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Sensation of discomfort, distress, or agony in the abdominal region.

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Major Trauma: Assessment and Initial Management

This guideline provides guidance on the assessment and management of major trauma, including resuscitation following major blood loss associated with trauma. For the purposes of this guideline, major trauma is defined as an injury or a combination of injuries that are life-threatening and could be life changing because it may result in long-term disability. This guideline covers both the pre-hospital and immediate hospital care of major trauma patients but does not include any management after definitive lifesaving intervention. It has been developed for health practitioners and professionals, patients and carers and commissioners of health services.

NICE Guideline - National Clinical Guideline Centre (UK).

Version: February 2016
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The use of analgesia for acute abdominal pain (AAP) does not mask clinical findings, nor does it delay diagnosis.

The use of analgesia for AAP does not mask clinical findings nor does it delay diagnosis.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Managing acute lower abdominal pain in women of childbearing age

Review question: Cochrane authors reviewed available evidence on the use of laparoscopy to manage acute lower abdominal pain, non‐specific lower abdominal pain or suspected appendicitis in women of childbearing age. We found 12 studies.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Antidepressants for the treatment of children and adolescents with functional abdominal pain

Abdominal pain‐related functional gastrointestinal disorders (FGIDs) are common in childhood and adolescence. In most cases no medical reason for the pain can be found. Various drug treatment approaches for the different types of abdominal pain‐related FGIDs exist. These drug treatments include: prokinetics and antisecretory agents for functional dyspepsia; pizotifen, propranolol, cyproheptadine or sumatriptane for abdominal migraine; and antispasmodic and antidiarrhoeal regimen for irritable bowel syndrome. Antidepressants have been shown to be effective in some studies of adults with functional gastrointestinal disorders. As a result young patients with similar complaints are sometimes treated with antidepressants. The purpose of this review was to examine the evidence assessing the advantages and disadvantages of such an approach. Only two studies met the inclusion criteria. Both of these studies were randomised controlled trials and assessed the effectiveness and safety of amitriptyline in children with FGIDs. Amitriptyline is a first generation antidepressant (tricyclic antidepressant). Amitriptyline is no longer an agent of first choice for the treatment of depressive disorders because of potentially serious side effects including overdose. Amitriptyline has not been approved for the treatment of functional abdominal pain in children or adolescents.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Psychosocial therapy for recurrent abdominal pain in childhood

Between 4% and 25% of school‐aged children complain of recurrent abdominal pain severe enough to interfere with their daily activities. No organic cause for this pain can be found on physical examination or investigation for the majority of such children. Although many children are managed by reassurance and simple measures, a large range of psychological and behavioural ('psychosocial') therapies have been recommended.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2017

Drug treatment of recurrent abdominal pain in children

Recurrent abdominal pain in childhood is a term used to describe unexplained episodes of tummy pain for which no cause can be found. The pain is often accompanied by other symptoms, such as diarrhoea or facial pallor. Some researchers have therefore classified different syndromes of unexplained pain according to these other associated symptoms. Recurrent abdominal pain is common in children. It is likely that the underlying cause or trigger differs among children.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2017

Opioids for abdominal pain in acute pancreatitis

The pancreas is a gland behind the stomach and close to the first part of the small intestine. It produces digestive juices, amylase, secreted into the small intestine and releases hormones, insulin and glucagon, into the bloodstream. Acute pancreatitis refers to a sudden inflammation of the pancreas. It happens when digestive juices become active inside the pancreas, causing swelling, bleeding and damage to the pancreas and its blood vessels. It is a serious condition and can lead to further problems. Common symptoms are severe pain in the upper abdomen, nausea, and vomiting. Treatment is usually a few days in hospital for fluids, antibiotics, and medicines to relieve pain, delivered by drip.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Pregabalin for decreasing abdominal pain in people with chronic pancreatitis

