An observational study to determine diagnostic accuracy of point of care ultrasound in cases of acute abdominal pain presenting in emergency department.

Acute abdominal pain is one of the common causes of emergency department visits and there has been increased use of bedside ultrasound imaging for initial assessment and preliminary diagnosis. Point of care Ultrasonography is a low cost, noninvasive, portable and safe means of energy used to create images with significantly low risk to the patients. It is a bedside imaging used by emergency physicians by performing a target ultrasound of various abdominal organs, correlating the signs and symptoms and helps in providing timely comprehensive management. It is used an adjunct to signs, symptoms and physical examination to make a quick diagnosis, prioritise the investigations and to determine the course of patients.

Acute abdominal pain causes can range from gastrointestinal and genitourinary issues to vascular and infectious conditions and acute coronary syndrome can also present with epigastric pain and therefore often causing a diagnostic dilemma.  The common gastrointestinal causes being acute appendicitis, peptic ulcer disease, acute pancreatitis, cholecystitis, diverticulitis, bowel obstruction, ischemic bowel, aortic aneurysm, lacerated injuries of solid organs like spleen and liver, peritonitis intra peritoneal free fluid and different primary bowel and secondary bowel malignancies. Obstetric and gynecologic causes include ovarian torsion, ruptured ectopic pregnancy and pelvis inflammatory disease. Urologic conditions presenting as acute abdominal pain are ureteral colic and pyelonephritis.

Acute abdominal pain requires immediate attention as there is a wide range of causes ranging from self-limiting conditions to several life-threatening conditions like ruptured bowel, aortic aneurysm rupture, mesenteric ischemia, therefore, point of care ultrasound can be used as one of the initial diagnostic procedures as it can significantly contribute to faster diagnosis for the patient [11]. Point of care ultrasound is a dynamic examination which can demonstrate bowel motility and blood flow like inability to compress the bowel indicates pathologies including appendicitis, intussusception and malignancy. It can help to identify key findings like signs of inflammation in acute pancreatitis and acute cholecystitis, free air, ruptured bowel and ruptured ectopic pregnancies.  It can detect free fluid of even 10 ml which could be due to different causes like ascites, biliary leak or trauma. It can also precisely give a clearer image for presence of free intra-peritoneal fluid.

In this study we will determine the role and diagnostic accuracy of point of care ultrasound in determining various causes of acute onset abdominal pain presenting to emergency department.