PPT Acute Abdomen, Nyeri akut abdomen

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    Acute

    Abdomen

    dr. Liza Nursanty, SpB, Mkes, FINACS

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    DEFINITION

    AcuteAbdomenis a ter" usedsynony"ously #or a !ondition that needsi""ediate surgi!al inter$ention

    *iagnosis !an e "ade "ost o# the ti"e

    y a good history and a proper physi!ale'a"ination.

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    ASSESMENT

    +ell eli!ited historyroper physi!ale'a"ination

    Investigations are usually carriedout :

    only to support the diagnosis.or to narro% do%n the dierentialdiagnoses.

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    History-istory o# resent illnessFa"ily -istoryast Medi!al history

    -istory o# drugs taken orMedi!ation eg. ingestion o#!ertain to'i! drugs or Al!oholintake

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    Free Peritoneal Air

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    This plain abdominal radiograph of a 55-year-old woman presenting with

    features of intestinal obstruction shows dilated loops of the small bowel

    associated with thickened edematous valvulae conniventes and a strangulated

    left inguinal hernia (arrow).

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    http://www.ajronline.org/content/vol176/issue1/images/large/01_AA0350_04.jpeg
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    AIN

    he Most I"portant Sy"pto"

    -istory o# pain should in!lude/

    0.1nset2.Se$erity3.ype o# pain4.5adiation o# ain6.Change in nature o# ain7.Asso!iated o%el or urinarysy"pto"s

    8.Aggra$ating or relie$ing #a!tors

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    !iii" Associated %o&el

    Sym'toms(ONSTIATIONa. rogressi$e intestinal ostru!tion

    #ro" a

    neoplas" or in9a""atory o%eldisease

    . aralyti! Ileus !. ost 1perati$e

    d. 1stru!ted groin hernia

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    !iv" Associated %o&el

    Sym'tomsDIA))HOEA*iarrhoea %ith pain is "ainly "edi!al.

    he #ollo%ing are the e'!eptions /

    a.1stru!ted 5i!hter;s -ernia.

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    D)*+ HISTO),

    (orticosteroids = "ask painAnticoagulants = !an lead to anintra"ural hae"ato"a o# the gut

    !ausing ostru!tionOral (ontrace'tives - ru'ture o#.e'atic adenomasNSAIDs - erosive gastritis / 'e'ticulcers

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    NA*SEA / 0OMITIN+

    i. Fre>uen!y o# $o"itingii. Chara!ter o# $o"iting/

    pro?e!tile, [email protected]?e!tile or sel#@indu!ed

    iii. Nature o# $o"iting/a. Bilious $o"iting o# s"all o%el

    ostru!tion. [email protected] $o"iting in

    ostru!tion pro'i"al to a"pulla o#$ater

    !. Fae!ulent $o"iting in distal s"allgut ostru!tion, large o%elostru!tion , stran ulation

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    NA*SEA / 0OMITIN+ain 1rst$ #ollo&ed by 0omiting isusually surgical2

    T.e vomiting is due to re9e'pylorospas"Nausea / vomiting 1rst $ #ollo&edby 'ain is usually due to a medicalcondition

    (o"iting is $ery pro"inent [email protected]+eiss syndro"e..Boerhaa$e syndro"[email protected] "ural

    esophageal tearD

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    ANO)E3IAAnore'ia or de!reased appetite %ithpain is usually seen in Acuteappendi!itis

    *rinary Sym'toms &it. ain:reteri! !oli!Cystitis

    FE0E) / (HI44S5)I+O)SA"oei! Li$er As!essygeni! Li$er As!esserinephri! [email protected]"inal us !olle!tion

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    OTHE) HISTO),ast Surgi!al history/ pre$ious [email protected] to adhesionsast Medi!al history/ Si!kle !ell disease,*iaetes or Can!er or 5enal #ailure

    Menstrual -istory in #e"alesiD Missed [email protected] e!topi! pregnan!y iiD Mid o# [email protected]$ulation pain [email protected]!h"erzD

    iiiD +ith hea$y [email protected] endo"etriosisFa"ily history o# !olon !an!er, any other"alignan!y or in9a""atory o%el disease

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    .ysical E6amination !contd2"e. Eaundi!ed/ CB* ostru!tion#. *ehydrated iD eritonitis

    iiD S"all Bo%el ostru!tiong. (ital Chartinge"perature, ulse, B, 5espiratory

    rate

    5uptured AAA or e!topi! pregnan!y!an lead to

    @ allor @ -ypotension

    @ a!hy!ardia

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    .ysical E6amination !contd2"h. Lo% grade te"p. is seen %ith

    @ Appendi!itis @ Acute!hole!ystitisi. -igh grade te"p. is seen %ith

    @ Salpingitis @ As!ess?. (ery -igh

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    Systemic E6aminationrythe"a or dis!olouration

    a. [email protected]"ili!al @ Cullen sign. Inguinal = Fo' sign!. Flanks @

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    Systemic E6aminationer abdomen/ alpationBe gentleStart a%ay #ro" site o# pathology then

    to%ardsChe!k #or -ernia sitesenderness5eound tenderness

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    Systemic E6amination5o$sings Sign in AcuteAppendi!itis1turator Sign in el$i! Appendi!itissoas Sign

    @ 5etro!ae!al appendi!itis

    @ Crohns *[email protected] erinephri! As!essMurphy;s sign in AcuteChole!ystitishu"ping tenderness o$er lo%er ris in

    in9a""ation o#@ *iaphrag"@ Li$er or spleen

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    Systemic E6aminationer (aginal 'a"ination @ Bleeding @ *is!harge @ Cer$i!al "otion tenderness

    @ Adne'al "asses or tenderness @ :terine Size or Contour

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    IN0ESTI+ATIONS

    GCo"plete Blood Count %ith [email protected]!ti$e protein esti"ationGle!trolyte ,Blood :rea , CreatinineG:rine dipsti!k

    GA"ylase or LipaseGLi$er Fun!tion est

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    IN0ESTI+ATIONS5adiology:pright H ray !hest #or

    Basal neu"onia 5uptured 1esophagus le$ated -e"i diaphrag" Free

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    IN0ESTI+ATIONS

    Ot.er Investigations:S