The pancreas is an abdominal organ that secretes several digestive enzymes into the pancreatic ductal system, which empties into the small bowel. It also comprises the Islets of Langerhans, which secrete several hormones, including insulin. Chronic pancreatitis is long‐standing and progressive inflammation of the pancreas resulting in destruction and replacement of pancreatic tissue with fibrous tissue. This may lead to a shortage of digestive enzymes and insulin (helps regulate blood sugar), leading to diabetes (a lifelong condition in which a person's blood sugar level becomes too high). Alcohol is considered the main cause but others include: smoking, some drugs, and a variety of other disorders. Chronic abdominal pain is the major symptom of chronic pancreatitis. The pain is usually in the upper abdomen and is usually described as deep, penetrating, and radiating to the back. Various theories exist about the reason for pain in chronic pancreatitis. One theory is that the disease process affects the nerves supplying the pancreas. Pregabalin inhibits the transmission of pain through the nerves. Pregabalin may decrease pain in people with chronic pancreatitis, but may also produce a number of side‐effects. Some common side‐effects include: excessive sleepiness, blurred vision, double vision, dry mouth, constipation, vomiting, excessive wind, feeling excited, confusion, reduced sexual desire, irritability, feeling dizzy, feeling unsteady, tremors, speech difficulty, tingling or pricking ('pins and needles') sensation, and disturbances of attention and memory. Less frequent, but serious adverse events include: fainting episodes, heart failure, and reversible kidney failure. This review included all studies 22 June 2015, on the benefits and harms of using pregabalin to treat chronic pain in people with chronic pancreatitis.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Dietary interventions for recurrent abdominal pain in children

We reviewed the evidence on the effects of dietary interventions on pain in children aged between five and 18 years with recurrent abdominal pain (RAP).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2017

Systematic reviews of clinical decision tools for acute abdominal pain

Making accurate decisions for patients with acute abdominal pain (AAP) is difficult. To avoid missing seriously ill patients, many undergo unnecessary surgery, with negative laparotomy rates of 25%. However, delays can lead to 20% perforation rates. Many conditions cause AAP and no single clinical finding or test is both specific and sensitive. Many decision tools (DTs) combining two or more findings have been developed to aid AAP management, but no consensus exists on their appropriateness for clinical use.

NIHR Health Technology Assessment programme: Executive Summaries - NIHR Journals Library.

Version: 2006

Ocena skutecznosci probiotykow w leczeniu czynnosciowych bolow brzucha u dzieci i doroslych: systematyczny przeglad pismiennictwa [Probiotic therapy for functional abdominal pain: a systematic review of randomised controlled trials]

Bibliographic details: Gawronska A, Szabunko M, Szajewska H.  Ocena skutecznosci probiotykow w leczeniu czynnosciowych bolow brzucha u dzieci i doroslych: systematyczny przeglad pismiennictwa [Probiotic therapy for functional abdominal pain: a systematic review of randomised controlled trials]. Pediatria Wspolczesna 2005; 7(4): 303-309

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2005

Routine abdominal drainage versus no drainage for patients undergoing uncomplicated laparoscopic cholecystectomy

The liver produces bile which has many functions, including elimination of waste processed by the liver and digestion of fat. The bile is temporarily stored in the gallbladder (an organ situated underneath the liver) before it reaches the small bowel. Concretions in the gallbladder are called gallstones. Gallstones are present in about 5% to 25% of the adult western population. Between 2% and 4% become symptomatic in a year. The symptoms include pain related to the gallbladder (biliary colic), inflammation of the gallbladder (cholecystitis), obstruction to the flow of bile from the liver and gallbladder into the small bowel resulting in jaundice (yellowish discolourisation of the body usually most prominently noticed in the white of the eye, which turns yellow), bile infection (cholangitis), and inflammation of the pancreas, an organ which secretes digestive juices and harbours the insulin secreting cells which maintain blood sugar level (pancreatitis). Removal of the gallbladder (cholecystectomy) is currently considered the best treatment option for patients with symptomatic gallstones. This is generally performed by key‐hole surgery (laparoscopic cholecystectomy). Drain is a tube that is left inside the tummy to allow drainage of fluids to outside the tummy. Some surgeons have routinely drained after laparoscopic cholecystectomy because of the fear of collection of bile or blood requiring re‐operation. As the name indicates, the drain may drain out these collections to the exterior, thereby avoiding open surgery. However, routine use of drains may necessitate the patient to stay overnight or require drain removal after discharge both of which increase resource utilisation in this era of day surgery (where patients are admitted and discharged on the same day of surgery). The review authors set out to determine whether it is preferable to use routine drainage after laparoscopic cholecystectomy. A systematic search of medical literature was performed in order to identify studies which provided information on the above question. The authors obtained information from randomised trials only since such types of trials provide the best information if conducted well. Two authors independently identified the trials and collected the information.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Celiac plexus block (CPB) in patients with unresectable pancreatic cancer‐related pain

