1 / 45

Acute Abdomen

Acute Abdomen. DR. David Swar Department of General surgery -(Resident) Stomach & Colorectal diseases Qilu hospital, Shandong University. Definition. A group of life threatening intra-abdominal conditions that often lead to peritonitis and require urgent surgical intervention.

tex
Download Presentation

Acute Abdomen

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Acute Abdomen DR. David Swar Department of General surgery -(Resident) Stomach & Colorectal diseases Qilu hospital, Shandong University

  2. Definition • A group of life threatening intra-abdominal conditions that often lead to peritonitis and require urgent surgical intervention

  3. Acute Abdomen

  4. Etiology • Surgical

  5. Etiology, cont…

  6. Common causes of abdominal pain

  7. Clinical evaluation History • Age Certain conditions occur in certain age groups E.g. diverticulitis in elderly Mesenteric adenitis (inflammation of mesenteric lymph nodes) in children • Pain • Onset sudden perforation gradual inflammatory causes

  8. site Peptic Ulcerative disease (PUD) Pancreatitis cholecystitis Gastric ulcer Perforated colon • Site Cholecystitis cholangitis Peptic Ulcerative Disease (PUD) Diverticulitis Salpingitis Tubo-ovarian abscess Appendicitis Salpingitis Ruptured. Ectopic pregnancy WWW.SMSO.CC

  9. History, cont… • Nature colicky obstruction (cramping pain) dull inflammation e.g. pancreatitis (constant pain) • Radiation to tip of the right shoulder in acute cholecystitis (boa’s sign)

  10. History, cont… • Aggravating factors breathing coughing peritonitis changing position fatty meal cholecystitis • Relieving factors lying still peritonitis leaning forward pancreatitis (prayer’s sign passing flatus Intestinal Obstruction

  11. History, cont… • Associated factors • vomiting • Precedes the pain medical condition • Follows the pain surgical condition • Contents • Bilious Small Bowel Obstruction • Nonbilious pyloric stenosis • Blood -bleeding

  12. History, cont… 2. Change in bowel habits • constipation • Obstipation (constipation +no flatus) • Diarrhea 3. Anorexia (poor appetite) • e.g. appendicitis 4. fever • Inflammatory causes

  13. Examination • Note: physical signs may be less obvious in elderly, obese patients, and those on steroids • General examination • Motionless peritonitis • Writhing in agony colic (to twist in pain) • Jaundice- obstructive jaundice • dehydration

  14. Examination, cont… • Vital signs • Pulse • Respiratory rate • Blood Pressure

  15. Abdominal examination • Inspection

  16. Abdominal examination, cont… • Palpation-(to feel)

  17. Abdominal examination, cont… • Percussion-(tapping on a surface)

  18. Abdominal examination, cont… • Auscultation-listening to the internal sounds(stethoscope)

  19. Specific signs

  20. Murphy’s sign, Psoas sign –if positive where is the appendix? Retrocecal

  21. Obturator sign,Cullen’s sign

  22. Abdominal examination, cont… • Rectal examination • Per vaginal examination

  23. Digital rectal examination,Per Vaginal Examination

  24. Investigations • To assess patients condition in general • Complete Blood Count (Blood Routine) • Electrolytes-Na ,K ,Cl • Blood Urea Nitrogen (BUN) & Creatinine • Arterial Blood Gas (ABG) • Urinalysis • Liver Function Test (LFT) • Prothrombin Time (PT)11 to 13.5 sec,PTT –25 to 35 sec(Partial thromboplastin time)(blood test that tells how long it takes for plasma to clot?) • Blood grouping and cross matching

  25. Investigations, cont… 2. Serum Beta HCG (human chorionic gonadotrophin hormone) • In female of child bearing age • To rule out ectopic pregnancy

  26. Investigations, cont… • Specific investigations A. Lab 1. Amylase & lipase • Lipase elevation is specific for pancreatitis • Amylase elevation confirms the diagnosis of Pancreatitis, but also seen in: • Perforated viscus (Internal organs) • Intestinal.Obstruction • Acute cholecystitis

  27. Investigations, cont… B. Radiological • Chest x-ray • Air under the diaphragm in perforated viscus (duodenal perforation) • Elevated diaphragm in abdominal distention

  28. Investigations, cont… • Abdominal x-ray • air fluid levels in intestinal obstruction • Stones (90% of kidney stones can be seen in x-ray and 10% can’t be seen but 10% of gallstones can be seen in x-ray but 90% can’t be seen) why ? Calcium .

  29. Investigations, cont…

  30. Kidney stone, Gall stones

  31. Investigations, cont… 3.USG-Ultra sound Scan • Gallstones • Appendicitis • Ectopic pregnancy • Torsion of ovarian cyst • empyema 4.CT scan • pancreatic pathology • Acute aortic aneurysm • Severe diverticulitis • Abdominal abscess

  32. Gall stones

  33. Abdominal CT scan

  34. Investigations, cont… 5.Duplex scan or angiography for superior mesenteric embolus or thrombosis 6. ERCP (Endoscopic retrograde cholangio-pancreatography)

  35. Investigations, cont… C. Paracentesis • To assess Small Bowel Perforation in ascitis • Free blood, bile, bowel contents suggest Bowel perforation D. Endoscopy & laparoscopy E. Diagnostic peritoneal lavage

  36. Peritoneal lavage, Paracentesis

  37. Management • Initial management • Nil Per Oral • Intravenous fluids, Bolus Ringer Lactate solution • Monitor urine output • Nasogastric tube • Decompression • suction • Analgesia • Pethidine

  38. Management, cont… • Antibiotics • Broadspectrum • In case of sepsis or peritonitits C

  39. Management, cont… • Surgical management • Indications • Physical findings • Localized peritoneal irritation with guarding or rigidity • Spreading tenderness • Tense or progressive distension • Tender abdominal or rectal mass with high fever or hypotension

  40. Indications for surgery, cont… • Rectal bleeding with shock or acidosis • Equivocal (uncertain)abdominal findings with • Septicemia: high fever, leukocytosis, mental status changes • Bleeding: shock, acidosis, falling hematocrit • Suspected ischemia: acidosis, fever, tachycardia

  41. Indications for surgery, cont… 2. Radiological findings • Pneumoperitonium –bowel perforation • Gross or progressive bowel distension-bowel obstruction • Free extravasation of contrast media-bowel perforation • Space occupying lesion –Mass or tumor • Mesenteric occlusion-Ischemia

  42. Indications for surgery, cont… 3. Endoscopic findings • Perforated lesion • Uncontrolled bleeding lesion 4. Paracentesis • Blood • bile • bowel contents • urine

  43. Thank you

More Related