ACUTE ABDOMINAL PAIN AT

UMBILICAL & HYPOGASTRIC REGION

By: Siti Nurulismah Bt Che Haron

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Transtubercular planeSubcostal plane

Midinguinal points

Midclavicular plane

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Umbilical region: SI Cecum Retroperitoneal organs Abdominal aorta

Hypogastric region: Urinary bladder Uterus Transverse colon

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Umbilical region: Acute SI obstruction Acute intestinal ischemia Ruptured abdominal aortic aneurysm Acute Crohn's disease and ulcerative colitis Acute cystitis

Hypogastric region: Acute cystitis Acute urinary retention Acute dysmenorrhea Acute salpingitis

IS ALWAYS MOVING

MOST OF ABDOMINAL CONTENTS

Acute SI obstruction Acute intestinal ischemia Ruptured abdominal aortic aneurysm Acute Crohn's disease and ulcerative colitis Acute cystitis

UMBILICAL REGION

Acute SI ObstructionAbdominal pain is:• The 1st symptom and sudden onset• *Colicky• Usually severe• Associated with vomiting and

distention• Pain more predominant with LSIO

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*Acute Intestinal IschemiaAbdominal pain is:• Sudden onset• Severe • Colicky/continuous• Associated with peritonitis and

shock

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Gangrenous bowel*sequence after ischemia

Acute C’s D & UC

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Ac Crohn’s disease

Ac Ulcerative colitis

*Ileocecal Rectum - blood stained/purulent rectal discharge

Diarrhea Bloody mucoid diarrhea

Abdominal pain resemble acute appendicitis

*Abdominal pain - is late symptom and persistent

*Ruptured AAAAbdominal pain is:• Sudden onset, pulsating and severe• Also being felt at *back, thigh and groinSigns:• Hypotensive• Distended and visible large central

pulsating mass• *Marked guarding, tender and pulsatile

mass• Diminish bowel sound and present of

vascular bruits

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Abdominal aortic aneurysm*exhibiting significant distension of the aortic wall

Rupture of aortic aneurysm

Acute Cystitis

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Acute cystitis Acute urinary retention Acute dysmenorrhea Acute salpingitis

HYPOGASTRIC REGION

*Acute CystitisAbdominal pain is:• Sudden onset but mild• Associated with frequency, urgency,

dysuria, cloudy offensive urineSign: • Tenderness over urinary bladder

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Acute Urinary RetentionAbdominal pain is:• Sudden onset• Severe pain• Associated with anuriaSigns:• Visible, palpable and tender urinary

bladder

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An enlarged urinary bladder

*Acute DysmenorrheaAbdominal pain is:• Sudden onset• Range from mild to severe• Cramping• Start at the onset of menstrual flow

and lasts 8 – 27 hours

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Acute SalpingitisAbdominal pain is:• Gradual onset, constant and severe• *Precede/radiated by pain at lower part

of back• Associated with (precede by) yellow

white vaginal discharge, dysmenorrhea and burning pain on micturition

Signs: • Tenderness and guarding bilaterally

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Salpingitis*one of PID

Management

Investigation & Treatment

REFERENCES:

Bailey and Love’s Short Practice of Surgery 25th edition 2008 by Norman S. William, Christopher J.K. Bulstrode and P. Ronan O’connell

Browse’s Introduction to The Symptom and Sign of Surgical disease 4th edition 2005 by Norman L. Browse, John Black, Kevin G. Burnand

and William E.G. Thomas

Oxford Handbook of Clinical Surgery 3rd edition 2007 by Grey McLatchie, Neil Borley and Joanna Chickwe

Some of