POCUS for acute abdominal pain: practical scan protocols on gastrointestinal diseases and an evidence review

Acute abdominal pain is a frequent emergency department presentation requiring prompt and accurate diagnosis to guide timely management. Ultrasound imaging plays a critical role in the differential diagnosis of this symptom, offering several advantages including wide availability, cost-effectiveness, and real-time assessment without ionizing radiation. Color and spectral Doppler further enhance diagnostic accuracy by allowing the assessment of blood flow and vascular patterns, which is crucial for identifying ischemic processes. Additionally, ultrasound can help distinguish between gynecological and non-gynecological conditions, such as appendicitis, urinary tract pathologies, or gastrointestinal abnormalities, thereby guiding more targeted investigative pathways or treatment modalities. The rapid, bedside application of ultrasound is especially valuable in unstable patients, ensuring expedited triage and intervention. In certain cases, a negative or inconclusive ultrasound may necessitate further imaging with computed tomography or magnetic resonance imaging. However, ultrasound remains the first-line modality, particularly in pregnant women, to minimize radiation exposure. By integrating ultrasound findings with clinical data and laboratory results, clinicians can establish a precise diagnosis, avoid unnecessary procedures, and initiate timely therapeutic interventions, ultimately improving patient outcomes.