Post on 05-Jan-2016
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Acute AbdomenAcute Abdomen
新光醫院 急診醫學科新光醫院 急診醫學科
Surgical causes?Surgical causes?
Acute Surgical AbdomenAcute Surgical Abdomen RUQ/LUQRUQ/LUQ
PPUPPU Acute cholecystitisAcute cholecystitis
RLQ/LLQRLQ/LLQ Acute appendicitisAcute appendicitis Acute diverticulitisAcute diverticulitis Meckel’s diverticulitisMeckel’s diverticulitis SBOSBO SMA occlusionSMA occlusion AAA ruptureAAA rupture Ectopic pregnancyEctopic pregnancy
Non-surgical Non-surgical causes?causes?
Acute Non-surgical Acute Non-surgical AbdomenAbdomen
Obs/GynObs/Gyn PID, ovarian cyst rupture, mittelschmerzPID, ovarian cyst rupture, mittelschmerz**
UroUro Renal stone, APN, cystitisRenal stone, APN, cystitis
Refer painRefer pain AMI, pneumoniaAMI, pneumonia
OthersOthers AGE, pancreatitis, mesenteric adenitis, CrohnAGE, pancreatitis, mesenteric adenitis, Crohn
’s disease, DKA, porphyria’s disease, DKA, porphyria
試述急性腹痛該如何試述急性腹痛該如何詢問病史?詢問病史?
病史病史 Onset / frequency / durationOnset / frequency / duration Location / radiationLocation / radiation IntensityIntensity Character / PatternCharacter / Pattern Associated symptomsAssociated symptoms Relieving / aggravating factorsRelieving / aggravating factors
Describe the following Describe the following signssigns
Peritoneal signsPeritoneal signs
Rovsing’s signRovsing’s sign
Obturator / psoas signObturator / psoas sign
Kehr’s signKehr’s sign
Describe the following Describe the following signssigns
Peritoneal signsPeritoneal signs Involuntary guarding, rebound/percussion tendeInvoluntary guarding, rebound/percussion tende
rnessrness Rovsing’s signRovsing’s sign
Palpation of LLQ Palpation of LLQ RLQ pain RLQ pain Obturator / psoas signObturator / psoas sign
Internal rotation of flexed thigh / thigh extensionInternal rotation of flexed thigh / thigh extension Kehr’s signKehr’s sign
Palpation of LUQ Palpation of LUQ left shoulder pain left shoulder pain
Urinalysis Urinalysis 在急性腹在急性腹痛之角色為何?痛之角色為何?
UrinalysisUrinalysis
Glucose, ketones Glucose, ketones DKA DKA Microscopic hematuria Microscopic hematuria urolithiasis urolithiasis Pyuria Pyuria cystitis cystitis
Pitfall……..??Pitfall……..??
UrinalysisUrinalysis
Glucose, ketones Glucose, ketones DKA DKA Microscopic hematuria Microscopic hematuria urolithiasis urolithiasis Pyuria Pyuria cystitis cystitis
Pitfall……..??Pitfall……..?? Appendicitis Appendicitis UA UA 可以有 可以有 RBCs RBCs 或 或 WBCsWBCs
Abdominal X-rays: what Abdominal X-rays: what views?views?
Free intra-peritoneal airFree intra-peritoneal air
Air-fluid levels (ileus)Air-fluid levels (ileus)
Level of obstruction in ileusLevel of obstruction in ileus
Abdominal X-rays: what Abdominal X-rays: what views?views?
Free intra-peritoneal airFree intra-peritoneal air Upright CXR, standing abdomen, left lateraUpright CXR, standing abdomen, left latera
l decubitusl decubitus Air-fluid levels (ileus)Air-fluid levels (ileus)
Standing abdomen, lateral decubitusStanding abdomen, lateral decubitus Level of obstruction in ileusLevel of obstruction in ileus
Supine abdomen, KUBSupine abdomen, KUB
什麼是 什麼是 Sentinel looSentinel loopp ??
Sentinel LoopSentinel Loop
Localized inflammatory conditionsLocalized inflammatory conditions Acute pancreatitisAcute pancreatitis Acute appendicitisAcute appendicitis
Diagnostic Work-upDiagnostic Work-up
History-PE
Echo
B-U-S
X-rays
CT scans
排排看排排看
??
Diagnostic Work-upDiagnostic Work-upHistory-PE
Echo
B-U-S
X-rays
CT scans
Diagnostic Work-upDiagnostic Work-upHistory-PE
Echo
B-U-S
X-rays
CT scans
Exploratory laparotomay