Abdominal pain is a major symptom in patients with inoperable pancreatic cancer and is often difficult to treat. Celiac plexus block (CPB) is a safe and effective method for reducing this pain. It involves the chemical destruction of the nerve fibres that convey pain from the abdomen to the brain. We searched for studies comparing CPB with standard analgesic therapy in patients with inoperable pancreatic cancer. We were interested in the primary outcome of pain, measured on a visual analogue scale (VAS). We also looked at the amount of opioid (morphine‐like drugs) patients took (opioid consumption) and adverse effects of the treatment. Six studies (358 participants) comparing CPB with standard therapy (painkillers) met our inclusion criteria. At four weeks pain scores were significantly lower in the CPB group. Opioid consumption was also significantly lower than in the control group. The main adverse effects were diarrhoea or constipation (this symptom was significantly more likely in the control group, where opioid consumption was higher). Endoscopic ultrasonography (EUS)‐guided CPB is becoming popular as a minimally invasive technique that has fewer risks, but we were not able to find any RCTs assessing this method (current medical literature on this subject is limited to studies without control groups). Although the data on EUS‐guided CPB and pain control are promising, we await rigorously designed RCTs that may validate these findings. We conclude that, although statistical evidence is minimal for the superiority of pain relief over analgesic therapy, the fact that CPB causes fewer adverse effects than opioids is important for patients.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2017

Psychological therapies for the management of chronic and recurrent pain in children and adolescents

Psychological therapies (e.g. relaxation, hypnosis, coping skills training, biofeedback, and cognitive behavioural therapy) may help people manage pain and its disabling consequences. Therapies can be delivered face‐to‐face by a therapist, via the Internet, by telephone call, or by computer programme. This review focuses on treatments that are delivered face‐to‐face by a therapist. For children and adolescents there is evidence that both relaxation and cognitive behavioural therapy (treatment that helps people test and revise their thoughts and actions) are effective in reducing the intensity of pain in chronic headache, recurrent abdominal pain, fibromyalgia, and sickle cell disease immediately after treatment.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Systematic review of randomized controlled trials: fiber supplements for abdominal pain-related functional gastrointestinal disorders in childhood

BACKGROUND: A lack of safe and reliable treatments for abdominal pain-related functional gastrointestinal disorders (FGIDs) has prompted interest in new therapies.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Gut-directed hypnotherapy for functional abdominal pain or irritable bowel syndrome in children: a systematic review

OBJECTIVES: Gut directed hypnotherapy (HT) is shown to be effective in adult functional abdominal pain (FAP) and irritable bowel syndrome (IBS) patients. We performed a systematic review to assess efficacy of HT in paediatric FAP/IBS patients.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Systematic review of treatments for recurrent abdominal pain

OBJECTIVE: To conduct a systematic review of evaluated treatments for recurrent abdominal pain (RAP) in children.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2003

Meta-analysis: Lactobacillus rhamnosus GG for abdominal pain-related functional gastrointestinal disorders in childhood

BACKGROUND: A lack of reliable treatments for abdominal pain-related functional gastrointestinal disorders prompts interest in new therapies.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2011

Opioid analgesia for acute abdominal pain in children: a systematic review and meta-analysis

OBJECTIVES: There are long-held concerns that analgesia in patients with acute abdominal pain may obscure the physical examination and lead to missing a diagnosis of appendicitis. Despite evidence to the contrary, analgesia continues to be underutilized and suboptimally dosed in children with acute abdominal pain. The objective of this systematic review and meta-analysis was to determine if opioids provide analgesia without an increase in side effects and appendicitis-related complications.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Systematic reviews of clinical decision tools for acute abdominal pain

OBJECTIVES: To review for acute abdominal pain (AAP), the diagnostic accuracies of combining decision tools (DTs) and doctors aided by DTs compared with those of unaided doctors. Also to evaluate the impact of providing doctors with an AAP DT on patient outcomes, clinical decisions and actions, what factors are likely to determine the usage rates and usability of a DT and the associated costs and likely cost-effectiveness of these DTs in routine use in the UK.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2006

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