acute abdomen
DESCRIPTION
Acute Abdomen. Acute Abdomen. General name for presence of signs, symptoms of inflammation of peritoneum (abdominal lining). Anatomic Landmarks. Divided in quadrants RUQ, LUQ, RLQ, LLQ Anatomic: Epigastrium Umbilical Suprapubic (hypogastrium). Pain. - PowerPoint PPT PresentationTRANSCRIPT
Acute Abdomen
• General name for presence of signs, symptoms of inflammation of peritoneum (abdominal lining)
Anatomic Landmarks
• Divided in quadrants RUQ, LUQ, RLQ, LLQ
• Anatomic:Epigastrium
Umbilical
Suprapubic (hypogastrium)
Pain
• Visceral pain is caused by distension, inflammation or ischemia in hollow viscous and solid organs.
• Parietal pain is localized to the dermatome above the site of stimulus and is initially unilateral.
Pain
• Referred pain produces symptoms, but not signs
• Usually lateralized
• Patterns of pain are based on embryologic sharing of dermatomes
Multiple Faces of Pain
• Pain can be characterized as:
Sharp
Stabbing
Burning
Heavy
Diffuse
Dull
Diagnosis
• History
Characterization of pain
Location? Duration?
Other symptoms
Nausea, vomiting? Bloody?
Inspection
• Description of abdominal habitusscaphoid,
Flat
Rotund
• Scars, wounds, erythema
• Anatomic Confines
Auscultation
• Listen with stethoscopeNot necessary in all quadrants
• QuantitativeAbsentDecreasedHyperactive
• QualitativeNormalBorbyrigmyObstructiveBruits
Percussion
• Abdomen Tympanitic gasDull fluid
• Liver Spanmid clavicular line by convention
• Bladder, UterusRising out of the pelvisPercussion is also a very sensitive sign of peritonitis
Palpation
Prepare the patient
warn them
make them comfortable
take tension off the abdominal wall• Pillow or bend the knees
Expose the entire abdomen• Xiphoid to pubis
Palpation
• Note the patient’s attitude (physically and emotionally)
• Watch their eyes as you touch them
• After percussion:Softly at first
Deeper• LUQ-RUQ note liver edge
• Then LLQ-RUQ
Laboratory Studies
Complete blood count
Urinalysis
Serum amylase and lipase
Liver function studies
HCG
Serum electrolytes
Imaging Tests
• X rays• Flat and upright abdo
minal films (the most common first step)Air
Calcific densities (stones, eggshell)
Mechanical obstruction / ileus
Imaging Tests
• Ultrasonography• CT scan• Specific organ studies
IVP
HIDA
• Angiography
Imaging Tests
• CT: 15-20% false negative for acute perforationPoor study for gallstones
Contrast obscures kidney stones
Undergo Operation
• Signs of peritonitis
• Increasing localized abdominal tenderness
• Abdominal pain with signs of sepsis
• Acute intestinal ischemia
• Certain radiographic findings
Appendicitis
• Usually due to obstruction with fecalith• Appendix becomes swollen, inflamed gangrene,
possible perforation
Appendicitis
• Pain begins periumbilical; moves to RLQ
• Nausea, vomiting, anorexia
• Patient lies on side; right hip, knee flexed
• Pain may not localize to RLQ if appendix in odd location
• Sudden relief of pain : possible perforation
Duodenal Ulcer Disease
• Steady, well-localized epigastric pain
• “Burning”, “gnawing”, “aching”
• Increased by coffee, stress, spicy food, smoking
• Decreased by alkaline food, antacids
Duodenal Ulcer Disease
• May cause massive GI bleed
• Perforation = intense, steady pain, pt lies still, rigid abdomen
Kidney Stone
• Mineral deposits form in kidney, move to ureter
• Often associated with history of recent UTI
• Severe flank pain radiates to groin, scrotum
• Nausea, vomiting, hematuria
• Extreme restlessness
Abdominal Aortic Aneurysm
• Localized weakness of blood vessel wall with dilation (like bubble on tire)
• Pulsating mass in abdomen
• Can cause lower back pain
• Rupture shock, exsanguination
Cholecystitis
• Inflammation of gall bladder
• Commonly associated with gall stones
• More common in 30 to 50 year old females
• Nausea, vomiting; RUQ pain, tenderness; fever
• Attacks triggered by ingestion of fatty foods
Bowel Obstruction
• Blockage of inside of intestine
• Interrupts normal flow of contents
• Causes include adhesions, hernias, fecal impactions, tumors
• Crampy abdominal pain; nausea, vomiting (often of fecal matter); abdominal distension
Gynecologic Disease
• A common cause
• A thorough history
• Complete pelvic and rectal exam
• Plain films of the abdomen
• Pelvic ultrasound
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