THE ACUTE ABDOMEN

THE ACUTE ABDOMEN

The medical issue in the death of JA centers on the diagnosis and treatment of an acute abdomen.

What Is An Acute Abdomen?

We are about to get to some pretty critical material. It’s accuracy is important to developing a conclusion regarding what transpired and whether JA was a non-victim, victim of simple medical negligence or the victim of something different.

If nothing else, I hope that you believe the information I am presenting to be accurate. That is why I am using outside, impartial sources to define and frame the topics and making those sources available, rather than just giving you my own narrative.

Additionally, the sources are from readily available data that even non-healthcare workers can access. I do this to suggest to you just how simple and obtainable the information is and to empower you to check me out.

Here are two definitions of “acute abdomen” from www.dictionary.com. Both are from medical dictionaries.

acute abdomen

A serious condition within the abdomen characterized by sudden onset, pain, tenderness, and muscular rigidity, and usually requiring emergency surgery. Also called surgical abdomen.

Source: The American Heritage® Stedman's Medical Dictionary

Main Entry: acute abdomen

Function: noun

: an acute internal abdominal condition requiring immediate operation

As you can see, the dictionaries are pretty clear and unified in their explanations. An acute abdomen is serious and requires immediate surgical intervention.

But, in all fairness, we need to determine the level of expertise needed to figure out how to deal with an acute abdomen. For example, if it were a very uncommon or esoteric entity, then arguably, missing it or failing to evaluate it might be justified. So…

How Basic Is The Diagnosis Of An Acute Abdomen?

Nurses are trained in the acute abdomen:

http://www.mcg.edu/son/cns/experience.htm

As are nurse practitioners:

http://pcap.stanford.edu/clinical/

Apparently, physician assistant students are taught about the acute abdomen:

http://www.ece.ncsu.edu/imaging/MedImg/SIMS/GE.html

“The Self-Instructional Medical Series has been developed to meet the educational needs of Physician Assistant students.”

http://www.ece.ncsu.edu/imaging/MedImg/SIMS/Module2/GE2_4.html

This is from the Self-Instructional Medical Series for Physician Assistant students website mentioned directly above:

“There are few situations in clinical medicine which demand prompt and decisive action as frequently as does acute abdominal pain…

An Approach to the Acute Abdomen

On completion of this minicourse you will be able to:

1. Define the acute abdomen.

2. Describe the cause and pathophysiology of the following acute abdominal diseases:

o a. acute appendicitis - inflammatory

o b. acute small bowel obstruction - mechanical

o c. mesenteric vascular occlusion vascular

o d. perforated duodenal ulcer perforated viscus

o e. peritonitis

3. Identify and describe the symptoms, signs, clinical course and laboratory and x-ray findings for the acute abdominal diseases listed under Objective 2.

4. Identify the clinical features that help to distinguish the surgical from the non-surgical acute abdomen.

5. Construct an approach to evaluation and management of the acute abdomen.”

It seems as if medical students are taught about the acute abdomen. The first is from the Baylor, the second from Dartmouth, the third Columbia, the fourth Cedars-Sinai Medical Center and the fifth is from the University of Pittsburgh.

http://www.debakeydepartmentofsurgery.org/home/content.cfm?menu_id=14

“However, there are some general core competencies and skills students should learn during their surgical clerkship. They are as follows.

Core Competencies

The following are basic surgical competencies that each student should obtain during their core surgical clerkship:

· Basic management of trauma patients

· Perioperative Care

· Critical Care

· Common Surgical Complications

· Critical Appraisal of the Surgical Literature

· Surgery as a career

· Recognition and Management of:

o Shock – ABC’s

o Acute Abdomen

o Bowel Obstruction – Pain: Abdomen x-rays”

http://www.dartmouth.edu/~mdfpr/PMMDFPR/Medstudclerkships.html

http://www.mainedartmouth.org/pdf_files/Clerkship_info.pdf

“f. The medical student should realize that thyroid disease, infections, cardiovascular disease and acute abdomen pulmonary embolism, malignancy, drug addiction illness, as well as many other medical diseases have an altered presentation in the elderly.”

http://cumc.columbia.edu/dept/obgyn/education/medical_students/learning_objectives.html

“· The student will be able to create a differential diagnosis of the "acute abdomen" in women of reproductive age, including pelvic infection, ectopic pregnancy, adnexal torsion, appendicitis, diverticulitis and renal calculi.”

