ABDOMINAL PAINABDOMINAL PAINACUTE ABDOMENACUTE ABDOMEN

PROF JHR BECKERPROF JHR BECKER

DEPARTMENT CHIRURGIEDEPARTMENT CHIRURGIE

Abdominal pain that requiresAbdominal pain that requires

• Hospital admission

• Investigation and treatment

• less than one week duration

ACUTE ABDOMENACUTE ABDOMEN

• 50% of Surgical admissions are emergencies

• 50% of that is acute abdominal pain

• 30 day mortality is 4%

• if operated rises to 8%

ACUTE ABDOMENACUTE ABDOMEN

• CAUSES– Surgical– Medical– Gynaecological

SURGICALSURGICAL

• Related to the – organ– pathology

TYPES OF PAINTYPES OF PAIN

• Visceral

• Somatic

SOMATICSOMATIC

• Dermatomes, Pain C3-5, T5 – L2

• Mechanical)

• Thermal ) Causes

• Chemical )

• Reflex contraction– rigidity– guarding– hyperaesthesia

VISCERAL PAINVISCERAL PAIN

• Insensitive to the above

• Sensitive to– Overdistension– Traction– Visceral muscle spasm– Ischaemia

NATURE OF THE PAINNATURE OF THE PAIN

• Somatic is Sharp or Knife-like

• Visceral – dull and deep seated– Somatic - Dermatome– Visceral

• Foregut - Epigastrium• Midgut - Umbilical• Hindgut - Hypogastrium

CLINICAL ASSESSMENTCLINICAL ASSESSMENT

• Site of pain (11 areas) (9+2)

• Nature of pain– Obstruction– Inflammation

OBSTRUCTIONOBSTRUCTION

• Colic/Spasms/Gripping

• Move around, draw up

• Knees etc.

INFLAMMATIONINFLAMMATION

• Pain does not disappear

• Becomes continuous

• Incarceration becomes strangulation

RADIATION OF THE PAINRADIATION OF THE PAIN

• Other structures are getting involved eg. D.U. to the back

• Kidney stone to the perineum

ONSET OF PAINONSET OF PAIN

• Sudden – acute – eg. P.U. perforation

SEVERITYSEVERITY

• Personality differences

• Consult G.P.

• Went to work

• Lie down

• Same for days

• Gets worse

• Fluctuate

PROGRESSIONPROGRESSION

MOVEMENTMOVEMENT

• e.g. Appendicitis

EXAMINATIONEXAMINATION

• INSPECTION:– Exposure (Chest to inguinal)– Swellings– Scars– Distended veins– Intestinal peristalsis

PALPATIONPALPATION

• Voluntary guarding

• Involuntary guarding

• Board-like rigidity

• Rebound tenderness (Cough-test)

PERCUSSIONPERCUSSION

• Resonance

• Dull

• Pain

• Shifting dullness

AUSCULTATIONAUSCULTATION

• Normal bowel sounds

• Decreased

• Increased