Jessica Crimaldi, NP: Diagnosing, Treating Abdominal Pain in GI Inpatients

Abdominal pain is one of the most frequent complaints driving patients to the emergency department, yet its diagnosis and management remain challenging for many healthcare providers.

In a session at the 2024 annual Gastroenterology and Hepatology Advanced Practice Providers (GHAPP) conference in National Harbor, Maryland, Jessica Crimaldi, NP, an advanced practice provider manager at Cleveland Clinic, reviewed common diagnoses related to abdominal pain that nurse practitioners and physician assistants frequently encounter in an inpatient GI consultant setting. Her discussion focused on bowel ischemia, diverticulitis, and small bowel obstructions, providing an overview of their presentation and management.

“I think it's important to go back to taking a really good history,” Crimaldi told HCPLive when explaining the management of patients with different causes of abdominal pain. “I think that's critical to trying to figure out what is going on with the patient. A lot of the questions seem pretty straightforward, but you don't want to forget to ask them.”

Specifically, she described the importance of asking patients when their pain started, what prompted them to seek evaluation, where the pain is specifically located, and if there is anything that exacerbates the pain in order to better understand the presentation and narrow down a cause.

“It's important when you meet [the patient] and you get through your history and your physical exam to explain to them what your thought process is and what the potential diagnoses are that you're considering based on the information that you have so far,” Crimaldi said, noting that patients should continue to be updated once any test results are received and what this means for their diagnosis and eventual treatment course. Throughout this process, she highlighted the importance of seeking the patient’s input and answering any questions they may have.

Beyond patient involvement, Crimaldi also pointed out the importance of knowing when you may need to call a consultant, such as in cases where a patient may be progressing to the need for a surgeon or additional aid is needed with their management. Additionally, she noted the importance of knowing “who you’re involving, why you’re involving them, and what you’re hoping to get out of that consult.”

“I think the talk was really great in terms of just going over some things that APPs might not be as familiar with, but frequently encounter in the hospital setting, and trying to take a stepwise approach to reviewing what those different diagnoses look like and what the potential plans would be for those patients so they can have a solid foundation to start seeing and hopefully effectively treating these people,” Crimaldi concluded.

Reference

^{Weiss AJ, Jiang HJ. Most Frequent Reasons for Emergency Department Visits, 2018. Healthcare Cost and Utilization Project. January 2022. Accessed September 27, 2024. https://hcup-us.ahrq.gov/reports/statbriefs/sb286-ED-Frequent-Conditions-2018.jsp}