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