Acute Abdomen
Acute Abdomen
Acute Abdomen
ACUTE ABDOMEN
The acute abdomen requires rapid and specific diagnosis as several etiologies
demand urgent operative intervention. Because undue delay in diagnosis and
treatment may adversely affect outcome.
COMMON CAUSES OF THE ACUTE
ABDOMEN
GIT Hepatobiliary and Urinary Gynaecological Others
pancreatic Tract
A. History
• Abdominal pain & Other Symptoms Associated with Abdominal Pain
• Past medical history / Past Surgical history
• Gynaecological history
• Medication history
• Family History
• Travel history
B. Physical Examination
C. Laboratory Investigation
D.Imaging studies
E. Diagnostic Laparoscopy.
ABDOMINAL PAIN IN ACUTE ABDOMEN
Visceral Pain:
* Distention, inflammation, ischemia or malignant infiltration of
sensory nerves.
* Slow in onset, dull, poorly localized.
* Most often felt in the midline because of the bilateral sensory
supply to the spinal cord.
FIGURE: VISCERAL PAIN SITES.
ABDOMINAL PAIN CONTD.
Parietal Pain:
• Direct irritation parietal peritoneum by pus, bile, urine, or GI
secretions.
• More acute, sharper, better localized pain.
• The cutaneous distribution of parietal pain corresponds to the T6-
L1 areas.
ABDOMINAL PAIN CONTD.
1. Appearance:
• Hippocratic facies
• Facies of dehydration
2. Attitude
3. Vitals
Pulse, BP, Respiratory rate, Temp, dehydration
1. Inspection: 2. Palpation:
• Hernial Orifices • Hyperasthesia
• Abdominal contour • Tenderness
• Respiratory Movement • Distension
• Peristaltic movement • Lump
• Visible swelling • Hernial Site
• Skin condition
ABDOMINAL FINDINGS IN DIFFERENT CONDITION
Other’s
* Alder’s Sign : Shifting tenderness helpful to differentiate between appendicitis
with uterine origin tenderness.
IMPORTANT SIGN IN PT WITH ABDOMINAL
PAIN
2. Auscultaion :
• Silent – peritonitis
• Increase peristaaltic sound in intestinal obstruction
3. Rectal examination
4. Vaginal examination
LABORATORY INVESTIGATION
A. Blood Studies:
• Neutrophilic leucocytosis
• CRP
• Electrolyte, Creatinine & BUN
• ABG
• Serum Lactate(Raised in ischemic bowel)
• Lipase
• Liver function tests if suspect hepato-biliary disease
• Beta HCG (women of childbearing age.)
B. Urine Tests:
RE & ME to see hematuria, pyuria
Dipstick Test - (for albumin, bilirubin, glucose and ketones), Pregnancy test.
IMAGING STUDIES
A. Plain Chest X-Ray Studies:
5% appendicolith
Also pancreatic calcification, AAA calcification are seen.
ULTRASONOGRAPHY
Pitfall :
• obesity;
• following previous surgery;
• ascites;
• gaseous distension of upper abdominal viscera
CT SCAN
Provides excellent diagnostic accuracy whom do not already have
clear indications for laparotomy or laparoscopy.
• Mis- or delayed diagnosed?
• Unknown diagnosis?
• Young female patient, GI or GYN problem?
• Intractable abdominal pain (infarction or vascular lesion?)
• High risk patient (sometimes…VIP)
• With or without contrast medium?
CT ANGIOGRAPHY (CTA),OR MAGNETIC
RESONANCE ANGIOGRAPHY (MRA)
Dept. No.
Surgery 234
23.02%
Urology 62 Surgery
Urology
Gynae 36 46.43%
Gynae
Paediatric 56 11.11% Paediatric Surgery
Surgery Gastro
Gastro 116 7.14%
Total: 234
Diagnosis Patients
1.79%
Total 64 Pt
40.62% Urolithiasis
43.75%
Renal Colic
Diagnosis No of Pt Ureteric colic
Urolithiasis 28 UTI
Renal Colic 4
UTI 26 6.25%
PAEDIATRIC SURGERY
Total 56 Pt
Appendicitis
Diagnosis No. of Pt
Appendicitis 24 41.07% 42% Biliary colic
Total 36 Pt
Ectopic
Diagnosis No. of Pt
pregnancy
Ovarian Cyst
Ectopic Pregnancy 22 33%
Others 1
TAKE HOME MESSAGE
Acute abdominal pain remains a challenging part of surgeons life.
So appropriate focus to approach such ways and to set the plan of action whether the
patient will need to:
• go directly to the operating room,
• be admitted for surgical observation and expected operative intervention,
• be admitted for surgical observation or further diagnostics, or
• be admitted to medical service for nonoperative abdominal pain.