Acute Abdomen Lpg 1

7/27/2019 Acute Abdomen Lpg 1

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Clinical Aspect of Acute Abdomen

Department of Surgery

Ciptomangunkusumo Hospital


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Acute Abdomen

Be defined generally as an intraabdominal

process causing severe pain and often

requiring surgical intervention.

It is a condition that requires a fairly

immediate judgment or decision as to

management


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Epidemiology

US 2002: abdominal pain was the chief complaint of over

7 million patients in emergency department

6.5 % of all emergency department visit

RSCM: Emergency department operation 2004 : 564

(52.9%) acute abdominal of 1155 emergency

operations.


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Acute Abdomen

Acute conditions of the abdomen are

produced by inflammatory, obstructive,

vascular mechanisms or high intra abdominalpressure and are manifested by sudden

onset of abdominal pain, gastrointestinal

symptoms and varying degrees oflocal and

systemic reaction.


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General causes of the acute abdomen

a. inflammatory

b. mechanical

c. neoplastic d. vascular

f. Traumatic/Blast injury

g. Abdominal hypertension


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Cause and Pathophysiology of the

following acute abdomen :

a. Acute appendicitis - inflammatory

b. Acute small bowel obstruction - mechanical c. Mesenteric vascular occlusion - vascular

d. Perforated duodenal ulcer perforated viscous

e. Peritonitis


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Characteristics of the

Acute Abdomen

Since pain is the most prominent presentingcomplaint in a patient with an acute

abdomen, it is important to know the origin,location, radiation and character of abdominalpain in order to understand its significance.

The perception of abdominal pain is firstvisceral and then becomes somatic


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Acute Abdomen

Visceral pain

Visceral sensation Ischemic/extension

Vague

Dull

Autonom symptoms

Somatic pain

Parietal sensation Mechanic /chemical

kimia

Localized

sharp


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.


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Type of Onset

sudden - rupture of viscous,

mesenteric thrombosis gradual

cholecystitis, appendicitis


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Quality

Dull - initial epigastric pain of appendicitis

Sharp - renal or biliary colic or obstruction of gut

Aching - pelvic inflammatory disease Lancinating - acute pancreatitis

Tearing - dissecting aneurysm


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Intensity

Severe - rupture of viscous or blood in

the peritoneal cavity

Moderate - RLQ appendiceal Mild peptic ulcer, without perforation


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Temporal Features

continuous - acute pancreatitis

pulsatile - abdominal aneurysm

colicky - lumen obstruction, intermittent severepain with pain-free intervals

frequency & duration transient pain of shortduration which does not recur is usually

insignificant. The longer the duration the morelikely a surgical condition


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Pain

Vomiting

Abdominal distension

Constipation

Diarrhea

Hematemesis & Melena

Haematochezia.

Acute Abdomen Symptoms & sign


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Patient's symptoms

All of the patient's symptoms must be

carefully considered and analyzed,

especially with regard to organs most likely

to give rise to acute conditions Extra abdominal conditions which simulate

the acute abdomen arise most often in the

heart, lungs, urinarytractand femalereproductive organs


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Acute Abdomen

Grey-Turner, Cullen sign

Murphy sign

GI Obstruction

Free air /Pneumoperitoneum

Free fluids

Increasing Bowel sound

Symptoms & sign


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GI tract

Acute appendicitis

Perforated Typhoid

Strangulated bowel obstruction Strangulated groin hernia

Perforated peptic ulcer

Massive bleeding

Acute Abdomen


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HPB

Liver abscess

Bleeding liver tumor Acute cholecystitis

Hemorrhagic pancreatitis

Acute Abdomen


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Gynecologic

Ectopic Pregnancy

Ovarial cyst torsion

Vascular problem

Aortic aneurysm Mesenteric thrombosis

Acute Abdomen


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Action on Acute Abdomen

require immediate surgery

require watchful expectancy,

require medical rather than surgical management.

Often the patient's condition is such that extensivelaboratory investigation requiring many hours wouldcompromise the patient's life and thus the outcomeoften depends on a precise and detailed history and

physical examination.


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Compartment Syndrome


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Severe contaminated peritonitis

Strangulated GI Obstruction

GI obstruction + Respiratory distress Perforation

Abdominal shot gun wound

Penetrated Abdominal wound

Massive GI bleeding

ABOMINAL COMPARTMENT SYNDROME (ACS)

Surgery interventions

Acute Abdomen


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LAB.

Routine Blood Test Specific Test (amylase)

Urine test

Acute Abdomen


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Other Imaging Technique

Plain abd X `rays

USG

CT Scan

Other Diagnostic Tools

Diagnostic Peritoneal Lavage

Endoscopy

Laparoscopy

Acute Abdomen


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Certain tests when associated with

characteristic clinical features

Markedly elevated serum amylase levels - acute

pancreatitis

Free air under diaphragm in an upright x-ray film

perforation of a hollow viscous - usually a duodenalulcer

Distended loops of small bowel above the level of

obstruction in small bowel obstruction with absence

of gas below by x-ray; generalized distention of largeand small bowel - paralytic


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Conclusion

Acute Abdomen is a common problem in

emergency department

Clinical examination is an important

diagnostic value to acute abdomen

Radiography findings helps clinicians to

implement the right therapy


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Thank You

Acute Abdomen Lpg 1

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