ACUTE ACUTE ABDOMENABDOMEN

Hasnain Raza Haider Hasnain Raza Haider MBBS, MRCS,FCPS, FICSMBBS, MRCS,FCPS, FICS

Assistant Professor SurgeryAssistant Professor SurgeryShifa College of MedicineShifa College of Medicine

Acute AbdomenAcute Abdomen

Severe abdominal pains, which appear Severe abdominal pains, which appear in previously healthy patients and in previously healthy patients and last for at least six hours, may last for at least six hours, may require surgical intervention. require surgical intervention.

Emergent problems such as Emergent problems such as appendicitis, perforated ulcer, appendicitis, perforated ulcer, intestinal obstruction, or other intestinal obstruction, or other obstructive problems may require obstructive problems may require immediate surgical intervention immediate surgical intervention

Hasnain Raza FCPS

ObjectivesObjectives

Name the etiologies of the acute Name the etiologies of the acute abdomen abdomen

Clinical signs and symptoms Clinical signs and symptoms Common causes of pain in different Common causes of pain in different

quardants of Abdomen quardants of Abdomen Pertinent patient history factors in Pertinent patient history factors in

the acute abdomen the acute abdomen Sonographic findingsSonographic findings TreatmentTreatment

Hasnain Raza FCPS

EtiologyEtiology

Infection: bacterial or chemical Infection: bacterial or chemical Traumatic: blunt or penetrating Traumatic: blunt or penetrating Mechanical: obstruction Mechanical: obstruction Congenital: atresia, hernia, Congenital: atresia, hernia,

malrotation of the bowel malrotation of the bowel

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Central Abdominal PainCentral Abdominal Pain

Intestinal colic Intestinal colic Acute appendicitis Acute appendicitis Obstruction of the small intestine Obstruction of the small intestine Acute pancreatitis Acute pancreatitis Mesenteric thrombosis Mesenteric thrombosis

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Right Hypochrondriac Pain Right Hypochrondriac Pain

Acute cholecystitis Acute cholecystitis Leaking duodenal Leaking duodenal

ulcer ulcer Hydatid disease of Hydatid disease of

the liverthe liver

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Left Hypochondriac PainLeft Hypochondriac Pain

Perforated gastric ulcer Perforated gastric ulcer Rupture of inflammed diverticulum Rupture of inflammed diverticulum Leakage of splenic artery aneurysm Leakage of splenic artery aneurysm Spontaneous rupture of spleen Spontaneous rupture of spleen

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Right Iliac PainRight Iliac Pain

Acute AppendicitisAcute Appendicitis Terminal IleitisTerminal Ileitis Gallbladder disease Gallbladder disease Meckel’s Meckel’s

diverticulum diverticulum Undescended testis Undescended testis PID PID Tubo-ovarian Tubo-ovarian

diseasedisease

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History of Present History of Present ConditionCondition

Several factors are important to know to help Several factors are important to know to help define the cause of the acute abdomen:define the cause of the acute abdomen:

Age Age Present physical condition Present physical condition Past history Past history Laboratory findings Laboratory findings Other diagnostic examinations the patient Other diagnostic examinations the patient

may have recently had performed may have recently had performed

Hasnain Raza FCPS

Acute Acute appendicitusappendicitus Acute pancreatitis Acute pancreatitis Mesenteric thrombosis Mesenteric thrombosis Dissecting aneurysm Dissecting aneurysm Ectopic pregnancy Ectopic pregnancy Acute cholecystitis Acute cholecystitis Trauma: rupture of spleen, liver, or kidney Trauma: rupture of spleen, liver, or kidney Hepatitis Hepatitis Bowel obstructionBowel obstruction

Causes of ACUTE Causes of ACUTE ABDOMENABDOMEN

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Symptoms of Acute Symptoms of Acute Appendicitis Appendicitis

Pain, epigastric with extension into the right Pain, epigastric with extension into the right iliac fossae iliac fossae

Nausea and vomiting, acute loss of appetite Nausea and vomiting, acute loss of appetite Local deep tenderness Local deep tenderness Rigidity of muscles may be present Rigidity of muscles may be present Fever Fever Change in bowel habits Change in bowel habits

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Acute AppendicitisAcute Appendicitis

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Eliciting Tenderness in Eliciting Tenderness in ChildrenChildren

www.medscape.com

Anatomy of APPENDIXAnatomy of APPENDIX

ACS Principles and Practice of Surgery

Inflammed APPENDIXInflammed APPENDIX

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Acute PancreatitisAcute Pancreatitis

Sudden onset of pain Sudden onset of pain Fainting may occur when pain is intense Fainting may occur when pain is intense Pain begins in epigastrium, with extension Pain begins in epigastrium, with extension

to back and groin to back and groin Shock may accompany pain Shock may accompany pain Reflex vomiting Reflex vomiting Epigastric tenderness & rigidity Epigastric tenderness & rigidity Jaundice present when head of pancreas Jaundice present when head of pancreas

compresses CBD compresses CBD Hasnain Raza FCPS

Symptoms of Ectopic Symptoms of Ectopic PregnancyPregnancy

Amenorrhea Amenorrhea Hypogastric pain Hypogastric pain

& tenderness & tenderness Uterine bleeding Uterine bleeding Passage of fetal Passage of fetal

membranes membranes

ACS Principles and Practice of Surgery

Right Hypochrondriac PainRight Hypochrondriac Pain Cholecystitis or biliary Cholecystitis or biliary

colic colic Inflamed or leaking Inflamed or leaking

duodenal ulcer duodenal ulcer Rupture of gallbladder Rupture of gallbladder

or biliary duct or biliary duct Hepatitis Hepatitis Torsion of gallbladderTorsion of gallbladder

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Primary Symptoms of Acute Primary Symptoms of Acute Cholecystitis Cholecystitis

RUQ pain RUQ pain Vomiting, nausea, Vomiting, nausea,

loss of appetite loss of appetite Abdominal Abdominal

tenderness & tenderness & muscular rigidity muscular rigidity

Distention of right Distention of right colon colon

Positive Murphy’s Positive Murphy’s signsign

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Peritonitis Peritonitis Rupture of Rupture of

organs organs

Abdominal TraumaAbdominal Trauma

Symptoms of Intussusception Symptoms of Intussusception

Shock Shock Passage of blood and Passage of blood and

mucus per rectum mucus per rectum Vomiting Vomiting Abdominal distention Abdominal distention Visible peristalsis Visible peristalsis Constipation Constipation Occasional fever Occasional fever Peritonitis (later Peritonitis (later

stagestage) )

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Gastric UlcerGastric Ulcer

Gastric UlcerGastric Ulcer

Gastric CancerGastric Cancer

Gastric CancerGastric Cancer

Upper GI TractUpper GI Tract

Indirect Inguinal HerniaIndirect Inguinal Hernia

Indirect Inguinal HerniaIndirect Inguinal Hernia

Direct Inguinal HerniaDirect Inguinal Hernia

ManagementManagement

Patient evaluation Patient evaluation and stabilisation and stabilisation

Differentiating Differentiating medical and surgical medical and surgical disorders disorders

The exploratory The exploratory laparotomy laparotomy

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Abdominal IncisionsAbdominal Incisions