Orient et al used a decision rule to evaluate men with abdominal pain. The rule was slightly modified by one developed by Wasson et al. The authors are from the University of Arizona.
The decision rule was developed in ambulatory men from the VA System.
(1) pain duration
(2) epigastric pain
(4) pain features
(5) effect of pain on sleep
(6) abdominal and pelvic physical examination findings
(7) occult blood in stool
(9) weight loss
(10) past history
pain for at least 6 months, OR at least 10 previous occurrence of pain
pain for less than 6 months AND less than 10 previous episodes
epigastric pain and tenderness
absent or other findings present
>= 60 years of age
< 60 years of age
pain is constant OR pain is unrelieved by food or medication
pain inconstant AND relieved by food or medication
pain has affected sleep
abdominal and pelvic exam findings
mass, rigidity, rebound, distention, absent bowel sounds or an abnormal liver
stool testing for occult blood
vomiting since pain began
change in weight
unintentional weight loss >= 10 pounds
weight gain or no change or unintentional weight loss < 10 pounds or intentional loss
cancer, diverticular disease, pancreatitis, gallstones, or inflammatory bowel disease
• Removal of the gallbladder would seem to reduce the significance of a history of gallbladder disease.
• The time interval for weight loss is unspecified.
total score =
= SUM(points for all parameters) - 5
• A score < 0 indicates a low likelihood of serious disease.
• Patients with peptic ulcer disease may be classified as low risk.
• Diseases outside of the abdomen and pelvis may present with abdominal pain. The score may indicate a low risk for serious abdominal disease yet the patient have a serious disease elsewhere.
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Purpose: To determine if an ambulatory male patient with abdominal pain has potentially serious disease using the decision rule of Orient et al.
Specialty: Gastroenterology, Surgery, general
Objective: clinical diagnosis, including family history for genetics, criteria for diagnosis