http://www.csmc.edu/1499.html

“The Trauma and Emergency Surgery course objectives include the ability to resuscitate the injured patient using advanced trauma life support protocols, initiation of urgent assessment of the trauma patient utilizing sequential diagnostic studies, management of chest tubes, vascular cutdowns, endotracheal intubation, interpretation of X-rays, CT scans, and blood gas analyses, critical care record keeping and chart maintenance, operative management of blunt and penetrating thoraco-abdominal trauma and evaluation of the acute abdomen and other urgent and emergent general surgery conditions.”

http://www.radiology.upmc.edu/edu_medstudents.html

“The continued success of the education program is a direct reflection of the dedication and enthusiasm of the radiology faculty who willingly participate on an ongoing basis. Radiology faculty who taught medical students during FY 2005 were:

Dr. Raucheline Akindele	GI
Dr. Omar Almusa	Acute Abdomen in Non-Traumatic Patients”

This is from University Hospital at Stony Brook:

http://www.saem.org/inform/advprin.htm

“We selected those topics from the core curriculum which the student needed to know immediately in the management of emergency patients and do not have time to 'look them up' in some reference prior to treating the patient. We also selected topics that were unique to emergency medicine, and that by introducing the students to these topics, they would be better able to understand the emergency medicine core curriculum.

These topics include:

Headaches

Acute Abdomen/Abdominal Pain”

Here is a link to the medical student info at the Joan C. Edwards School of Medicine. I include this just in case you were thinking that only the “high-power” schools cover the acute abdomen as part of the medical student curriculum. (No offense to the Joan C. Edwards School of Medicine intended. It is just less well known than some others.)

http://musom.marshall.edu/documents/JCESOM_learning_objectives.pdf

This link is to an on-line test for University of Pennsylvania medical students and includes questions about the acute abdomen:

http://www.uphs.upenn.edu/surgery/dse/medicalstudents/pbl/103questions.html

Oh, and then there is this:

http://www.vet.ksu.edu/depts/itc/conted/archive/2002/manage.htm

“8:15 am

The Acute Abdomen: Presentation and Diagnosis

Initial diagnostic plan and stabilization of patients presenting with signs associated with intra-abdominal disease. Distinguishing between surgical and nonsurgical patients, ancillary tests, and methods of resuscitation. Specific topics include imaging, abdominocentesis, diagnostic peritoneal lavage, and management of electrolyte, acid base, and hemodynamic instability.”

It is from a veterinary seminar where, even vets, vet techs and vet students are taught about the acute abdomen. See.

“An invitation to Veterinary Medical Practitioners, Veterinary Medical Technicians, and Veterinary Medical Students to attend the...

10th Annual Emergency Medicine Conference on

Management of Acute Abdomen and Hemodynamic Monitoring of Critically Ill Patients

Saturday, February 9, 2002”

This links to the Merck Manual, a resource to physicians, physicians-in-training, nurses, veterinarians and the general public.

Introduction to Acute Abdomen and Surgical Gastroenterology

Acute Abdominal Pain

Acute Mesenteric Ischemia

The bottom line here is that we are talking about some very basic stuff when we speak of the diagnosis and management of an acute abdomen. Even medical students are expected to know it before they can qualify to graduate.

So it is reasonable to expect a full-fledged physician to be aware of the condition.

Does Delay In Diagnosis Matter?

Apparently.

http://www.emedmag.com/html/pre/gic/consults/121502.asp

http://www.emedmag.com/html/pre/gic/consults/081505.asp

But, Find Out For Yourself

Here is a simple little test anyone can perform to evaluate my contentions that not only is an acute abdomen well-known and an emergency, but that any doctor would acknowledge that to be true.

If you are going to get involved in Who Killed JA? and you are not yet convinced, speak with a physician and ask him or her the following questions:

1.    Have you ever heard of an acute abdomen?

2.    Is it bad? Is it an emergency?

3.    Suppose I was in the hospital and you received a call from a licensed, board-certified practicing physician who said that he or she was in my room and had diagnosed me with an acute abdomen. What would you do? Would you:

a.    Ignore it or

b.    Come see me?

4.    Can you think of any reason why a physician would, on purpose, ignore, fail to see or fail to examine a patient he or she was informed had an acute abdomen?

5.    In your opinion is it a scholastic or intellectual possibility for a licensed physician to not know that an acute abdomen requires immediate attention?

I believe that herein lies a crux of the matter. I opine the reason these defendants are so aggressively attempting to get this case tossed out of court on technicalities is because they will be unable to find experts who will testify in public, before a jury and on the record, that the behavior of the defendants was within the standard of care.

Further, since this is such a fundamental matter, no expert will likely be able to explain the behavior of these defendants as a matter of simple negligence. Arguably, something else had to be going on. That is why counts other than simple negligence are in the Complaint.

If you are willing to help, please click here.