inhibit gastric acid secretion, and high doses of them significantly reduce the incidence of gastric ulcers.4 However, standard doses of HRAs have not been shown to be effective in reducing the risk of NSAID-induced gastric ulcers.4 Misoprostol, a synthetic prostaglandin E1 analogue that inhibits gastric secretion and protects the gastric mucosa is also an option; it has been used in combination with nonselective NSAIDs to counteract the increase in GI permeability.4
