Obligatory medical device diagnostics.
- Abdominal ultrasonography (ultrasound examination of abdominal organs) – as a standard diagnostic tool for abdominal pain [including free fluid, free air (suspicion of cavity perforation; here, CT as an alternative if necessary), bowel wall changes (e.g., ileitis/chronic inflammatory bowel disease, diverticulitis/inflammation of protrusions of the bowel), changes in the gallbladder, bile ducts, or appendix; indications for:
- Adnexitis (ovarian inflammation), acute appendicitis (appendicitis), acute pancreatitis (pancreatitis), extrauterine pregnancy (pregnancy outside the uterus), biliary colic, ureteral colic, nephrolithiasis (kidney stones)/hydronephrosis (abnormal enlargement of the renal pelvis), ruptured abdominal aortic aneurysm, pedunculated ovarian cyst (ovarian cyst), organ rupture/laceration (rupture)]
- Electrocardiogram (ECG; recording of the electrical activity of the heart muscle) – to rule out myocardial infarction (heart attack).
Optional medical device diagnostics – depending on the results of the history, physical examination and obligatory laboratory parameters – for differential diagnostic clarification.
- Radiography of the abdomen (radiographic abdomen; abdominal overview) – if hollow organ perforation or ileus (intestinal obstruction) is suspected.
- Abdominal plain radiograph in the standing position: Evidence of hollow organ perforation due to free air under the diaphragm (diaphragm).
- Abdominal voiding radiograph in supine position (overview radiograph in supine and left lateral position): suitable for detection of ileus [cavity perforation: free air; mechanical ileus: “mirror formation”].
- Detection of approximately 90% of renal or ureteral stones.
Note: High radiation exposure (radiation dose up to 30 times that of a chest x-ray) combined with limited diagnostic value. In a study of 874 patients, abnormalities were found in only 19% of abdominal plain radiographs.
- Computed tomography (CT) of the abdomen (abdominal CT) – for suspected tumors, inflammation (appendicitis / inflammation of the appendix, diverticulitis / disease of the colon, in which inflammation is formed in protrusions of the mucosa), etc. in the abdomen.
- Computed tomography (CT) of the abdomen (abdominal CT) or CT angiography – showing the blood vessels:
- Biphasic contrast CT with multiplane reconstruction (MPR) in three planes [first-line diagnostic] – in cases of suspected acute occlusive mesenteric ischemia (intestinal infarction).
- (Perform an arterial and venous phase; the latter is necessary to diagnose mesenteric vein thrombosis).
- Catheter angiography (digital subtraction angiography (DSA) with i.a. infusion of vasodilators) – if non-occlusive mesenteric ischemia is suspected.
- Magnetic resonance imaging (MRI) of the abdomen (abdominal MRI) – indications:
- Esp. in patients in whom radiation exposure should be avoided (children, pregnant women): e.g., in the case of unclear ultrasound findings.
- In V. a. Appendicitis (appendicitis); Choledocholithiasis (presence of stones in the bile ducts); Ovarialtorsion (ovarian stem rotation) in pregnant women on suspicion of discopathies (disc lesions) or nucleus pulposus prolapse (herniated disc); chronic abdominal pain, eg, in the context of chronic inflammatory bowel disease (IBD).
- X-ray contrast enema (KE) with gastrografin with abdominal overview images after 12 and 24 h; indications:
- If small bowel ileus (small bowel obstruction) is suspected [if contrast is in the colon (large bowel) and peritonitis (inflammation of the peritoneum) is clinically ruled out, it can be waited without risk to the patient]
- In colonic ileus for surgical planning or alternatively CT scan combined with rectal contrast administration.
- X-ray of the pelvis – if urolithiasis (urinary stones) is suspected.
- X-ray of the thorax (X-ray thorax/chest), in two planes – if pneumonia (pneumonia) is suspected.
- X-rays of the spine, ribs – if bony cause is suspected.
- Pulmonary function examination – if pulmonary disease is suspected in obstructive or restrictive lung disease.
- Gastroscopy (gastroscopy) – for suspected diseases of the esophagus, stomach.
- Endosonography (endoscopic ultrasound (EUS); ultrasound examination performed from the inside, i.e., the ultrasound probe is brought into direct contact with the internal surface (for example, the mucosa of the stomach/intestine) by means of an endoscope (optical instrument)). – When suspected diseases of the esophagus, stomach.
- Colonoscopy (colonoscopy) – in case of suspected bleeding / tumors in the area of the colon (large intestine).
- Endoscopic retrograde cholangiopancreatography (ERCP; imaging of the bile ducts) – if cholelithiasis (gallstones) is suspected.
- Echocardiography (echo; heart ultrasound) – if pericarditis (inflammation of the pericardium) is suspected.
- Urography or retrograde pyelography – if urinary stones are suspected.
- Angiography – imaging procedure for the visualization of arteries and veins using contrast medium.
- Fructose H2 breath test – for suspected fructose intolerance (fructose intolerance).
- Lactose H2 breath test – if lactose intolerance (lactose intolerance) is suspected.
- Computed tomography of the thorax/chest (thoracic CT) – for suspected pulmonary embolism, mediastinitis.
