acute abdomen - copy

8/12/2019 Acute Abdomen - Copy

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ACUTE ABDOMEN

Mugarura Robert


2/21

Definition

Severe rapid onset of abdominal pain in a

previously well patient 6 hrs

An abdomen with immense pain and/or

peritonitis.

An abdominal condition that needs immediate

attention but does not necessarily require an

operation


3/21

Classify as

Peritonic

Obstructive

Hemorrhagic

Medical

Chest-


4/21

Gastrointestinal causes

Bowel perforations

Appendicitis

Gastritis, penetrating/perforated peptic ulcer

Bowel obstruction Stragulated hernias

Pancreatitis

Biliary colic

Diverticulitis mesenteric embolus/thrombus

IBD


5/21

Acute cholecystitis

Raptured spleen,

Cholangitis


6/21

Urology causes

Testicular torsion

Pyelonephritis

Cystitis

Renal colic- ureteral stones

Renal infarct

Vascular causes. Raptured abdominal aorta aneurysm

Mesenteric thrombosis


7/21

Gyn - causes

Raptured ectopic pregnancy

Raptured / twisted ovarian cyst

Pyosalphinx, Acute PID

Endometritis

Mitschelmerz pain

Endometriosis


8/21

Extra peritoneal

Myocardial infarction

Pleurisy

Lower lobe pneumonia

Abdominal wall

Psoas inflamation/ abscess


9/21

others

Diabetes mellitus (DM)

Lead poisoning

Porphyria

Herpes Zoster

Tertiary syphilis


10/21

Abdominal pain

Visceral pain

Impulses carried by ANS- sympathetic nerves

caused by irritation of peritoneum, ischemia,

stretch Dull and Poorly localized

Foregut Epigastrium

Mid gut- Umblical region

Hind gut- Hypogastrium


11/21

Somatic pain

Impulses carried by somatic nerves T5-L2

Due to irritation of the parietal peritoneum

Sharp and well localized

Associated with Muscle spasms


12/21

Assessment

Objective-

To elicit symptoms and signs necessary to make adiagnosis

Need for immediate treatment before diagnosis

Senior surgeon- 4/5 correct diagnosis

50% for junior doctors


13/21

Abdominal Pain

Site

Radiation, migration

Onset

Frequency/ character

Aggravation/ alleviation

Nausea and vomiting Bowel function- diarrhea / vomiting


14/21

Gyn

LNMP

Vaginal discharge Assess risk of pregnancy

Urinary system

Altered micturition Past surgery

Adhesions, prev. diagnosis,

Drugs- steroids, anticoagulants, diuretics,


15/21

Specific signs

Blumberg's sign(rebound tenderness): constant,

held pressure with sudden release causes severetenderness

Guarding-

Courvoisier's sign: palpable, non-tender gall

bladder with jaundice Cullen's sign: blue discoloration around umbilicus

Grey Turner's sign: flank discoloration

Iliopsoas sign: flexion of hip against resistance orpassive hyperextension of hip causes pain

Murphy's sign: inspiratory arrest on deep palpationof RUQ

McBurney's point tenderness: 1/3 from anteriorsuperior iliac spine (ASIS) to umbilicus;


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Obturator sign: flexion then external or internal rotation aboutthe right hip

Percussion tenderness: often good substitute for reboundtenderness

Rovsing's sign: palpation pressure to left abdomen causesMcBurney's point tenderness

Shake tenderness: peritoneal irritation

Boass sign: right subscapular pain due to cholelithiasis Foxs sign: ecchymosis of inguinal ligament seen with

retroperitoneal bleeding

Kehrs sign: severe left shoulder pain with splenic rupture

Dances sign: empty right lower quadrant in children with

ileocecal intussusception


17/21

Investigation

Specific- help in making the

diagnosis

Baseline- important in the

management of patients


18/21

Laboratory

CBC and differential

Group + x match

Electrolytes, BUN, Creatinine

Amylase, Lipase levels Liver function tests

Urinalysis - C&S,

Stool for occult blood

-hCG Serum lactate


19/21

DPL

Radiology

X Ray- abdominal, CXR

Contrast / contrast

Abdominal USS

Endoscopy

Arteriograhy

Laparascopy- direct visualization

CT, MRI


20/21

Decision to operate

Signs of peritonitis

Severe or increasing localized abdominaltenderness

Abdominal pain with unexplained sepsis

Suspected acute intestinal ischemia

Radiological confirmation of diagnosis free air

massive bowel distention (colon > 12 cm)

space occupying lesion with fever

Persistent unequivocal abdominal findings/ if youare in doubt


21/21

Decision to op

Endoscopic

perforation

uncontrollable bleeding

Paracentesis/ DPL

blood, pus, bile, feces, urine

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